title: Three suspected cases of sugammadex-induced anaphylactic shock.
abstract: BACKGROUND
  Sugammadex has a unique mechanism of action and is widely used because of its safety and efficacy. A few recent reports have described allergic reactions to clinical doses of sugammadex. We hereby describe another series of cases of possible anaphylaxis to sugammadex.
  
  
  METHODS
  We present three suspected cases of sugammadex-induced anaphylactic shock, including a 13-year-old boy who underwent laparoscopic appendectomy, a 75-year-old woman who underwent left knee arthroplasty, and a 34-year-old man who underwent left pansinectomy for sinobronchitis. All three patients received general anesthesia with rocuronium and their tracheas were intubated. Shortly after injection of sugammadex for reversal of rocuronium, all of them experienced a decrease in blood pressure along with mucocutaneous erythema. In the most severe case, reintubation after extubation was required due to difficulty in manual ventilation. All patients recovered with anti-allergic therapy. On later investigation, all three patients had a positive skin reaction to sugammadex.
  
  
  CONCLUSIONS
  Our results suggest that physicians using sugammadex should be aware of the possibility of sugammadex-induced anaphylaxis.
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Takazawa
authors.affiliation: Department of Anesthesiology, Isesaki Municipal Hospital, 12-1 Tsunatorihoncho, Isesaki, 372-0817 Japan.
authors.forename: Yukinari
authors.initials: Y
authors.lastname: Tomita
authors.affiliation: Department of Anesthesiology, Saiseikai Maebashi Hospital, 564-1 Kamishinden-machi, Maebashi, 971-0821 Japan.
authors.forename: Nagahide
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Department of Anesthesiology, Gunma Chuo General Hospital, 1-7-13 Kouuncho, Maebashi, 371-0025 Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tomioka
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Horiuchi
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Nagata
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Orihara
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Japan.
authors.forename: Makiko Hardy
authors.initials: MH
authors.lastname: Yamada
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511 Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000209:etiology*; D000732:Androstanols; D001062:Appendectomy / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents; D010256:Paranasal Sinuses / Q000601:surgery; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000009:adverse effects*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium
keywords: Anaphylactic shock; General anesthesia; Sugammadex