Sugammadex induced bradycardia and hypotension

Abstract

Rationale: There is evidence that sugammadex can facilitate extubation post-surgery and attenuate postoperative pulmonary complications resulting from postoperative residual neuromuscular blockade. However, it may induce adverse effects, including bronchospasm, laryngospasm, bradycardia, hypotension, and cardiac arrest. Here, we present a case of sugammadex-induced bradycardia and hypotension.Patient concerns: An 82-year-old female received video-assisted thoracic surgery decortication and wedge resection of the lung for empyema. Post-surgery, she developed bradycardia, hypotension, hypoxia, and weakness.Diagnoses: The patient was suspected to have sugammadex-induced bradycardia, hypotension, hypoxia and weakness. Interventions:The patient received immediate treatment with atropine (0.5 mg) for bradycardia. Glycopyrrolate (0.1 mg) and neostigmine (1 mg) were administered to improve the train-of-four (TOF) ratio.Outcomes: Following initial management, we observed improvement in the hemodynamics of the patient. She was discharged without any sequelae.Lessons: Sugammadex-induced bradycardia or cardiac arrest are rare; however, anesthesiologists must consider the possibility of the occurrence of such events and initiate appropriate management measures. Immediate treatment with atropine and inotropic or vasopressors is warranted if the patient presents with bradycardia.Abbreviations: bpm = beats per minute, NMTM = neuromuscular transmission monitors, TOF = train-of-four.

Sugammadex to Facilitate Neurologic Assessment in Severely Brain-Injured Patients: Retrospective Analysis and Practical Guidance

“…We did not find a significant reduction in HR after sugammadex administration, which is an interesting finding given that sugammadex is known to cause transient bradycardia that may be more likely in vulnerable patients and at higher doses [13,15,18,33]. We hypothesize that any sugammadex-mediated bradycardia could have been counteracted by the concurrent patient stimulation incurred during the neurologic exams for which sugammadex was administered, and/or by the catecholamine surge that often accompanies acute TBI [34,35].…”

“…To date, very limited studies have described patient outcomes and clinical considerations associated with sugammadex use outside of anesthesia settings [7][8][9][10][11][12]. While known to be well-tolerated across diverse surgical populations [13,14], sugammadex administration carries an infrequent risk of severe bradycardia, hypotension, and even asystole [15][16][17][18]. These risks may be more prevalent and deleterious in the neurocritically ill than in the elective surgical populations in which sugammadex has been studied and need to be better understood before this practice can be recommended routinely.…”

Cardiac arrest due to coronary vasospasm after sugammadex administration -a case report-

“…Another serious complication is profound bradycardia with a heart rate of 20-30 beats/min with or without hypotension, which can be treated with repeated injections of atropine and ephedrine [13,14].…”

REVersal of nEuromusculAr bLocking Agents in Patients Undergoing General Anaesthesia (REVEAL Study)

“…Some of the consequence of the increased use of sugammadex in the everyday anesthesiologist’s activity require further consideration. Several articles in the medical literature highlight the risk of hypersensitivity, bradycardia, and hypotension [ 26 , 27 ] following administration of sugammadex, including anecdotical case reports that describe the potential evolution of this clinical picture into asystole [ 28 , 29 ]. The exact mechanism by which sugammadex may induce these hemodynamic impairments remains unknown.…”