Sugammadex-induced bradycardia and asystole: how great is the risk?

Hunter, Jennifer M.; Naguib, Mohamed

doi:10.1016/j.bja.2018.03.003

Cited by 52 publications

(47 citation statements)

References 29 publications

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“…In this case, approximately 4 min after sugammadex administration, the patient's heart rate decreased to 36 bpm accompanied by severe hypotension, which was unresponsive to intravenous atropine but recovered with intravenous adrenaline. Some case reports have described severe bradycardia associated with sugammadex [4][5][6][7][8][9]. Sugammadex-induced bradycardia is not due to cholinergic effects as it has been noted even in a patient with a denervated, transplanted heart [8]; however, no other mechanism has been postulated.…”

Section: Discussionmentioning

confidence: 99%

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A rare case of atropine-resistant bradycardia following sugammadex administration

et al. 2020

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Background: Profound bradycardia caused by sugammadex has been reported, although its mechanism is unclear. Herein, we suggest a possible culprit for this phenomenon. Case presentation: A 50-year-old woman without comorbidity except mild obesity underwent a transabdominal hysterectomy and right salpingo-oophorectomy. After surgery, sugammadex 200 mg was intravenously administered. Approximately 4 min later, her heart rate decreased to 36 bpm accompanied by hypotension (41/20 mmHg) and ST depression in limb lead electrocardiogram (ECG). Atropine 0.5 mg was injected intravenously without improving the hemodynamics. Intravenous adrenaline 0.5 mg was added despite the lack of signs suggesting allergic reactions. Her heart rate and blood pressure quickly recovered and remained stable thereafter, although 12-lead ECG taken 1 h later still showed ST depression. Conclusions: In this case, the significant bradycardia appeared attributable to coronary vasospasm (Kounis syndrome) induced by sugammadex, considering the ECG findings and high incidence of anaphylaxis due to sugammadex.

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Section: Discussionmentioning

confidence: 99%

“…However, the incidence of sugammadex-induced anaphylaxis is relatively high [3]. In addition, several case reports have described profound bradycardia, even cardiac arrest, possibly caused by sugammadex administration, although the mechanism of this rare adverse event has remained unclear [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

A rare case of atropine-resistant bradycardia following sugammadex administration

et al. 2020

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“…Reversal from greater depths of relaxation does increase the risk of less than optimal reversal with either neostigmine or sugammadex [13]. Using sugammadex may also inhibit the ability to re-paralyze patients, should that be required in the immediate postoperative period, and possibly induce serious bradycardias and hypotension [3,14]. Finally, the larger dose of sugammadex required to reverse deep NMB will increase the direct cost of care [15].…”

Section: Discussionmentioning

confidence: 99%

Does Deep Neuromuscular Blockade Improve Operating Conditions during Minimally Invasive Anterolateral Total Hip Replacements?: A Randomized Controlled Trial

Curry¹,

Steen²,

Craig³

et al. 2020

Cureus

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Background Neuromuscular blockade (NMB) is thought to improve operative conditions during certain procedures. Published descriptions of minimally invasive hip replacement techniques specify the need for "excellent relaxation", however, the optimal degree of NMB required for such cases has not been studied. We performed a randomized, single-blind study comparing the effect of moderate and deep neuromuscular blockade on surgical conditions and operating time during minimally invasive anterolateral hip replacement. Vecuronium was administered to maintain moderate NMB (train-of-four count of 1-2) or deep NMB (train-of-four count of 0, post-tetanic count of 1-2). Methods In this study, 116 patients were randomized to receive moderate or deep neuromuscular blockade; depth of blockade was monitored using acceleromyography. The primary outcome was the number of requests from the surgeon for additional blockade intraoperatively. Secondary outcomes included operative times and assessment of the operative conditions by the surgeon utilizing the Leiden-Surgical Rating Scale. Results Cases with additional requests for blockade did not differ between the deep and moderate NMB groups (11/58, 19.0% vs 8/58, 13.8%); relative risk, 1.22 (95% CI [confidence interval], 0.70-2.15), p=0.62. Neither time from incision to prosthesis reduction (33.8±1.2 min vs. 32.6 ±1.2 min; difference in geometric mean, 0.96 [95% CI, 0.90-1.04] minutes, p=0.33), nor the surgeon's assessment of operative conditions (p=0.88), differed between the deep or moderate NMB groups, respectively. Conclusions Deep NMB did not produce significantly improved operative conditions compared with moderate NMB. Routine use of deep NMB during minimally invasive anterolateral hip arthroplasty is not supported by this study.

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“…The incidence of perioperative anaphylaxis in the literature is 1/6.000-1/20.000; and the mortality rate is between 3-6% (1,4) . Most of the anaphylactic reactions occur in the operating room (58%) and 3% of these occur before, and 81% of them after preoperative induction of anesthesia, 13% during and 3% after surgery (4,5) . It is difficult to determine the cause of anaphylaxis as various medications are being used during anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Anaphylactic Shock Case After Sugammadex Application

Miniksar¹,

Kırteke²

2020

jarss

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Sugammadex is a synthetic gamma-cyclodextrin-derived agent that selectively encapsules nondepolarizing neuromuscular blockers (NMBAs) such as rocuronium. This case report aims to present a life-threatening anaphylactic shock that is thought to be related to sugammadex application after reversal of the neuromuscular blockade. The patient was a 59-year-old male who had a history of uncomplicated inguinal hernia repair under general anesthesia 10 years ago and had no additional disease. Endovascular coil embolization of cerebral aneurysm was planned under general anesthesia by the interventional radiology clinic. No complications related to surgery or anesthesia were observed during the operation. At the end of the operation, intravenous (IV) 200 mg sugammadex was administered to the patient. Approximately 2 minutes after extubation, the patient developed an anaphylactic reaction, which was thought to be due to sugammadex injection. The symptoms of the patient regressed with the administration of ephedrine, adrenaline and methylprednisolone. We should be aware of the fact that life-threatening anaphylactic reactions may develop after administration of sugammadex.

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Sugammadex-induced bradycardia and asystole: how great is the risk?

Cited by 52 publications

References 29 publications

A rare case of atropine-resistant bradycardia following sugammadex administration

A rare case of atropine-resistant bradycardia following sugammadex administration

Does Deep Neuromuscular Blockade Improve Operating Conditions during Minimally Invasive Anterolateral Total Hip Replacements?: A Randomized Controlled Trial

Anaphylactic Shock Case After Sugammadex Application

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