ESRA Academy. Mansur I. Sep 8, 2016; 138370; 0209 Topic: ANATOMY
Dr. Irfan Mansur
Dr. Irfan Mansur

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Background and Aims:

Anaphylaxis during anaesthesia is rare event and can occur in 1:20,000 cases. Aim of the case is to describe rocuronium induced anaphylaxis leading to cardiac arrest unresponsive to traditional therapy. Sugammadex administration resulted in resolution of anaphylaxis 



80 yrs male with squamous cell tongue tumour scheduled for right neck dissection developed anaphylactic shock and cardiac arrest at induction of anaesthesia. Anaesthesia was induced with propofol,remifentanil and rocuronium. Patient developed difficulty in ventilation,
hypotension and cardiac arrest.Cardiopulmonary resuscitation and anaphylaxis treatment started. After 15 mins of resuscitation 6mg/kg sugammadex resulted in restoration of spontaneous circulation and anaphylaxis resolution . Patient was transferred to intensive care unit
and made uneventful recovery .Later anaphylactic reaction to rocuronium was confirmed by mast cell tryptase levels and intra dermal skin immunology tests



Resolution of rocuronium induced grade IV anaphylaxis after administration of 6mg/kg dose of sugammadex .Administration of sugammadex in such a situation not only results in resolution of anaphylaxis but also reverses neuromuscular blockade and thus stop anaesthesia and its hemodynamic effects.Possible mechanism of action of sugammadex in anaphylaxis is by encapsulation of rocuronium and coats the portion of rocuronium molecules that binds to IgE receptors which provokes mast cell degranulation.



Our case demonstrated the effectiveness of sugammadex in reversing the effect rocuronium induced anaphylaxis. If anaphylaxis is suspected and rocuronium is used,no harm trying sugammadex as there isn't much to loose 

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