Should We Use Sugammadex in Rocuronium-Induced Anaphylaxis?
Keywords:
anaphylaxis, sugammadex, rocuroniumAbstract
Intraoperative anaphylaxis is a rare but potentially life-threatening complication of anaesthesia, with neuromuscular blocking drugs (NMBDs) being the most frequent cause. Published reports indicate that the incidence of anaphylaxis is higher for rocuronium compared to other non-depolarising NMBDs. Sugammadex is a novel reversal agent with a unique mechanism of action, specifically designed to encapsulate aminosteroid NMBDs and antagonise their pharmacological effects. Due to this mechanism, sugammadex has been suggested as a potential treatment option for rocuronium-induced anaphylaxis. Several case reports have described reversal or mitigation of rocuronium-induced anaphylaxis following sugammadex administration.
In contrast, both in vitro and in vivo immunological studies suggest that sugammadex is unable to modify a type I hypersensitivity reaction. The small number of available case reports and limited prospective non-clinical immunological studies do not fully explain the underlying pathophysiological mechanisms. The role of sugammadex in rocuronium-induced anaphylaxis therefore remains unclear. Despite the reported clinical benefits, there are currently no recommendations to include sugammadex in standard anaphylaxis management algorithms.
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