title: Sugammadex and rocuronium-induced anaphylaxis.
abstract: Perioperative anaphylaxis is a life-threatening clinical condition that is typically the result of drugs or substances used for anesthesia or surgery. The most common cause of anaphylaxis during anesthesia is reportedly neuromuscular blocking agents. Of the many muscle relaxants that are clinically available, rocuronium is becoming popular in many countries. Recent studies have demonstrated that succinylcholine (but also rocuronium use) is associated with a relatively high rate of IgE-mediated anaphylaxis compared with other muscle relaxant agents. Sugammadex is widely used for reversal of the effects of steroidal neuromuscular blocking agents, such as rocuronium and vecuronium. Confirmed cases of allergic reactions to clinical doses of sugammadex have also been recently reported. Given these circumstances, the number of cases of hypersensitivity to either sugammadex or rocuronium is likely to increase. Thus, anesthesiologists should be familiar with the epidemiology, mechanisms, and clinical presentations of anaphylaxis induced by these drugs. In this review, we focus on the diagnosis and treatment of anaphylaxis to sugammadex and neuromuscular blocking agents. Moreover, we discuss recent studies in this field, including the diagnostic utility of flow cytometry and improvement of rocuronium-induced anaphylaxis with the use of sugammadex.
authors.affiliation: Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan. takazawt@gunma-u.ac.jp.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Takazawa
authors.affiliation: Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-Ku, Tokyo, 136-0075, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Mitsuhata
authors.affiliation: Service d'anesthésie-réanimation chirurgicale, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France.
authors.forename: Paul Michel
authors.initials: PM
authors.lastname: Mertes
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced*; D000732:Androstanols / Q000009:adverse effects*; D000758:Anesthesia / Q000009:adverse effects; D006801:Humans; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects; D000077123:Rocuronium; D013390:Succinylcholine / Q000009:adverse effects; D000077122:Sugammadex; D014673:Vecuronium Bromide / Q000009:adverse effects; D047408:gamma-Cyclodextrins / Q000009:adverse effects*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D014673:Vecuronium Bromide; D013390:Succinylcholine; D000077123:Rocuronium
keywords: Anaphylaxis; Flow cytometry; Neuromuscular blocking agent; Rocuronium; Sugammadex