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Sugammadex-induced anaphylactic reaction: A systematic review

Perioperative anaphylaxis is a rare, but life-threatening hypersensitivity reaction for patients undergoing surgical procedures. Sugammadex is a relatively new drug used to reverse the neuromuscular blockade of specific anesthetics in surgery. Several case reports indicate that there may be a risk o...

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Autores principales: Zecic, Fatih, Smart, Mary H., Abbey, Taylor C., Pazhempallil, Alex, Korban, Colin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9728450/
https://www.ncbi.nlm.nih.gov/pubmed/36505200
http://dx.doi.org/10.4103/joacp.JOACP_573_20
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author Zecic, Fatih
Smart, Mary H.
Abbey, Taylor C.
Pazhempallil, Alex
Korban, Colin
author_facet Zecic, Fatih
Smart, Mary H.
Abbey, Taylor C.
Pazhempallil, Alex
Korban, Colin
author_sort Zecic, Fatih
collection PubMed
description Perioperative anaphylaxis is a rare, but life-threatening hypersensitivity reaction for patients undergoing surgical procedures. Sugammadex is a relatively new drug used to reverse the neuromuscular blockade of specific anesthetics in surgery. Several case reports indicate that there may be a risk of anaphylaxis associated with the use of sugammadex This review examines the literature in order to evaluate the strength of the association between sugammadex use and anaphylaxis. A query of PubMed, EMBASE, and Web of Science was conducted using a combination of terms to identify relevant articles from inception until March 9, 2020. We included any primary study that identified sugammadex as a probable causative agent based on the World Allergy Organization diagnostic criteria for anaphylaxis. A total of 24 articles were reviewed. Across the three randomized controlled trials, there were only four cases of anaphylaxis identified. Incidence of anaphylaxis was reported in only one trial at 0.33%. Two retrospective observational studies conducted in Japan identified cases of anaphylaxis, with incidences of 0.02 and 0.04%. Among 19 case reports and series, 25 patient cases of anaphylaxis were confirmed via allergy testing to be caused by sugammadex or sugammadex–rocuronium complex. Commonly reported symptoms included hypotension, erythema, and decreased oxygen saturation. Based on the findings of this review, there appears to be a rare, but serious, association of sugammadex-induced perioperative anaphylaxis with an incidence between 0.02 and 0.04% in observational studies. It is unclear whether sugammadex on its own or in complex with rocuronium triggers this reaction, but it is clearly involved in inducing anaphylaxis. Further population studies are needed to get a more accurate global incidence rate, and more detailed allergy testing is required to better describe which step of the sugammadex reversal pathway initiates the anaphylactic attack.
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spelling pubmed-97284502022-12-08 Sugammadex-induced anaphylactic reaction: A systematic review Zecic, Fatih Smart, Mary H. Abbey, Taylor C. Pazhempallil, Alex Korban, Colin J Anaesthesiol Clin Pharmacol Review Article Perioperative anaphylaxis is a rare, but life-threatening hypersensitivity reaction for patients undergoing surgical procedures. Sugammadex is a relatively new drug used to reverse the neuromuscular blockade of specific anesthetics in surgery. Several case reports indicate that there may be a risk of anaphylaxis associated with the use of sugammadex This review examines the literature in order to evaluate the strength of the association between sugammadex use and anaphylaxis. A query of PubMed, EMBASE, and Web of Science was conducted using a combination of terms to identify relevant articles from inception until March 9, 2020. We included any primary study that identified sugammadex as a probable causative agent based on the World Allergy Organization diagnostic criteria for anaphylaxis. A total of 24 articles were reviewed. Across the three randomized controlled trials, there were only four cases of anaphylaxis identified. Incidence of anaphylaxis was reported in only one trial at 0.33%. Two retrospective observational studies conducted in Japan identified cases of anaphylaxis, with incidences of 0.02 and 0.04%. Among 19 case reports and series, 25 patient cases of anaphylaxis were confirmed via allergy testing to be caused by sugammadex or sugammadex–rocuronium complex. Commonly reported symptoms included hypotension, erythema, and decreased oxygen saturation. Based on the findings of this review, there appears to be a rare, but serious, association of sugammadex-induced perioperative anaphylaxis with an incidence between 0.02 and 0.04% in observational studies. It is unclear whether sugammadex on its own or in complex with rocuronium triggers this reaction, but it is clearly involved in inducing anaphylaxis. Further population studies are needed to get a more accurate global incidence rate, and more detailed allergy testing is required to better describe which step of the sugammadex reversal pathway initiates the anaphylactic attack. Wolters Kluwer - Medknow 2022 2022-02-08 /pmc/articles/PMC9728450/ /pubmed/36505200 http://dx.doi.org/10.4103/joacp.JOACP_573_20 Text en Copyright: © 2022 Journal of Anaesthesiology Clinical Pharmacology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Review Article
Zecic, Fatih
Smart, Mary H.
Abbey, Taylor C.
Pazhempallil, Alex
Korban, Colin
Sugammadex-induced anaphylactic reaction: A systematic review
title Sugammadex-induced anaphylactic reaction: A systematic review
title_full Sugammadex-induced anaphylactic reaction: A systematic review
title_fullStr Sugammadex-induced anaphylactic reaction: A systematic review
title_full_unstemmed Sugammadex-induced anaphylactic reaction: A systematic review
title_short Sugammadex-induced anaphylactic reaction: A systematic review
title_sort sugammadex-induced anaphylactic reaction: a systematic review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9728450/
https://www.ncbi.nlm.nih.gov/pubmed/36505200
http://dx.doi.org/10.4103/joacp.JOACP_573_20
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