A case of anaphylaxis apparently induced by sugammadex and rocuronium in successive surgeries

Abstract Rocuronium is the agent most frequently involved in perioperative anaphylaxis, and sugammadex has also been known to induce anaphylactic reactions. We describe a case of successive anaphylactic episodes that seemed to be induced by clinical doses of rocuronium and sugammadex. The patient wa...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2016-08, Vol.32, p.30-32
Main Authors: Yamada, Yuko, MD, Yamamoto, Takuji, MD, PhD, Tanabe, Kumiko, MD, PhD, Fukuoka, Naokazu, MD, PhD, Takenaka, Motoyasu, MD, PhD, Iida, Hiroki, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Anaphylaxis
Anaphylaxis - chemically induced
Androstanols - adverse effects
Anesthesia
Anesthesia & Perioperative Care
Female
gamma-Cyclodextrins - adverse effects
Humans
Intensive care
Neuromuscular Nondepolarizing Agents - adverse effects
Pain Medicine
Rocuronium
Sugammadex
Surgery
Surgical Procedures, Operative
Trauma
Young Adult
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Summary:Abstract Rocuronium is the agent most frequently involved in perioperative anaphylaxis, and sugammadex has also been known to induce anaphylactic reactions. We describe a case of successive anaphylactic episodes that seemed to be induced by clinical doses of rocuronium and sugammadex. The patient was a 19-year-old woman who had a medical history of asthma, but no history of surgery. She had been injured in a fall, and several surgeries were scheduled for multiple bone fractures. At the first surgery under general anesthesia, she developed anaphylaxis 5 min after sugammadex administration. A second general anesthesia for treatment of calcaneal fracture was induced uneventfully without neuromuscular blockade after 10 days. A third general anesthesia was scheduled to reinforce the spinal column 12 days after the first surgery. She developed anaphylaxis 8 min after rocuronium administration. The level of plasma histamine was elevated, but serum tryptase level remained normal. This surgery was canceled and rescheduled without use of a neuromuscular blockade. Skin tests were performed in a later investigation. The patient showed positive results on intradermal tests for sugammadex and rocuronium, supporting a diagnosis of allergic reactions to both drugs. Clinicians must be aware that anaphylactic reactions can be induced by both sugammadex and rocuronium.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2015.11.004