Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000400007
Brazilian Journal of Anesthesiology
Clinical Information

Caso de anafilaxia induzida por rocurônio tratado com o auxílio de sugamadex

Case of anaphylaxis induced by rocuronium treated with sugammadex

Fabiano Timbó Barbosa; Rafael Martins da Cunha

http://dx.doi.org/10.1590/S0034-70942012000400007 Braz J Anesthesiol, vol.62, n4, p.540-542, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: A anafilaxia durante a anestesia é um evento raro que pode ocorrer em até 1:20.000 casos sendo que aproximadamente 60% a 70% destes casos são secundários ao uso de ralaxantes musculares onde os mais implicados a succinilcolina e o rocurônio. O objetivo deste relato foi descrever o tratamento de um caso de anafilaxia induzida por rocurônio com resposta inadequada a terapia tradicional e resolução do caso após o uso do sugamadex. RELATO DO CASO: Paciente do sexo feminino, com 62 anos de idade, 72 kg, foi encaminhada ao centro cirúrgico para tratamento de hematoma extradural após acidente em domicílio. Foi monitorada com oxímetro de pulso, cardioscópio e tensiômetro para medida da pressão anterial não invasiva (PA). Seus dados basais foram: PA de 138/80 mm Hg, frequência cardíaca (FC) de 80 bpm e saturação arterial (SaO2) de 100% em ar ambiente. A indução da anestesia se processou com propofol 70 mg, fentanil 200 µg e rocurônio 45 mg. Após a intubação traqueal, diagnosticou-se quadro de anafilaxia que não respondeu ao tratamento convencional. Optou-se pelo uso de sugamadex 700 mg por via venosa como agente coadjuvante. A paciente apresentou reversão do quadro com melhora do perfil hemodinâmico sendo operada e conduzida à unidade de terapia intensiva. CONCLUSÃO: Neste caso, o sugamadex foi utilizado para reverter quadro hemodinâmico induzido pela anafilaxia por rocurônio, entretanto não foi possível esclarecer qual o mecanismo exato para a reversão do quadro hemodinâmico.

Palavras-chave

Anafilaxia, BLOQUEADOR MUSCULAR, Rocurônio, COMPLICAÇÕES, Alergia

Abstract

BACKGROUND AND OBJECTIVES: Anaphylaxis during anesthesia is a rare event that may occur in up to 1:20,000 cases and approximately 60% to 70% of these cases are secondary to the use of muscle relaxants, particularly succinylcholine and rocuronium. The aim of this report is to describe the treatment of a case of rocuronium-induced anaphylaxis with inadequate response to traditional therapy, and the case resolution after using sugammadex. CASE REPORT: A female patient, 62 years old, 72 kg, was referred to the surgical center for treatment of epidural hematoma following an accident at home. She was monitored with pulse oximetry, cardioscope, and blood pressure meter for non-invasive blood pressure (BP) measurement. The baseline data were: BP 138/80 mm Hg, heart rate (HR) 80 bpm, and oxygen saturation (SaO2) 100% on room air. Anesthesia was induced with propofol 70 mg, fentanyl 200 mg, and rocuronium 45 mg. After tracheal intubation, anaphylaxis non-responsive to conventional treatment was diagnosed. We chose the use of sugammadex 700 mg intravenously as an adjuvant agent. The patient had reversal of the anaphylactic reactions with improvement of hemodynamic profile and was operated and conducted to the intensive care unit. CONCLUSION: In this case, sugammadex was used to reverse the hemodynamic picture caused by rocuronium-induced anaphylaxis. However, it was not possible to identify the exact mechanism for the reversal.

Keywords

Anaphylaxis, Hypersensitivity, Neuromuscular Nondepolarizing Agents

References

McDonnell NJ, Pavy TJ, Green LK. Sugammadex in the management of rocuronium-induced anaphylaxis. Br J Anaesth. 2011;106:199-201.

Harper NJ, Dixon T, Dugué P. Suspected anaphylactic reactions associated with anaesthesia. Anaesthesia. 2009;64:199-211.

Mertes PM, Laxenaire MC. Anaphylactic and anaphylactoid reactions occurring during anaesthesia in France: Seventh epidemiologic survey (January 2001-December 2002). Ann Fr Anesth Reanim. 2004;23:1133-1143.

Jones PM, Turkstra TP. Mitigation of rocuronium-induced anaphylaxis by sugammadex: the great unknown. Anaesthesia. 2010;65:89-90.

Hepner DL, Castells MC. Anaphylaxis during the perioperative period. Anesth Analg. 2003;97:1381-1395.

Koppert W, Blunk JA, Petersen LJ. Different patterns of mast cell activation by muscle relaxants in human skin. Anesthesiology. 2001;95:659-667.

Fisher MM, Baldo BA. The incidence and clinical features of anaphylactic reactions during anesthesia in Australia. Ann Fr Anesth Reanim. 1993;12:97-104.

Mertes PM, Laxenaire MC, Alla F. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Anesthesiology. 2003;99:536-545.

Axon AD, Hunter JM. Editorial III: Anaphylaxis and anaesthesia-all clear now?. Br J Anaesth. 2004;93:501-504.

Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analg. 2007;104:575-581.

Gijsenbergh F, Ramael S, Houwing N. First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide. Anesthesiology. 2005;103:695-703.

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