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Lin XN, Zeng YJ, Cao S, Jing XB. A real-world pharmacovigilance study of cardiac adverse events induced by sugammadex in the FDA adverse event reporting system. Expert Opin Drug Saf 2024:1-9. [PMID: 39174878 DOI: 10.1080/14740338.2024.2396645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/31/2024] [Accepted: 08/10/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Sugammadex is a novel agent that reverses neuromuscular blockade during general anesthesia. Recent case reports have raised concerns regarding potential cardiac adverse events (CAEs). However, no large-scale real-world studies have yet evaluated the potential link between sugammadex and CAEs. RESEARCH DESIGN AND METHODS Data from the FDA Adverse Event Reporting System were obtained. The association between sugammadex and CAE was evaluated using reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker methods. Serious outcomes resulting from sugammadex-related CAEs were assessed, and complications associated with CAEs were evaluated. RESULTS Nineteen CAEs were identified and classified into two categories: cardiac arrhythmias and coronary artery disorders. The most frequent CAEs were bradycardia (n = 202), cardiac arrest (n = 119), tachycardia (n = 30), and Kounis syndrome (n = 22). Subgroup analysis based on age, sex, and weight revealed parallel findings. The CAEs most likely to result in serious consequences were pulseless electrical activity and cardiac arrest. The most common concurrent adverse effects with CAEs were hypotension (n = 51), anaphylactic reactions (n = 46), and anaphylactic shock (n = 23). CONCLUSION This study suggests a potential link between sugammadex and CAEs, highlighting the need for careful monitoring and personalized risk assessment, especially in patients with cardiovascular risk factors.
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Affiliation(s)
- Xiao-Na Lin
- Department of Cardiovascular Surgery, Shandong Second Provincial General Hospital, Jinan, China
| | - You-Jie Zeng
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Si Cao
- Clinical Research Center for Reproduction and Genetics in Hunan Province, Reproductive and Genetic Hospital of CITIC-XIANGYA, Changsha, Hunan, China
| | - Xi-Bo Jing
- Department of Structural Cardiology, Shandong Second Provincial General Hospital, Jinan, China
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2
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Yakushin S, Gurbanova A, Pereverzeva K. Kounis Syndrome: Review of Clinical Cases. Cardiovasc Hematol Disord Drug Targets 2024; 24:83-97. [PMID: 39021170 DOI: 10.2174/011871529x305833240708051508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Kounis syndrome is defined as a combination of acute coronary syndrome and allergic reactions. OBJECTIVE In this review, we aim to describe the etiological, clinical, and diagnostic characteristics of Kounis syndrome. METHODS A literature search using PubMed was conducted for the past 32 years using keywords, resulting in the selection of 761 scientific papers. From these, 217 articles describing 235 clinical cases were selected. Patients under 18 years of age or without a confirmed diagnosis were excluded. RESULTS Among the 235 patients, type I Kounis syndrome was observed in 49.7%, type II in 27.2%, type III in 5.9%, and a combination of types I and II in 1.0%; in 16.2%, it was not possible to classify the type of Kounis syndrome. The median age was 57 years, and 68.5% of the patients were male. The most common causes were antibiotics (32.3%) and non-steroidal anti-inflammatory drugs (24.3%). The clinical features included chest pain (59.1%), hypotension (74.2%), itching (30.6%), and dyspnea (30.6%). Electrocardiographic monitoring revealed ST-segment elevation in 42.9% and was normal in only 5.5% of patients. Coronary angiography was performed in 80.4% of the patients, revealing unchanged coronary arteries in 50.3% of cases. Сonclusion: Allergic myocardial infarction is a serious complication of drug therapy.
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Affiliation(s)
- Sergey Yakushin
- Department of Hospital Therapy with a Course of Medical and Social Expertise, Federal State Budgetary Educational Institution of Higher Education, "Ryazan State Medical University Named after Academician I.P. Pavlov" of the Ministry of Health of the Russian Federation, Ryazan, 390026, Russia
| | - Arzu Gurbanova
- Department of Hospital Therapy with a Course of Medical and Social Expertise, Federal State Budgetary Educational Institution of Higher Education, "Ryazan State Medical University Named after Academician I.P. Pavlov" of the Ministry of Health of the Russian Federation, Ryazan, 390026, Russia
| | - Kristina Pereverzeva
- Department of Hospital Therapy with a Course of Medical and Social Expertise, Federal State Budgetary Educational Institution of Higher Education, "Ryazan State Medical University Named after Academician I.P. Pavlov" of the Ministry of Health of the Russian Federation, Ryazan, 390026, Russia
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3
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Weerasuriya S, Seddon D, Salota V. Asystolic cardiac arrest secondary to sugammadex administration in a young patient. Anaesthesiol Intensive Ther 2024; 56:160-163. [PMID: 39166508 PMCID: PMC11284579 DOI: 10.5114/ait.2024.141235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/09/2024] [Indexed: 08/23/2024] Open
Affiliation(s)
- Scott Weerasuriya
- Department of Anaesthesia, Queen Elizabeth Hospital, Lewisham & Greenwich NHS Trust, United Kingdom
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Jeyadoss J, Johnson DJ, Brownlie DJ, Thiruvenkatarajan V. Complete heart block of multifactorial aetiology following sugammadex administration. Anaesth Intensive Care 2023; 51:359-361. [PMID: 37314218 DOI: 10.1177/0310057x231173001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Jellsingh Jeyadoss
- Department of Anaesthesia, Queen Elizabeth Hospital, Woodville South, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Australia
| | - Damian Jg Johnson
- Department of Anaesthesia, Queen Elizabeth Hospital, Woodville South, Australia
| | - David J Brownlie
- Department of Anaesthesia, Queen Elizabeth Hospital, Woodville South, Australia
| | - Venkatesan Thiruvenkatarajan
- Department of Anaesthesia, Queen Elizabeth Hospital, Woodville South, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Australia
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5
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Johnson KB, Chacin R. Clarifying the grey space of sugammadex induced bradycardia. Curr Opin Anaesthesiol 2023; 36:422-427. [PMID: 37314178 DOI: 10.1097/aco.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW This review describes recent prospective and retrospective work exploring the incidence and clinical consequence of sugammadex-induced bradycardia and an update of recent evidence and adverse event reports to the United States Food and Drug Administration regarding the incidence of sugammadex induced bradycardia. RECENT FINDINGS This work suggests that the incidence of sugammadex-induced bradycardia can range from 1 to 7% depending on the definition to reverse moderate to deep neuromuscular blockade. For most instances, the bradycardia is inconsequential. For those instances that have hemodynamic instability, the adverse physiology is easily treated with appropriate vasoactive agents. One study demonstrated that the incidence of bradycardia from sugammadex is less than with neostigmine. There are several case reports that describe marked bradycardia with cardiac arrest from reversal with sugammadex. The incidence of this type of reaction to sugammadex appears to be very rare. Data from the United States Food and Drug Administration's Adverse Event Reporting System public dashboard corroborates this presence of this rare finding. SUMMARY Sugammadex-induced bradycardia is common and, in most instances, of minimal clinical consequence. Nevertheless, anesthesia providers should maintain proper monitoring and vigilance to treat hemodynamical instability with each administration of sugammadex.
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Affiliation(s)
- Ken B Johnson
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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6
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Abdelrahim MT, Kassels AC, Stark CW, Roberts CJ, Vogt JA, Ebert TJ. A Case Report of Acute Onset and Rapid Resolution of Atrioventricular Block After Sugammadex: Is the Autonomic System Involved? A A Pract 2023; 17:e01683. [PMID: 37146215 DOI: 10.1213/xaa.0000000000001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Administering sugammadex to reverse neuromuscular blockade can cause marked bradycardia and rarely asystole. In this case, a rapid onset, biphasic heart rate response; slowing then speeding, after administering sugammadex was noted while at steady state, 1.3% end-tidal sevoflurane. On review of the electrocardiogram (ECG), the heart rate slowing coincided with the onset of a second-degree, Mobitz type I block that lasted 45 seconds. No other events, drugs, or stimuli coincided with the event. The acute onset and transient nature of the atrioventricular block without evidence of ischemia implies a brief parasympathetic effect on the atrioventricular node after sugammadex administration.
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Affiliation(s)
- Mohamed T Abdelrahim
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Austin C Kassels
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cain W Stark
- From the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher J Roberts
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Julia A Vogt
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Thomas J Ebert
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
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7
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Hirsch JG, Chia PA, Jahr JS. Sugammadex: A Review of the Considerations for Women of Childbearing Age. Am J Ther 2023; 30:e146-e150. [PMID: 36892560 DOI: 10.1097/mjt.0000000000001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 03/10/2023]
Affiliation(s)
- Jason G Hirsch
- David Geffen School of Medicine at UCLA, Los Angeles, CA
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8
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Olesnicky BL, Trumper R, Chen V, Culwick MD. The use of sugammadex in critical events in anaesthesia: A retrospective review of the webAIRS database. Anaesth Intensive Care 2022; 50:220-226. [PMID: 35172631 DOI: 10.1177/0310057x211039859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sugammadex has been used for more than ten years in Australia and New Zealand and has been implicated as an effective treatment, and in some cases a potential cause, of a critical incident. We aimed to identify and analyse critical incidents involving sugammadex reported to webAIRS, a de-identified voluntary online critical incident reporting system in Australia and New Zealand. We identified 116 incidents where the reporter implicated sugammadex as either a cause (23 cases) or a treatment (93 cases) during anaesthesia. There were 17 incidents suggestive of sugammadex anaphylaxis, although not all were confirmed by skin testing. There were six incidents when bradycardia was temporally related to sugammadex administration, although it was not possible to exclude other causes or contributory factors. There were nine incidents in which sugammadex was used to reverse aminosteroid-related neuromuscular blockade successfully in a 'can't intubate, can't oxygenate' (CICO) situation, and a further 67 incidents in which sugammadex was used to reverse aminosteroid neuromuscular blockade as part of the management of other critical incidents. While sugammadex was used during the management of 16 cases of anaphylaxis, there was no clear indication that this altered the course of the anaphylaxis in any of the cases. These reports indicate that sugammadex can be a potential trigger for anaphylaxis and that its use may be associated with the development of significant bradycardia. However, it is not possible to estimate or even speculate on the incidence of these sugammadex-related incidents on the basis of voluntary reporting to a database such as webAIRS. The reports also indicate that sugammadex has been used successfully to reverse residual or deep aminosteroid neuromuscular blockade in critical incident situations and to help rescue CICO scenarios. These findings provide further support for ensuring the ready availability of sugammadex wherever aminosteroid muscle relaxants are used.
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Affiliation(s)
- Benjamin L Olesnicky
- Department of Anaesthesia, 60086Royal North Shore Hospital, Royal North Shore Hospital, St Leonards, Australia.,School of Medicine, 4334The University of Sydney, The University of Sydney, Sydney, Australia
| | - Rosie Trumper
- Department of Anaesthesia, 60086Royal North Shore Hospital, Royal North Shore Hospital, St Leonards, Australia
| | - Vanessa Chen
- Department of Anaesthesia, 60086Royal North Shore Hospital, Royal North Shore Hospital, St Leonards, Australia
| | - Martin D Culwick
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, The University of Queensland, Herston, Australia.,Australian and New Zealand Tripartite Anaesthetic Data Committee, Australia
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9
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Dai B, Cavaye J, Judd M, Beuth J, Iswariah H, Gurunathan U. Perioperative presentations of Kounis syndrome: a systematic literature review. J Cardiothorac Vasc Anesth 2022; 36:2070-2076. [DOI: 10.1053/j.jvca.2022.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/11/2022]
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10
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Zecic F, Smart MH, Abbey TC, Pazhempallil A, Korban C. Sugammadex-induced anaphylactic reaction: A systematic review. J Anaesthesiol Clin Pharmacol 2022; 38:360-370. [PMID: 36505200 PMCID: PMC9728450 DOI: 10.4103/joacp.joacp_573_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/03/2021] [Accepted: 05/14/2021] [Indexed: 11/07/2022] Open
Abstract
Perioperative anaphylaxis is a rare, but life-threatening hypersensitivity reaction for patients undergoing surgical procedures. Sugammadex is a relatively new drug used to reverse the neuromuscular blockade of specific anesthetics in surgery. Several case reports indicate that there may be a risk of anaphylaxis associated with the use of sugammadex This review examines the literature in order to evaluate the strength of the association between sugammadex use and anaphylaxis. A query of PubMed, EMBASE, and Web of Science was conducted using a combination of terms to identify relevant articles from inception until March 9, 2020. We included any primary study that identified sugammadex as a probable causative agent based on the World Allergy Organization diagnostic criteria for anaphylaxis. A total of 24 articles were reviewed. Across the three randomized controlled trials, there were only four cases of anaphylaxis identified. Incidence of anaphylaxis was reported in only one trial at 0.33%. Two retrospective observational studies conducted in Japan identified cases of anaphylaxis, with incidences of 0.02 and 0.04%. Among 19 case reports and series, 25 patient cases of anaphylaxis were confirmed via allergy testing to be caused by sugammadex or sugammadex-rocuronium complex. Commonly reported symptoms included hypotension, erythema, and decreased oxygen saturation. Based on the findings of this review, there appears to be a rare, but serious, association of sugammadex-induced perioperative anaphylaxis with an incidence between 0.02 and 0.04% in observational studies. It is unclear whether sugammadex on its own or in complex with rocuronium triggers this reaction, but it is clearly involved in inducing anaphylaxis. Further population studies are needed to get a more accurate global incidence rate, and more detailed allergy testing is required to better describe which step of the sugammadex reversal pathway initiates the anaphylactic attack.
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Affiliation(s)
- Fatih Zecic
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA,Address for correspondence: Dr. Fatih Zecic, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St., Chicago - 60612, IL, USA. E-mail:
| | - Mary H. Smart
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Taylor C. Abbey
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Alex Pazhempallil
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Colin Korban
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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11
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Kounis NG, Mplani V, Koniari I. Aortic dissection type 1, windsock sign, neglected lead, and Kounis syndrome: What a coincidence! Anatol J Cardiol 2021; 25:747-748. [PMID: 34622792 DOI: 10.5152/anatoljcardiol.2021.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras-Greece
| | - Virginia Mplani
- Intensive Care Unit, University of Patras Hospital, Patras-Greece
| | - Ioanna Koniari
- Department of Cardiology, University Hospital of South Manchester NHS Foundation Trust; Manchester-UK
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12
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Fábián ÁI, Tassonyi E, Csernoch V, Fedor M, Sohajda T, Szente L, Fülesdi B. Carboxymethyl-γ-cyclodextrin, a novel selective relaxant binding agent for the reversal of neuromuscular block induced by aminosteroid neuromuscular blockers: an ex vivo laboratory study. BMC Anesthesiol 2021; 21:206. [PMID: 34404345 PMCID: PMC8369779 DOI: 10.1186/s12871-021-01424-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Residual neuromuscular block at the end of surgery may compromise the patient's safety. The risk of airway complications can be minimized through monitoring of neuromuscular function and reversal of neuromuscular block if needed. Effective reversal can be achieved with selective relaxant binding agents, however, sugammadex is the only clinically approved drug in this group. We investigated the concentration-response properties of a novel selective relaxant binding agent, carboxymethyl-γ-cyclodextrin for the reversal of neuromuscular block. We evaluated the hypothesis that it is equally potent for reversing neuromuscular block as sugammadex. METHODS Phrenic nerve - hemidiaphragm tissue preparations were isolated from male Wistar rats and suspended in a tissue holder allowing electrical stimulation of the nerve and monitoring of muscle contraction force. Concentration-response relationships were constructed for the neuromuscular blocking agents rocuronium, pipecuronium, and vecuronium. The half-effective concentrations of sugammadex and carboxymethyl-γ-cyclodextrin for reversal of neuromuscular block were determined. RESULTS The half effective concentrations (95% confidence interval, CI) were 7.50 (6.93-8.12) μM for rocuronium, 1.38 (1.33-1.42) μM for pipecuronium, and 3.69 (3.59-3.80) μM for vecuronium. The half effective concentrations (95% CI) of carboxymethyl-γ-cyclodextrin and sugammadex were 35.89 (32.67-39.41) μM and 3.67 (3.43-3.92) μM, respectively, for the reversal of rocuronium-induced block; 10.14 (9.61-10.70) μM and 0.67 (0.62-0.74) μM, respectively, for the reversal of pipecuronium-induced block; and 376.1 (341.9-413.8) μM and 1.45 (1.35-1.56) μM, respectively, for the reversal of vecuronium-induced block. CONCLUSIONS Carboxymethyl-γ-cyclodextrin is an effective, but less potent agent for reversal of neuromuscular block than sugammadex.
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Affiliation(s)
- Ákos I Fábián
- Department of Anaesthesiology and Intensive Care, University of Debrecen Clinical Center, Nagyerdei krt. 98, 4012, Debrecen, Hungary
| | - Edömér Tassonyi
- Department of Anaesthesiology and Intensive Care, University of Debrecen Clinical Center, Nagyerdei krt. 98, 4012, Debrecen, Hungary
| | - Vera Csernoch
- Department of Anaesthesiology and Intensive Care, University of Debrecen Clinical Center, Nagyerdei krt. 98, 4012, Debrecen, Hungary
| | - Marianna Fedor
- Department of Anaesthesiology and Intensive Care, University of Debrecen Clinical Center, Nagyerdei krt. 98, 4012, Debrecen, Hungary
| | | | | | - Béla Fülesdi
- Department of Anaesthesiology and Intensive Care, University of Debrecen Clinical Center, Nagyerdei krt. 98, 4012, Debrecen, Hungary.
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13
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Teng IC, Chang YJ, Lin YT, Chu CC, Chen JY, Wu ZF. Sugammadex induced bradycardia and hypotension: A case report and literature review. Medicine (Baltimore) 2021; 100:e26796. [PMID: 34397735 PMCID: PMC8322479 DOI: 10.1097/md.0000000000026796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/12/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE There is evidence that sugammadex can facilitate extubation post-surgery and attenuate postoperative pulmonary complications resulting from postoperative residual neuromuscular blockade. However, it may induce adverse effects, including bronchospasm, laryngospasm, bradycardia, hypotension, and cardiac arrest. Here, we present a case of sugammadex-induced bradycardia and hypotension. PATIENT CONCERNS An 82-year-old female received video-assisted thoracic surgery decortication and wedge resection of the lung for empyema. Post-surgery, she developed bradycardia, hypotension, hypoxia, and weakness. DIAGNOSES The patient was suspected to have sugammadex-induced bradycardia, hypotension, hypoxia and weakness. INTERVENTIONS The patient received immediate treatment with atropine (0.5 mg) for bradycardia. Glycopyrrolate (0.1 mg) and neostigmine (1 mg) were administered to improve the train-of-four (TOF) ratio. OUTCOMES Following initial management, we observed improvement in the hemodynamics of the patient. She was discharged without any sequelae. LESSONS Sugammadex-induced bradycardia or cardiac arrest are rare; however, anesthesiologists must consider the possibility of the occurrence of such events and initiate appropriate management measures. Immediate treatment with atropine and inotropic or vasopressors is warranted if the patient presents with bradycardia.
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Affiliation(s)
- I-Chia Teng
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Food Science and Technology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Zhi-Fu Wu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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14
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Kounis NG, Koniari I, Soufras GD, Tsigkas G, Plotas P, Davlouros P, Hahalis G. Sugammadex-induced atropine-resistant bradycardia: clinical, pathophysiologic, and electrocardiographic considerations. JA Clin Rep 2020; 6:31. [PMID: 32383018 PMCID: PMC7205945 DOI: 10.1186/s40981-020-00336-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 12/29/2022] Open
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15
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Kounis NG, Koniari I, Tsigkas G, Soufras GD, Plotas P, Davlouros P, Hahalis G. Gadolinium-induced Kounis syndrome including electrocardiographic considerations. Proc AMIA Symp 2020; 33:474-476. [PMID: 32675996 DOI: 10.1080/08998280.2020.1765665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/30/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical SchoolPatrasGreece
| | - Ioanna Koniari
- Electrophysiology and Device Department, University Hospital of South Manchester NHS Foundation TrustManchesterUK
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical SchoolPatrasGreece
| | - George D Soufras
- Department of Cardiology, "Saint Andrews" State General HospitalPatrasGreece
| | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical SchoolPatrasGreece
| | - Periklis Davlouros
- Department of Cardiology, University of Patras Medical SchoolPatrasGreece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical SchoolPatrasGreece
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