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• W2940987030 abstract "Editor—We read the article by McDonnell and colleagues1McDonnell N.J. Pavy T.J.G. Green L.K. Platt P.R. Sugammadex in the management of rocuronium-induced anaphylaxis.Br J Anaesth. 2011; 106: 199-201Abstract Full Text Full Text PDF PubMed Scopus (97) Google Scholar with great interest; although sugammadex has been reported as a treatment of rocuronium-induced anaphylaxis, we believe that further research is needed to demonstrate the safety profile of sugammadex. Here, we report a rare but potentially life-threatening adverse effect that can occur after administration of sugammadex for antagonism of neuromuscular block with rocuronium during general anaesthesia with desflurane maintenance. A previously healthy 31-yr-old female with no history of pulmonary disease underwent laparoscopic cholecystectomy. She was premedicated with midazolam and anaesthesia was induced with i.v. fentanyl, lidocaine, and propofol. Paralysis was facilitated with a single dose of rocuronium 40 mg i.v. at induction, and anaesthesia was maintained with inhaled desflurane. Sugammadex 4 mg kg−1 i.v. was used to antagonise neuromuscular block 35 min after rocuronium administration (0 train-of-four twitches at ulnar nerve, SunStim™ peripheral nerve stimulator, SunMed, 2710 Northridge Dr. NW, Suite A Grand Rapids, MI, 49544, USA). Shortly after administration of sugammadex, peak inspiratory pressures increased from 21 to 40 cm H2O, with associated elevation of end-tidal CO2 (EtCO2), reduced tidal volumes, prolonged phase II capnogram segment, and bilateral wheezes on auscultation. Treatment for bronchospasm was initiated with deepening of desflurane anaesthesia, albuterol administered with a metered-dose inhaler, and dexamethasone 10 mg i.v., with resolution of wheezing, improvement in tidal volume, and normalisation of peak inspiratory pressures and EtCO2. The patient was extubated successfully, and had an uneventful course in the PACU with no need for further treatment. The patient recovered completely and was discharged home after being observed at the hospital for 1 day. There are limited published data on the incidence of bronchospasm in patients receiving sugammadex. Eskander and colleagues2Eskander J.P. Cornett E.M. Stuker W. Fox C.J. Breehl M. The combination of sugammadex and desflurane may increase the risk of bronchospasm during general anesthesia.J Clin Anesth. 2017; 41: 73Crossref PubMed Scopus (6) Google Scholar reported three cases of bronchospasm after sugammadex administration in patients with no pre-existing pulmonary disease who received general anaesthesia with desflurane and rocuronium. These authors hypothesised that the irritant properties of desflurane, and the interaction of sugammadex with circulating rocuronium molecules, is the probable aetiology for an increased incidence of bronchospasm in patients in whom all these agents are administered together. In a recent case report,3Yamaoka M. Deguchi M. Ninomiya K. Kurasako T. Matsumoto M. A suspected case of rocuronium-sugammadex complex-induced anaphylactic shock after cesarean section.J Anesth. 2017; 31: 148-151Crossref PubMed Scopus (30) Google Scholar the sugammadex–rocuronium complex, rather than sugammadex or rocuronium alone, was confirmed by intradermal allergy testing as the causative agent for anaphylaxis during a Caesarean section. Amao and colleagues4Amao R. Zornow M.H. Cowan R.M. Cheng D.C. Morte J.B. Allard M.W. Use of sugammadex in patients with a history of pulmonary disease.J Clin Anesth. 2012; 24: 289-297Crossref PubMed Scopus (36) Google Scholar reported two patients with pre-existing pulmonary disease receiving sugammadex, rocuronium, and desflurane who developed bronchospasm. Based on these reports and our clinical experience, we advise caution when using sugammadex in patients receiving both desflurane and rocuronium, irrespective of pre-existing pulmonary disease. Of note, there have been no reports of bronchospasm with sugammadex during isoflurane or sevoflurane anaesthesia. The authors declare that they have no conflicts of interest." @default.
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• W2940987030 date "2019-07-01" @default.
• W2940987030 modified "2023-10-10" @default.
• W2940987030 title "Sugammadex-induced bronchospasm during desflurane anaesthesia" @default.
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• W2940987030 doi "https://doi.org/10.1016/j.bja.2019.04.001" @default.
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