Timing of sugammadex administration: a case report

Abstract

Sugammadex is a relatively new drug used to reverse the effects of rocuronium, a nondepolarizing
muscle relaxing agent to hasten emergence from general anesthesia. Unlike neostigmine
and atropine, its use is not associated with re-curarization or cardiac arrhythmias. Sugammadex carries a
small risk of allergic reactions including anaphylactic shock.
We present a case report of a 67 years old woman who underwent an urgent operation for small bowel
obstruction. Due to atrial fibrillation (AF) the anesthesiologist administered Sugammadex just before
skin closure. Soon after the injection, peak inspiratory pressures (PIP) increased precipitously followed
by hypotension and increasing tachycardia. For anticipated cardioversion, the chest was exposed and
it revealed urticarial. There was severe bronchospasm on auscultation. Treatment of anaphylactic shock
was initiated, the patient improved dramatically and fully recovered.
This case is presented to alert practitioners to the importance of a sudden rise in PIP after Sugammadex
administration in the early diagnosis of an anaphylactic reaction, and to suggest that due to the risk of
anaphylaxis, it may be advisable to initiate sugammadex only when the patient can be fully exposed
without compromising the sterility of the operating field.