Rocuronium bromide
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Immunoglobulin E-mediated anaphylaxis: case report A 74-year-old woman developed immunoglobulin E-mediated anaphylaxis following procedural administration of rocuronium bromide to facilitate tracheal intubation. The woman, who had a history of Meniere disease, was scheduled to undergo tracheal echoendoscopy to explore mediastinum ganglions. She was administered remifentanil and propofol for induction of general anaesthesia. Additionally, she was administered rocuronium bromide [rocuronium] 0.46 mg/kg to facilitate tracheal intubation [route not stated]. Three minutes after the administration of rocuronium bromide, she developed moderate hypotension, tachycardia and elevated airway pressure. No vesicular breath sounds were noted on auscultation. She was diagnosed with bronchospasm. The depth of the anaesthesia was increased, and the woman was administered 10 puffs of salbutamol through the laryngeal mask. However, no effect was observed. She was then intubated, and small volume controlled ventilation was achieved. Oxygen saturation was measured at 97%. She was administered IV epinephrine injection 10µg twice, with no durable effect. She was then administered sugammadex inducing the appearance of 4 responses to the train-of-four stimulation in 1 minute. Five minutes later, her HR decreased from 140 beats/minute to 100 beats/minute. However, the airway pressures remained high. She was administered the third epinephrine injection, and her peak airway pressure decreased quickly. Finally, in view of the persistently low BP, she received the fourth dose of epinephrine 100µg that led to tachycardia and hypertension. The surgery was postponed, and she was brought to the recovery room. Five minutes later, she was extubated. A probable anaphylactic reaction during the anaesthesia was suspected. She was monitored for 1 day in the recovery room to avoid potential recurrence of anaphylaxis. Allergy consultation revealed elevated levels of histamine. A positive serum-specific immunoglobulin-E against neuromuscular blocking drug test with quaternary ammonium and 67.86% of inhibition for rocuronium was observed. Intradermic test was positive for rocuronium at 1:1000 dilution. The intradermic test was negative for sugammadex, and for mixture of rocuronium with sugammadex in an equal molecular ratio from 1/1000th to 1/10th concentration. A rocuronium-induced immunoglobulin E–mediated anaphylaxis was confirmed. Binczak M, et al. Efficacy of Sugammadex in Preventing Skin Test Reaction in a Patient With Confirmed Rocuronium Anaphylaxis: A Case Report. A and A Practice 13: 803444562 17-19, No. 1, 1 Jul 2019. Available from: URL: http://doi.org/10.1213/XAA.0000000000000973
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Reactions 11 Jan 2020 No. 1786
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