Perioperative Reactions to Sugammadex

AbstractPurpose of the reviewThe γ-cyclodextrin sugammadex, chemically modified to encapsulate the steroidal muscle relaxant rocuronium, was introduced into anesthesia as the first selective relaxant binding agent to reverse neuromuscular blockade. In the face of sugammadex’s alleged propensity to cause anaphylaxis, the agent wa s finally approved by the FDA in 2015. With its steadily increasing usage, it has become apparent that there is a small but concerning incidence of perioperative anaphylaxis to sugammadex and some reactions that are anaphylactic like but where diagnosis has not been definitive. The purpose here is t o examine the symptoms of the induced reactions, successful treatments undertaken, diagnostic conclusions reached, and the terminology applied to the reactions studied.Recent findingsFollowing relatively large numbers of early reports of anaphylaxis to sugammadex in Japan (where it was approved in 2010), accumulated data and evidence for the drug ’s involvement in provoking reactions has been assembled (from Japan and elsewhere) and analyzed from 33 case reports and other relevant publications. A feature of the diagnostic conclusions is the varied terminology and nomenclature ascribed to the observed reactions with up to nine different dia gnostic descriptions used. Although anaphylaxis is the most commonly applied designation, compelling evidence for an immune basis for many of the reported reactions is lacking. In accord with early predictions, the ...
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research