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Sugammadex-induced bronchospasm: a case report

  • Saeyoung Kim (Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University) ;
  • Hyojun Choo (Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University) ;
  • Hoon Jung (Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University) ;
  • Ji Hyun Kim (Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University)
  • Received : 2023.07.24
  • Accepted : 2023.09.02
  • Published : 2023.10.01

Abstract

Sugammadex has shown faster reversal of steroidal neuromuscular blockade (NMB) than neostigmine, a traditional reversal agent for NMB, even in the intense block phase. This efficiency is possible because of the unique mechanism of action by encapsulating the NMB molecules. Therefore, with the use of sugammadex, we can also expect to avoid direct interactions with the cholinergic system and its subsequent side effects, which are disadvantages of traditional drugs. However, despite these benefits and US Food and Drug Administration (FDA) approval in 2015, rare adverse events associated with sugammadex have been reported. Herein, we report a case of bronchospasm that developed immediately after sugammadex administration.

Keywords

References

  1. Carron M, Zarantonello F, Tellaroli P, Ori C. Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials. J Clin Anesth 2016; 35: 1-12. https://doi.org/10.1016/j.jclinane.2016.06.018
  2. Kheterpal S, Vaughn MT, Dubovoy TZ, Shah NJ, Bash LD, Colquhoun DA, et al. Sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (STRONGER): a multicenter matched cohort analysis. Anesthesiology 2020; 132: 1371-81. https://doi.org/10.1097/ALN.0000000000003256
  3. Ruetzler K, Li K, Chhabada S, Maheshwari K, Chahar P, Khanna S, et al. Sugammadex versus neostigmine for reversal of residual neuromuscular blocks after surgery: a retrospective cohort analysis of postoperative side effects. Anesth Analg 2022; 134: 1043-53. https://doi.org/10.1213/ANE.0000000000005842
  4. Menendez-Ozcoidi L, Ortiz-Gomez JR, Olaguibel-Ribero JM, Salvador-Bravo MJ. Allergy to low dose sugammadex. Anesthesia 2011; 66: 217-9. https://doi.org/10.1111/j.1365-2044.2010.06611.x
  5. Godai K, Hasegawa-Moriyama M, Kuniyoshi T, Kaoi T, Ikoma K, Isowaki S, et al. Three cases of suspected sugammadex-induced hypersensitivity reactions. Br J Anaesth 2012; 109: 216-8. https://doi.org/10.1093/bja/aes137
  6. Min KC, Bondiskey P, Schulz V, Woo T, Assaid C, Yu W, et al. Hypersensitivity incidence after sugammadex administration in healthy subjects: a randomised controlled trial. Br J Anaesth 2018; 121: 749-57. https://doi.org/10.1016/j.bja.2018.05.056
  7. Eskander JP, Cornett EM, Stuker W, Fox CJ, Breehl M. The combination of sugammadex and desflurane may increase the risk of bronchospasm during general anesthesia. J Clin Anesth 2017; 41: 73.
  8. Baronos S, Selvaraj BJ, Liang M, Ahmed K, Yarmush J. Sugammadex-induced bronchospasm during desflurane anaesthesia. Br J Anaesth 2019; 123: e155-6. https://doi.org/10.1016/j.bja.2019.04.001
  9. Trivedi K, O'Brien VJ, Rochetto RP. Sugammadexassociated bronchospasm. Am J Ther 2021; 29: e139-41. https://doi.org/10.1097/MJT.0000000000001390
  10. Aggarwal P. Risk of bronchospasm and coronary arteriospasm with sugammadex use: a post marketing analysis. Ther Adv Drug Saf 2019; 10: 2042098619869077.
  11. Li G, Freundlich RE, Gupta RK, Hayhurst CJ, Le CH, Martin BJ, et al. Postoperative pulmonary complications' association with sugammadex versus neostigmine: a retrospective registry analysis. Anesthesiology 2021; 134: 862-73. https://doi.org/10.1097/ALN.0000000000003735
  12. Cammu G, De Kam PJ, Demeyer I, Deoopman M, Peeters PA, Smeets JM, et al. Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers. Br J Anaesth 2008: 100: 373-9. https://doi.org/10.1093/bja/aem402
  13. Peeters PA, van den Heuvel MW, van Heumen E, Passier PC, Smeets JM, van lersel T, et al. Safety, tolerability and pharmacokinetics of sugammadex using single high doses (up to 96 mg/kg) in healthy adult subjects: a randomized, double-blind, crossover, placebo-controlled, single-centre study. Cin Drug Investig 2010; 30: 867-74. https://doi.org/10.1007/BF03256915
  14. Yoshioka N, Hanazaki M, Fujita Y, Nakatsuka H, Katayama H, Chiba Y. Effect of sugammadex on bronchial smooth muscle function in rats. J Smooth Muscle Res 2012; 48: 59-64. https://doi.org/10.1540/jsmr.48.59
  15. Cortese G, Carron M, Montrucchio G, Brazzi L. Sugammadex-induced bronchospasm during desflurane anaethesia: an open question. Br J Anaesth 2020; 124: e17-8. https://doi.org/10.1016/j.bja.2019.10.011