[A case of rocuronium-induced anaphylactic shock successfully treated with sugammadex].
We report a case of a 19-year-old male with rocuronium-induced anaphylactic shock. He was scheduled for endoscopic sinus surgery for chronic sinusitis under general anesthesia. Induction of anesthesia was done with fentanyl, propofol and sevoflurane. Just after administration of rocuronium, he developed tachycardia with extended exanthema on the face, anterior chest wall and abdomen. He was difficult to ventilate manually with mask and then intubated without difficulty. The carotid arterial pulse was not palpable and adrenaline was given intermittently to maintain blood pressure. Although the systolic blood pressure increased to 80 mmHg, hemodynamics was unstable with adrenaline. Sugammadex was then given and the blood pressure became stable without adrenaline. Exanthema also disappeared gradually. He was then transferred to ICU and extubated without any sequela. The plasma beta-tryptase increased to 46 microg x l(-1) during the shock state and returned to 14.1 microg x l(-1) 8 hrs after the event. The blood hemoglobin level also increased to 21.3 g x dl(-1) during the shock state and returned to 17.2 g x dl(-1) during the recovery phase. The laboratory data showed a marked increase in vascular permeability caused by rocuronium-induced anaphylactic shock.
Department of Anesthesiology, Okayama Red Cross Hospital, Okayama 700-0941.
Tomoki
T
Ishikawa
Naoya
N
Kawanoue
Eriko
E
Minami
Etsu
E
Iwasaki
Mizue
M
Ishii
Hiroyuki
H
Kobayashi
Satoru
S
Oku
Takeshi
T
Mikane
Hiroaki
H
Tokioka
Keiko
K
Kanazawa
D000707:Anaphylaxis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D000732:Androstanols / Q000009:adverse effects*; D002199:Capillary Permeability / Q000187:drug effects; D006801:Humans; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D000077123:Rocuronium; D000077122:Sugammadex; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium