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Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
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Sugammadex and rocuronium-induced anaphylaxis.

Tomonori Takazawa1, Hiromasa Mitsuhata2, Paul Michel Mertes3

  • 1Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan. takazawt@gunma-u.ac.jp.

Journal of Anesthesia
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Perioperative anaphylaxis, often caused by neuromuscular blocking agents like rocuronium, requires anesthesiologist awareness. This review covers diagnosis and treatment of hypersensitivity to sugammadex and neuromuscular blocking agents.

Keywords:
AnaphylaxisFlow cytometryNeuromuscular blocking agentRocuroniumSugammadex

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Area of Science:

  • Anesthesiology
  • Immunology
  • Pharmacology

Background:

  • Perioperative anaphylaxis is a severe complication of anesthesia.
  • Neuromuscular blocking agents, particularly rocuronium, are common triggers.
  • Sugammadex, used for reversal, has also been linked to allergic reactions.

Purpose of the Study:

  • To review the diagnosis and treatment of anaphylaxis to sugammadex and neuromuscular blocking agents.
  • To discuss the increasing incidence of hypersensitivity reactions to these agents.
  • To highlight the importance of anesthesiologist familiarity with these reactions.

Main Methods:

  • Review of recent studies on anaphylaxis to sugammadex and neuromuscular blocking agents.
  • Discussion of diagnostic methods, including flow cytometry.
  • Analysis of treatment strategies and potential improvements.

Main Results:

  • Rocuronium and succinylcholine are associated with a high rate of IgE-mediated anaphylaxis.
  • Sugammadex has confirmed cases of allergic reactions.
  • The incidence of hypersensitivity to sugammadex and rocuronium is expected to rise.

Conclusions:

  • Anesthesiologists must be prepared for increasing cases of anaphylaxis to sugammadex and rocuronium.
  • Understanding the epidemiology, mechanisms, and clinical presentations is crucial.
  • Flow cytometry shows diagnostic utility, and sugammadex may improve rocuronium-induced anaphylaxis management.