Deep bradycardia after sugammadex: is it due to anaphylaxis or by any other unknown mechanism(s) of sugammadex?
- PDF / 820,833 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 121 Downloads / 186 Views
Ain-Shams Journal of Anesthesiology
(2020) 12:42
CASE REPORT
Open Access
Deep bradycardia after sugammadex: is it due to anaphylaxis or by any other unknown mechanism(s) of sugammadex? Fulya Yilmaz1*
and Koray Bas2
Abstract Background: Sugammadex is a ɣ-cyclodextrin containing 8-thiopropionate side chains, which selectively binds to nondepolarizing aminosteroid neuromuscular blocking agents. Here, we report a case who developed deep bradycardia after administration of sugammadex. Case presentation: A 38-year-old-man was scheduled for laparoscopic right hemicolectomy. Besides history of light smoking, he had no other medical/surgical history that included any allergic reactions. At the end of the operation, 200 mg sugammadex was administered to antagonize residual neuromuscular blockade. One minute after the administration of sugammadex, the patient had deep bradycardia (25 beat min−1) and his systolic blood pressure fell below a measurable level. The patient’s blood pressure was restored to 95/55 mmHg and heart rate 110 beats min−1 with the administration of a total dose of ephedrine 10 mg, atropine sulfate 0.5 mg, 0.9% saline 1 L, and 6% hydroxyethylated starch 500 mL over 15 min. Then, he was extubated uneventfully and transferred to the intensive care unit for closer monitoring. Conclusions: According to the current literature as well as the case we presented here, we suggest that physicians who use sugammadex especially in endoscopic/laparoscopic procedures using CO2 should be aware of the possibility of sudden bradycardia and/or cardiac arrest. Keywords: Sugammadex, Deep bradycardia, Anaphylaxis, Laparoscopic surgery
Background Sugammadex is a ɣ-cyclodextrin containing 8 thiopropionate side chains, which selectively binds to nondepolarizing aminosteroid neuromuscular blocking agents, forming a host-guest complex by directly encapsulating the rocuronium (Mineoka et al., 2016; Yamaoka et al., 2017; Ho et al., 2016; Min et al., 2018). It supplies rapid, safe, predictable, and urgent reversal of aminosteroid neuromuscular blocking agents especially rocuronium and is considered as a well-tolerated drug (Mineoka et al., 2016; Ho et al., 2016; Min et al., 2018; Menedez* Correspondence: [email protected] 1 University of Health Sciences Izmir Bozyaka Training and Research Hospital Department of Anaesthesiology and Reanimation, Saim Çıkrıkçı Caddesi No: 59 Karabağlar, Izmir, Turkey Full list of author information is available at the end of the article
Ozcoidi et al., 2011). In recent years, sugammadex has been used more frequently in clinical practice with the changes in anesthesia management. By the frequent use of sugammadex in clinical practice, the adverse reaction(s) of sugammadex, sudden bradycardia and/or cardiac arrest, have been encountered often and the number of publications about this adverse reaction(s) has been increased (Ho et al., 2016). Here, we report a case who developed deep bradycardia after administration of sugammadex.
Case presentation Written informed consent was obtained from the pati
Data Loading...
