Sugammadex and Hypersensitivity-Related Reactions: a Review

AbstractPurpose of ReviewThe purpose of this review is to identify and understand the incidence and implications of sugammadex-induced hypersensitivity and anaphylaxis. This review also focuses on the mechanistic causation of anaphylaxis with regard to sugammadex administration and the management of anaphylaxis.Recent FindingsThe overall incidence of sugammadex-induced anaphylaxis is low, approximately 1:3500, and is comparable with other medications commonly used during the intraoperative period. Several studies and case reports have demonstrated that the mechanism of anaphylaxis is likely IgE- or basophil-mediated and that a diagnosis of anaphylaxis to confirm the etiology of urticaria, hypotension, bronchospasm, and other symptoms is based on positive skin prick testing, elevated tryptase levels, and dose-dependent activation of basophils during in vitro analysis. Bradycardia is a poorly understood adverse effect of sugammadex; however, the risk of bradycardia does not appear to be increased when compared with neostigmine.SummarySugammadex-induced anaphylaxis is a relatively rare complication but carries a risk of morbidity and mortality if inadequately identified and treated. Existing severity scales allow anesthesiologists to stratify the severity of an anaphylactic response and provide appropriate intraoperative treatment.

Source: Current Anesthesiology Reports - March 31, 2020 Category: Anesthesiology Source Type: research