Escher Allan R, Cohen Jonathan B
Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.
Cureus. 2019 Jan 12;11(1):e3871. doi: 10.7759/cureus.3871.
In this case report, we present a patient who developed anaphylaxis immediately after sugammadex administration. A 67-year-old female with the diagnosis of papillary serous carcinoma was scheduled for an exploratory laparotomy exam under anesthesia and total abdominal hysterectomy. At the end of the operation, sugammadex was administered; it was rapidly accompanied with marked hypotension and bradycardia. Multiple boluses of phenylephrine were administered with minimal effect. Boluses of epinephrine and vasopressin were given and the patient's hemodynamic instability rapidly abated. A 12-lead electrocardiogram (ECG) obtained in the post-anesthesia care unit (PACU) showed sinus tachycardia and a prolonged corrected QT (QTc) interval. A tryptase level was drawn in the operating room. After an uneventful PACU stay, the patient was observed overnight in the intensive care unit (ICU) as a precaution. Cardiology service was consulted, and they agreed with the anesthesia team that the cause of the patient's hemodynamic instability collapse was consistent with the diagnosis of anaphylaxis. The serum tryptase returned with a level of 62.3 ng/mL, confirming the diagnosis. The patient was discharged on postoperative Day 4. Anaphylaxis may result from sugammadex usage, and this might cause severe hypotension and cardiac arrhythmias. The prompt recognition and treatment of hypotension and anaphylaxis are critical to minimize morbidity and prevent mortality in these patients.
在本病例报告中，我们介绍了一名患者，其在使用舒更葡糖钠后立即发生过敏反应。一名67岁诊断为乳头状浆液性癌的女性计划在麻醉下进行剖腹探查术和全腹子宫切除术。手术结束时，给予了舒更葡糖钠；随后迅速出现明显的低血压和心动过缓。多次给予去氧肾上腺素推注，效果甚微。给予肾上腺素和血管加压素推注后，患者的血流动力学不稳定迅速缓解。在麻醉后护理单元（PACU）获得的12导联心电图（ECG）显示窦性心动过速和校正QT（QTc）间期延长。在手术室检测了类胰蛋白酶水平。在PACU平稳度过之后，作为预防措施，患者在重症监护病房（ICU）观察了一夜。咨询了心脏病科，他们与麻醉团队一致认为患者血流动力学不稳定崩溃的原因符合过敏反应的诊断。血清类胰蛋白酶水平回报为62.3 ng/mL，证实了诊断。患者于术后第4天出院。使用舒更葡糖钠可能导致过敏反应，这可能会引起严重的低血压和心律失常。迅速识别和治疗低血压及过敏反应对于将这些患者的发病率降至最低并预防死亡至关重要。
