Takise Yoshiaki, Kato Jungo, Suhara Tomohiro, Yamada Takashige, Funakoshi Takeru, Takahashi Hayato, Amagai Masayuki, Morisaki Hiroshi
Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan.
Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
JA Clin Rep. 2020 Dec 7;6(1):95. doi: 10.1186/s40981-020-00402-y.
Recognition of rocuronium-induced anaphylaxis is often challenging, owing to its diverse clinical manifestations. Regarding treatment, several reports have described the efficacy of sugammadex, while conflicting reports have also been published.
A 71-year-old man was scheduled to undergo split-thickness skin grafting surgery on his hip. During the induction of general anesthesia, the patient developed profound circulatory collapse without any cutaneous manifestations, which required 40 min of cardiopulmonary resuscitation. Later, the patient developed circulatory collapse again during the induction of anesthesia for tracheostomy surgery, which apparently coincided with the administration of rocuronium. Rocuronium-induced anaphylactic shock was suspected, and the administration of sugammadex resulted in swift recovery of hemodynamics. The basophil activation test revealed a positive reaction to rocuronium.
The possibility of rocuronium-induced anaphylaxis should be considered when the circulatory collapse coincides with rocuronium administration, even though cutaneous manifestation is absent. Sugammadex can be a treatment option in such atypical cases.
由于罗库溴铵所致过敏反应的临床表现多样，其识别往往具有挑战性。关于治疗，有几份报告描述了舒更葡糖钠的疗效，但也有相互矛盾的报告发表。
一名71岁男性计划接受髋部的中厚皮片移植手术。在全身麻醉诱导期间，患者出现严重循环衰竭，无任何皮肤表现，需要进行40分钟的心肺复苏。后来，患者在气管造口术麻醉诱导期间再次出现循环衰竭，这显然与罗库溴铵的给药时间一致。怀疑为罗库溴铵所致过敏性休克，给予舒更葡糖钠后血流动力学迅速恢复。嗜碱性粒细胞活化试验显示对罗库溴铵呈阳性反应。
当循环衰竭与罗库溴铵给药同时发生时，即使没有皮肤表现，也应考虑罗库溴铵所致过敏反应的可能性。在这种非典型病例中，舒更葡糖钠可以作为一种治疗选择。
