Deep bradycardia after sugammadex: is it due to anaphylaxis or by any other unknown mechanism(s) of sugammadex?

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Abstract

Background
Sugammadex is a ɣ-cyclodextrin containing 8-thiopropionate side chains, which selectively binds to nondepolarizing aminosteroid neuromuscular blocking agents. Here, we report a case who developed deep bradycardia after administration of sugammadex.
Case presentation
A 38-year-old-man was scheduled for laparoscopic right hemicolectomy. Besides history of light smoking, he had no other medical/surgical history that included any allergic reactions. At the end of the operation, 200 mg sugammadex was administered to antagonize residual neuromuscular blockade. One minute after the administration of sugammadex, the patient had deep bradycardia (25 beat min) and his systolic blood pressure fell below a measurable level. The patient’s blood pressure was restored to 95/55 mmHg and heart rate 110 beats min with the administration of a total dose of ephedrine 10 mg, atropine sulfate 0.5 mg, 0.9% saline 1 L, and 6% hydroxyethylated starch 500 mL over 15 min. Then, he was extubated uneventfully and transferred to the intensive care unit for closer monitoring.
Conclusions
According to the current literature as well as the case we presented here, we suggest that physicians who use sugammadex especially in endoscopic/laparoscopic procedures using CO should be aware of the possibility of sudden bradycardia and/or cardiac arrest.

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