A further case of rocuronium-induced anaphylaxis treated with sugammadex.

摘要

Editor-We write in support of the recent descriptions of sugammadex in the management of rocuronium-induced anaphylaxis. We describe a remarkably similar case of ana-phylaxis and cardiovascular collapse in a peripheral hospital rapidly reversed by the use of sugammadex affording the stability to transfer the patient to the nearest intensive care unit (ICU). A fit 47-yr-old lady was undergoing laparoscopic cholecys-tectomy for recurrent right upper quadrant pain. This 78 kg, non-smoker, had no significant medical co-morbidities and had experienced two previous Caesarean sections under general anaesthesia more than 12 yr ago, receiving first atra-curium and second vecuronium, without complications. She described a pre-existing allergy to cotrimoxazole manifesting as a peripheral rash and swelling. Anaesthesia for surgery was induced with a combination of ondansetron 4 mg, fenta-nyl 100 mug, morphine 10 mg, and propofol 200 mg. The patient was easy to hand ventilate and rocuronium 50 mg was given. After this ventilation quickly became difficult necessitating tracheal intubation, correct positioning was confirmed by capnography. End-tidal CO_2 was noted to be low at 2.3 kPa, the SpO_2 trace disappeared, and florid erythema was seen all over the abdomen and chest. The systolic arterial pressure was measured as 63 mm Hg, while heart rate increased to 150 beats min~(-1). A diagnosis of anaphylaxis was made and vasopressor therapy commenced.