Timing of sugammadex administration: A case report

Sugammadex is a relatively new drug used to reverse the effects of rocuronium, a non-depolarizing muscle relaxing agent to hasten emergence from general anesthesia. Unlike neostigmine and atropine, its use is not associated with re-curarization or cardiac arrhythmias. Sugammadex carries a small risk of allergic reactions including anaphylactic shock. We present a case report of a 67 years old woman who underwent an urgent operation for small bowel obstruction. Due to atrial fibrillation (AF) the anesthesiologist administered Sugammadex just before skin closure. Soon after the injection, peak inspiratory pressures (PIP) increased precipitously followed by hypotension and increasing tachycardia. For anticipated cardioversion, the chest was exposed and it revealed urticarial. There was severe bronchospasm on auscultation. Treatment of anaphylactic shock was initiated, the patient improved dramatically and fully recovered. This case is presented to alert practitioners to the importance of a sudden rise in PIP after Sugammadex administration in the early diagnosis of an anaphylactic reaction, and to suggest that due to the risk of anaphylaxis, it may be advisable to initiate sugammadex only when the patient can be fully exposed without compromising the sterility of the operating field.