Barbosa Fabiano Timbó, da Cunha Rafael Martins
Universidade Federal de Alagoas, Maceio, AL, Brazil.
Rev Bras Anestesiol. 2012 Jul;62(4):538-42. doi: 10.1016/S0034-7094(12)70152-6.
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.
A female patient, 62 years old, 72kg, 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 (SaO(2)) 100% on room air. Anesthesia was induced with propofol 70 mg, fentanyl 200mg, 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.
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.
麻醉期间发生过敏反应是一种罕见事件，发生率可达1/20000，其中约60%至70%的病例继发于肌肉松弛剂的使用，尤其是琥珀胆碱和罗库溴铵。本报告旨在描述一例罗库溴铵诱导的过敏反应，对传统治疗反应不佳，以及使用舒更葡糖钠后病例得到解决的情况。
一名62岁、体重72kg的女性患者因在家中意外导致硬膜外血肿被转诊至手术中心。使用脉搏血氧仪、心电图仪和血压计对其进行监测以测量无创血压（BP）。基线数据为：血压138/80mmHg，心率（HR）80次/分钟，室内空气中氧饱和度（SaO₂）100%。使用丙泊酚70mg、芬太尼200μg和罗库溴铵45mg诱导麻醉。气管插管后，诊断为对传统治疗无反应的过敏反应。我们选择静脉注射舒更葡糖钠700mg作为辅助药物。患者过敏反应逆转，血流动力学状况改善，接受了手术并被送入重症监护病房。
在本病例中，舒更葡糖钠用于逆转罗库溴铵诱导的过敏反应所引起的血流动力学情况。然而，无法确定逆转的确切机制。
