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Sugammadex-induced anaphylactic shock
Anesth Pain Med 2020;15(1):131
Published online January 31, 2020
© 2020 Korean Society of Anesthesiologists.

Ha-Jung Kim1 , Hae Kyung Lee2 , Chan Woo Lee2 , Eung Gyun Kim2 , and Hong Seuk Yang2
Department of Anesthesiology and Pain Medicine, 1Asan Medical Center, University of Ulsan College of Medicine, Seoul, 2Daejeon Sun Medical Center, Daejeon, Korea
Correspondence to: Hong Seuk Yang, M.D., Ph.D.
Department of Anesthesiology and Pain Medicine, Daejeon Sun Medical Center, 29 Mokjung-ro, Jung-gu, Daejeon 34811, Korea Tel: 82-42-220-8921 Fax: 82-42-220-8933 E-mail: hsyang@amc.seoul.kr
ORCID: https://orcid.org/0000-0003-2023-8705
Received September 10, 2019; Accepted December 2, 2019.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
BODY

Since sugammadex has begun to be clinically used as an antagonist of nondepolarizing neuromuscular blockers, there have been many reports of its side effects, such as anaphylaxis. We read with great interest the paper titled “A suspected sugammadex-induced anaphylactic shock-A case report.” We have some concerns, which we want to discuss.

Transthoracic echocardiography was considered effective for the diagnosis and treatment in this case. Impairment of the coronary circulation can occur in cases of anaphylaxis [1,2]. In this case, rocuronium was continuously infused during anesthesia. However, the depth of the neuromuscular blockade during the operation should have been mentioned. Among the reports on maintenance of the neuromuscular blockade during surgery, some papers suggest that profound neuromuscular blockade is effective but that it is better to maintain 95–97% neuromuscular blockade [3,4]. Further, the depth of the neuromuscular blockade at the time of injecting 200 mg of sugammadex should have been mentioned. In addition, 200 mg of sugammadex was administered at a dose of 3.257 mg/kg in this patient, who weighed 61.4 kg. However, a basis of determining this dose should have been provided. Furthermore, it remains unclear whether or not this dose was sufficient [3,4].

Identification of the antigen is considered an important component of patient care. Three suspicious substances, including rocuronium, sugammadex, and the rocuronium–sugammadex complex, should be selected as antigens for the skin test in cases of anaphylaxis following the administration of rocuronium and sugammadex. It will be helpful to identify the causative substances of anaphylaxis [5].

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References
  1. Kounis NG. Coronary hypersensitivity disorder: the Kounis syndrome. Clin Ther 2013;35:563-71.
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  2. Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med 2016;54:1545-59.
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  3. Lien CA, and Kopman AF. Current recommendations for monitoring depth of neuromuscular blockade. Curr Opin Anaesthesiol 2014;27:616-22.
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  4. Brull SJ, and Kopman AF. Current status of neuromuscular reversal and monitoring: challenges and opportunities. Anesthesiology 2017;126:173-90.
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  5. Baldo BA. Anaphylaxis caused by sugammadex- rocuronium inclusion complex: what is the basis of the allergenic recognition?. J Clin Anesth 2019;54:48-9.
    Pubmed CrossRef


January 2020, 15 (1)
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