Two Cases of Rocuronium-Induced Anaphylaxis/Anaphylactic Shock Successfully Treated With Sugammadex

• Published in: Anesthesia progress 2019, Vol.66 (3), p.151-155
• Main Authors: Hashimoto, Mayumi, Sato Boku, Aiji, Tachi, Naoko, Okumura, Yoko, Kadoi, Kanenori, Harada, Jun, Okuda, Masahiro
• Format: Article
• Language: English
• Subjects: Allergens; Anaphylaxis; Anaphylaxis - chemically induced; Androstanols; Anesthesia; Anesthesiology; Blood pressure; Case Reports; Drugs; Food allergies; gamma-Cyclodextrins; Heart rate; Hematocrit; Hemodynamics; Humans; Immunoglobulins; Infectious diseases; Intubation; Latex; Leukocytes (basophilic); Methylprednisolone; Neuromuscular Nondepolarizing Agents; Propofol; Respiration; Rocuronium - adverse effects; Sugammadex - therapeutic use; Tryptase
• ISSN: 0003-3006; 1878-7177; 1878-7177
• DOI: 10.2344/anpr-66-01-07

While anaphylaxis can occur at any time during general anesthesia, 90% of cases occur at induction of anesthesia. As several drugs are administered simultaneously at this time, it is difficult to identify the causative agent. However, it has been found that rocuronium is the most common drug associated with perioperative anaphylaxis. We treated 2 cases of patients who were administered sugammadex for anaphylactic symptoms thought to be caused by rocuronium, after which the anaphylactic symptoms disappeared. One of the most important aspects of treating anaphylactic shock is improving hemodynamics. If signs indicating circulatory collapse are observed, epinephrine should be administered immediately. However, because rocuronium was suspected of being the causative agent, and taking the patients' clinical course over time into consideration, sugammadex was initially administered. As a result, symptoms improved. Therefore, we believe that the administration of sugammadex may be effective for treating anaphylaxis caused by rocuronium and also help in identifying the causative agent.