Sugamadex in the reversal of anaphylaxis due to rocuronium in a pediatric patient: Case report

Authors

DOI:

https://doi.org/10.33448/rsd-v12i14.44396

Keywords:

Sugammadex; Anaphylaxis; Rocuronium.

Abstract

Neuromuscular blockers, notably rocuronium, are a prominent cause of anaphylactic reactions in the perioperative period. Rocuronium, known for its rapid action and intermediate duration, has gained prominence due to the benefits of Sugammadex, its reversal agent, which provides agile and predictable reversal of neuromuscular blockade. We report the case of a 6-year-old patient, weighing 30 kg, who underwent video-assisted thoracoscopic surgery (VATS), who presented an adverse reaction after the administration of rocuronium, manifesting chest flushing, tachycardia, severe hypotension and generalized petechiae. Despite attempts at treatment with adrenaline, there was no improvement in hemodynamics. After administration of Sugammadex, a positive response was observed, with an increase in heart rate and blood pressure, allowing the patient to be transferred to the Pediatric Intensive Care Unit. In this sense, this case report aimed to describe the treatment of an episode of anaphylaxis induced by rocuronium and treated with the administration of sugammadex.

References

Admass, B. A., Hassen, A. E., Agegnehu, A. F., Temesgen, M. M., Gebeyehu, N. A., Ferede, Y. A., & Tegegne, B. A. (2023). Management of perioperative anaphylaxis: Systematic review. International Journal of Surgery Open, 52, 100595.

Barbosa, F. T., Neto, O. B. de O., Barbosa, L. T., Andrade, R. R. de, Ribeiro, Ê. A. N., & Rodrigues, C. F. de S. (2020). Efetividade do sulfato de magnésio comparado ao rocurônio para intubação em sequência rápida em adultos: ensaio clínico randomizado. Brazilian Journal of Anesthesiology, 70(1), 42–47.

Chen, A. T., Patel, A., McKechnie, T., Lee, Y., Doumouras, A. G., Hong, D., & Eskicioglu, C. (2022). Sugammadex in Colorectal Surgery: A Systematic Review and Meta-analysis. Journal of Surgical Research, 270, 221–229.

Chen, I.-Y., Sugita, C., Wei, Y., Daimaruya, N., Itami, T., Sano, T., & Yamashita, K. (2023). Sugammadex for reversal of rocuronium-induced neuromuscular blockade during alfaxalone anesthesia in dogs. Veterinary Anaesthesia and Analgesia, 50(6), 485–491.

Germano-Filho, P. A., Cavalcanti, I. L., Micuci, A. J. Q. R., Velarde, L. G. C., de Boer, H. D., & Verçosa, N. (2023). Recurarization with magnesium sulfate administered after two minutes sugammadex reversal: A randomized, double-blind, controlled trial. Journal of Clinical Anesthesia, 89, 111186.

Hodge, C., Myers, A., Ceneviva, G. D., Zhao, R., Zhou, S., Thomas, N. J., & Krawiec, C. (2023). Retrospective Analysis of Sugammadex Use in Adolescent Females on Progestin-Containing Contraceptives. Journal of Pediatric and Adolescent Gynecology, 36(5), 459–464.

Höfer, V., Dölle-Bierke, S., Francuzik, W., Ruëff, F., Sabouraud-Leclerc, D., Treudler, R., Moeser, A., Hartmann, K., Pföhler, C., Wagner, N., Ensina, L. F., Wedi, B., Cardona, V., & Worm, M. (2023). Fatal and Near-Fatal Anaphylaxis: Data From the European Anaphylaxis Registry and National Health Statistics. The Journal of Allergy and Clinical Immunology: In Practice. 2023.

Hotta, E., Tamagawa-Mineoka, R., Masuda, K., Taura, M., Nakagawa, Y., Kanehisa, F., Tashima, S., & Katoh, N. (2016). Anaphylaxis caused by γ-cyclodextrin in sugammadex. Allergology International, 65(3), 356–358.

Hunter, J. M., & Sneyd, J. R. (2023). Is adamgammadex the brother of sugammadex or the next generation of reversal agent? British Journal of Anaesthesia. 2023.

Ji, Y., Yuan, H., Chen, Y., Zhang, X., Wu, F., Tang, W., Lu, Z., & Huang, C. (2023). Sugammadex Is Associated With Reduced Pulmonary Complications in Patients With Respiratory Dysfunction. Journal of Surgical Research, 290, 133–140.

Lima Cavalcanti, I., Braga, E. L. C., Verçosa, N., Schanaider, A., Barrucand, L., Boer, H. D. de, & Vane, L. (2020). Efeitos do rocurônio, sugamadex e complexo rocurônio‐sugamadex sobre a coagulação em ratos. Brazilian Journal of Anesthesiology, 70(6), 635–641.

Merchán-Hamann, E. (2021). Proposta de classificação dos diferentes tipos de estudos epidemiológicos descritivos Proposal for classifying the different types of descriptive epidemiological studies Propuesta de clasificación de los diferentes tipos de estudios epidemiológicos descriptivos. AplicAções DA EpidemiologiA Epidemiol. Serv. Saude, 30(1), 2021.

Noguchi, S., Iwasaki, H., Shiko, Y., Kawasaki, Y., Ishida, Y., Shinomiya, S., Ono Uokawa, R., & Mazda, Y. (2023). Fetal outcomes with and without the use of sugammadex in pregnant patients undergoing non-obstetric surgery: a multicenter retrospective study. International Journal of Obstetric Anesthesia, 53, 103620.

Nolte, H., Calderon, M. A., Bernstein, D. I., Roberts, G., Azuma, R., Juhl, R. G., & Hulstrøm, V. (2023). Anaphylaxis in Clinical Trials of Sublingual Immunotherapy Tablets. The Journal of Allergy and Clinical Immunology: In Practice. 2023.

Pistiner, M., Mendez-Reyes, J. E., Eftekhari, S., Carver, M., Lieberman, J., Wang, J., & Camargo, C. A. (2023). Factors Associated with Epinephrine Use in the Treatment of Anaphylaxis in Infants and Toddlers. The Journal of Allergy and Clinical Immunology: In Practice. 2023.

Rubio-Baines, I., Honorato-Cia, C., Valencia, M., Panadero, A., Cacho-Asenjo, E., Manzanilla, O., Alegre, M., Nuñez-Cordoba, J. M., & Martinez-Simon, A. (2023). Effect of sugammadex on processed EEG parameters in patients undergoing robot-assisted radical prostatectomy. British Journal of Anaesthesia, 131(3), 523–530.

Schmidt, M., Rössler, J., Brooker, J., Lara-Erazo, V., Ekrami, E., Pu, X., Turan, A., Sessler, D. I., & Ruetzler, K. (2023). Postoperative oxygenation assessed by SpO2/FiO2 ratio and respiratory complications after reversal of neuromuscular block with Sugammadex or neostigmine: A retrospective cohort study. Journal of Clinical Anesthesia, 88, 111138.

Stiles, S. L., Sanfilippo, F. M., Loh, R., Said, M., Clifford, R. M., & Salter, S. M. (2023). Contemporary trends in anaphylaxis burden and healthcare utilisation in Western Australia: A linked data study. World Allergy Organization Journal, 16(9), 100818.

Sugizaki, C., Sato, S., Yanagida, N., & Ebisawa, M. (2023). Analysis of drug-induced anaphylaxis cases using the Japanese Adverse Drug Event Report (JADER) database – secondary publication. Allergology International, 72(4), 580–587.

Takazawa, T., Horiuchi, T., Nagumo, K., Sugiyama, Y., Akune, T., Amano, Y., Fukuda, M., Haraguchi, T., Ishibashi, C., Kanemaru, E., Kato, T., Katoh, K., Kawano, T., Kochiyama, T., Kuri, M., Kurita, A., Matsuoka, Y., Muramatsu, T., Orihara, M., … Saito, S. (2023). The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: allergen exposure, epidemiology, and diagnosis of anaphylaxis during general anaesthesia. British Journal of Anaesthesia, 131(1), 159–169.

Uchida, M., Kikuchi, M., Haruyama, Y., Takiguchi, T., Hifumi, T., Inoue, A., Sakamoto, T., & Kuroda, Y. (2023). Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study. Resuscitation Plus, 16, 100476.

Published

14/12/2023

How to Cite

FERNANDES, J. P. C. .; AMORIM, J. A.; MENDES FILHO, A. M. Sugamadex in the reversal of anaphylaxis due to rocuronium in a pediatric patient: Case report. Research, Society and Development, [S. l.], v. 12, n. 14, p. e28121444396, 2023. DOI: 10.33448/rsd-v12i14.44396. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/44396. Acesso em: 21 may. 2024.

Issue

Section

Health Sciences