rocuronium and Shock

Sugammadex is a reversal agent for non-depolarizing neuromuscular blockers and widely used worldwide on account of its rapid and effective reversal from neuromuscular blockade, despite its advantages, multiple cases of sugammadex-induced anaphylactic shock have been reported.. A 42-year-old man developed anaphylactic shock in the postanesthesia care unit. Initially, sugammadex was suspected as the causative agent, but an intradermal skin test revealed negative results. A further skin test was performed with sugammadex-rocuronium complex that yielded positive results.. Anesthesiologists and healthcare providers should be aware of the possibility of anaphylaxis from the sugammadex-rocuronium complex, as well as from sugammadex or rocuronium alone.

Topics: Adult; Anaphylaxis; Humans; Male; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Rocuronium; Shock; Sugammadex

The danger of anaphylaxis, a rare but life threatening complication of general anesthesia (GA) can be summarized in two: 1. General Anesthesia masks the typical early signs of allergy which can be seen in an awake patient. 2. Anaphylaxis during GA manifests mostly as circulatory/ventilatory failures which can be interpreted as adverse effects of anesthetics or surgery and this can lead to critical delay of effective therapy. A 19-year-old female admitted for posterior spinal fusion and instrumentation (the 5th surgery in patient's life) desaturated seconds after intubation. Cardiopulmonary resuscitation (CPR) was started and the absence of cutaneous signs along with a loud holosystolic murmur were questioned. The patient was promptly resuscitated and allergy to rocuronium was confirmed by intradermal tests 6weeks later. Factors influencing decision making and potential etiology of the newly heard holosystolic murmur during anaphylaxis are discussed.

Topics: Adult; Anaphylaxis; Androstanols; Anesthesia, General; Anesthetics, Intravenous; Cardiopulmonary Resuscitation; Clinical Decision-Making; Drug Hypersensitivity; Female; Fentanyl; Humans; Hypotension; Intradermal Tests; Neuromuscular Nondepolarizing Agents; Propofol; Rocuronium; Scoliosis; Shock; Spinal Fusion; Systolic Murmurs; Vasoconstrictor Agents; Young Adult