• Tomonori Takazawa, Yukinari Tomita, Nagahide Yoshida, Akihiro Tomioka, Tatsuo Horiuchi, Chie Nagata, Masaki Orihara, Makiko Hardy Yamada, and Shigeru Saito.
• Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Japan.
• BMC Anesthesiol. 2014 Jan 1;14:92.

BackgroundSugammadex has a unique mechanism of action and is widely used because of its safety and efficacy. A few recent reports have described allergic reactions to clinical doses of sugammadex. We hereby describe another series of cases of possible anaphylaxis to sugammadex.Case PresentationWe present three suspected cases of sugammadex-induced anaphylactic shock, including a 13-year-old boy who underwent laparoscopic appendectomy, a 75-year-old woman who underwent left knee arthroplasty, and a 34-year-old man who underwent left pansinectomy for sinobronchitis. All three patients received general anesthesia with rocuronium and their tracheas were intubated. Shortly after injection of sugammadex for reversal of rocuronium, all of them experienced a decrease in blood pressure along with mucocutaneous erythema. In the most severe case, reintubation after extubation was required due to difficulty in manual ventilation. All patients recovered with anti-allergic therapy. On later investigation, all three patients had a positive skin reaction to sugammadex.ConclusionOur results suggest that physicians using sugammadex should be aware of the possibility of sugammadex-induced anaphylaxis.

This article appears in the collection: Sugammadex anaphylaxis: all that glitters?.

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