engleski

Severe allergic reactions following administration of Sugammadex with low tryptase levels but positive skin prick test: a case report

We describe here the case of a severe anaphylactic episode to Sugammadex administered to reverse neuromuscular block in a 54-year-old man who underwent lumbar discectomy under general anaesthesia. Induction to anaesthesia and the entire surgical procedure were without any peculiarities. At the end of the surgery, 200 mg of Sugammadex was administered. Three minutes later, he developed a severe anaphylactic reaction accompanied by severe bronchospasm, with high peak airway pressures, drop of pulse oxygen saturation down to 70% despite FiO2 of 1.0, moderate decrease of arterial blood pressure (lowest was 80/50 mmHg) and normal heart rate of 70/min. Also, five minutes later he developed generalized skin rash and piloerection. The patient recovered completely after initial medical treatment per guidelines for treatment of anaphylactic shock. He was extubated in the Intensivel Care Unit a few hours later. Repeated blood mastocyte tryptase levels showed only a mild increase during the acute reaction. The allergic reaction to Sugammadex was confirmed by a positive intradermal test to Sugammadex a couple months later.

anaesthesia, general ; hypersensitivity ; allergic reaction: anaphylaxsis ; Sugammadex

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