In this episode, I’ll discuss anaphylaxis to sugammadex.
The rate of anaphylactic reaction to the use of sugammadex is probably somewhere between 1 in 2000 and 1 in 4000 patients.
This makes anaphylaxis to sugammadex probably 2-4 times more rare than anaphylaxis to rocuronium. Not to mention the rate of anaphylaxis from preoperative antibiotics, which is by far the most common identifiable cause of anaphylaxis in the perioperative period.
Why then, should there be such a focus on the risk of anaphylaxis from sugammadex?
The reason, according to experts writing in Anesthesia and Analgesia, is when the anaphylactic reaction from each of these medications is most likely to occur.
When a patient experiences anaphylaxis from preop antibiotics, this is likely to occur a time that patient monitoring is high, leading to a rapid recognition and treatment.
When a patient experiences anaphylaxis from rocuronium, this is likely to occur after an airway has been established, which greatly simplifies the management of anaphylaxis.
However anaphylaxis from sugammadex is most likely to occur within 5 minutes of the patient receiving sugammadex. During this time, the patient’s airway may already be removed, and the monitoring of the patient may be interrupted by the transfer process leaving the OR or PACU areas. This means that when anaphylaxis occurs from sugammadex, recognition and treatment may be delayed, and the placement of an advanced airway may be made more challenging by edema.
While management of anaphylaxis from sugammadex is no different than from other antigens, clinicians using sugammadex should be especially alert to the possibility of a serious reaction occurring within the first few minutes after administration so that in the rare event anaphylaxis occurs, recognition and treatment is not delayed.
To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Leave a Reply