Anaphylaxis Induced by Sugammadex in a Patient with Papillary Serous Carcinoma of the Uterine Adnexa Undergoing Exploratory Laparotomy

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.