In this episode, I’ll discuss anaphylaxis to sugammadex.
The rate of anaphylactic reaction to the use of sugammadex has historically been put at somewhere between 1 in 2000 and 1 in 4000 patients; however, one article that used population statistics suggests it is more like 1 in 25,000 patients.
This makes anaphylaxis to sugammadex probably 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 the timing of when the anaphylactic reaction to each of these medications is most likely to occur.
When a patient experiences anaphylaxis from pre-op antibiotics, this is likely to occur at a time when the patient is being monitored closely, leading to rapid recognition and treatment.
When a patient experiences anaphylaxis to rocuronium, it is likely to occur after an airway has been established, which greatly simplifies management.
However, anaphylaxis from sugammadex is most likely to occur within 5 minutes of its administration. During this time, the patient’s airway may already have been removed, and the patient’s monitoring may be interrupted by the transfer process, leaving the OR or PACU areas. This means that when anaphylaxis occurs with sugammadex, recognition and treatment may be delayed, and the placement of an advanced airway may be more challenging due to 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.
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