Severe bradycardia and asystole associated with sugammadex: case report
Background and objectives: Sugamadex is a modified gamma-cyclodextrin, the first selective agent for reversal of neuromuscular blockade induced by steroidal non-depolarizing muscle relaxants, with greater affinity for rocuronium. In this article we present a case of severe bradycardia and asystole f...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-03-01
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| Series: | Brazilian Journal of Anesthesiology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001418301325 |
| _version_ | 1811205240976834560 |
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| author | Catarina Oliveira Catarina Marques Vânia Simões Leina Spencer Rita Poeira Margarida Casteleira |
| author_facet | Catarina Oliveira Catarina Marques Vânia Simões Leina Spencer Rita Poeira Margarida Casteleira |
| author_sort | Catarina Oliveira |
| collection | DOAJ |
| description | Background and objectives: Sugamadex is a modified gamma-cyclodextrin, the first selective agent for reversal of neuromuscular blockade induced by steroidal non-depolarizing muscle relaxants, with greater affinity for rocuronium. In this article we present a case of severe bradycardia and asystole following sugammadex administration. Case report: A 54-year-old male patient, ASA II, with a history of hypertension, dyslipidemia and obesity, who underwent an emergency umbilical herniorrhaphy under balanced general anesthesia. Intraoperative muscle relaxation was maintained with rocuronium. At the end of the surgery, the patient maintained a neuromuscular block with two TOF responses, and sugammadex (200 mg) was administered. About thirty seconds after its administration, the patient developed marked bradycardia (HR 30 bpm) followed by asystole. Conclusions: Documented bradycardia and asystole were attributed to the administration of sugammadex. This case shows that, although rare, cardiac arrest is a possible adverse effect of this drug, and that the knowledge of this situation can be determinant for the patient's evolution. Resumo: Justificativa e objetivos: O sugamadex é uma gama ciclodextrina modificada, o primeiro agente seletivo para reversão do bloqueio neuromuscular induzido pelos relaxantes musculares não despolarizantes do tipo esteroide, com maior afinidade para o rocurônio. Neste artigo apresentamos um caso de bradicardia grave e assistolia após administração de sugamadex. Relato do caso: Doente do sexo masculino, 54 anos, ASA II, com antecedentes pessoais de hipertensão, dislipidemia e obesidade, submetido à herniorrafia umbilical em regime de urgência sob anestesia geral balanceada. O relaxamento muscular intraoperatório foi mantido com rocurônio. No fim da cirurgia o doente mantinha bloqueio neuromuscular com duas respostas no TOF, pelo que foi administrado sugamadex 200 mg. Cerca de trinta segundos após a sua administração, o doente desenvolveu bradicardia acentuada (FC 30 bpm) seguida de período de assistolia. Conclusões: A bradicardia e a assistolia documentadas foram atribuídas à administração do sugamadex. Este caso evidencia que, apesar de rara, a parada cardíaca é um efeito adverso possível desse fármaco e que o conhecimento dessa situação pode ser determinante para a evolução do doente. Keywords: Sugamadex, Severe bradycardia, Asystole, Palavras-chave: Sugamadex, Bradicardia grave, Assistolia |
| first_indexed | 2024-04-12T03:28:41Z |
| format | Article |
| id | doaj.art-97d6e9e168794bb6ba41c88dbf359098 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-12T03:28:41Z |
| publishDate | 2019-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-97d6e9e168794bb6ba41c88dbf3590982022-12-22T03:49:37ZengElsevierBrazilian Journal of Anesthesiology0104-00142019-03-01692218221Severe bradycardia and asystole associated with sugammadex: case reportCatarina Oliveira0Catarina Marques1Vânia Simões2Leina Spencer3Rita Poeira4Margarida Casteleira5Corresponding author.; Centro Hospitalar Lisboa Central, EPE, Lisbon, PortugalCentro Hospitalar Lisboa Central, EPE, Lisbon, PortugalCentro Hospitalar Lisboa Central, EPE, Lisbon, PortugalCentro Hospitalar Lisboa Central, EPE, Lisbon, PortugalCentro Hospitalar Lisboa Central, EPE, Lisbon, PortugalCentro Hospitalar Lisboa Central, EPE, Lisbon, PortugalBackground and objectives: Sugamadex is a modified gamma-cyclodextrin, the first selective agent for reversal of neuromuscular blockade induced by steroidal non-depolarizing muscle relaxants, with greater affinity for rocuronium. In this article we present a case of severe bradycardia and asystole following sugammadex administration. Case report: A 54-year-old male patient, ASA II, with a history of hypertension, dyslipidemia and obesity, who underwent an emergency umbilical herniorrhaphy under balanced general anesthesia. Intraoperative muscle relaxation was maintained with rocuronium. At the end of the surgery, the patient maintained a neuromuscular block with two TOF responses, and sugammadex (200 mg) was administered. About thirty seconds after its administration, the patient developed marked bradycardia (HR 30 bpm) followed by asystole. Conclusions: Documented bradycardia and asystole were attributed to the administration of sugammadex. This case shows that, although rare, cardiac arrest is a possible adverse effect of this drug, and that the knowledge of this situation can be determinant for the patient's evolution. Resumo: Justificativa e objetivos: O sugamadex é uma gama ciclodextrina modificada, o primeiro agente seletivo para reversão do bloqueio neuromuscular induzido pelos relaxantes musculares não despolarizantes do tipo esteroide, com maior afinidade para o rocurônio. Neste artigo apresentamos um caso de bradicardia grave e assistolia após administração de sugamadex. Relato do caso: Doente do sexo masculino, 54 anos, ASA II, com antecedentes pessoais de hipertensão, dislipidemia e obesidade, submetido à herniorrafia umbilical em regime de urgência sob anestesia geral balanceada. O relaxamento muscular intraoperatório foi mantido com rocurônio. No fim da cirurgia o doente mantinha bloqueio neuromuscular com duas respostas no TOF, pelo que foi administrado sugamadex 200 mg. Cerca de trinta segundos após a sua administração, o doente desenvolveu bradicardia acentuada (FC 30 bpm) seguida de período de assistolia. Conclusões: A bradicardia e a assistolia documentadas foram atribuídas à administração do sugamadex. Este caso evidencia que, apesar de rara, a parada cardíaca é um efeito adverso possível desse fármaco e que o conhecimento dessa situação pode ser determinante para a evolução do doente. Keywords: Sugamadex, Severe bradycardia, Asystole, Palavras-chave: Sugamadex, Bradicardia grave, Assistoliahttp://www.sciencedirect.com/science/article/pii/S0104001418301325 |
| spellingShingle | Catarina Oliveira Catarina Marques Vânia Simões Leina Spencer Rita Poeira Margarida Casteleira Severe bradycardia and asystole associated with sugammadex: case report Brazilian Journal of Anesthesiology |
| title | Severe bradycardia and asystole associated with sugammadex: case report |
| title_full | Severe bradycardia and asystole associated with sugammadex: case report |
| title_fullStr | Severe bradycardia and asystole associated with sugammadex: case report |
| title_full_unstemmed | Severe bradycardia and asystole associated with sugammadex: case report |
| title_short | Severe bradycardia and asystole associated with sugammadex: case report |
| title_sort | severe bradycardia and asystole associated with sugammadex case report |
| url | http://www.sciencedirect.com/science/article/pii/S0104001418301325 |
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