Case of a Severe SugammadexInduced Bradycardia in the Young - Abstract
Neuromuscular blocking agents (NMBAs) are a critical component of general anesthesia used to ease endotracheal intubation, mechanical ventilation, and surgical access. Residual paralyzing effects are among the most dangerous occurrence in the post-operative wards, leading to dyspnea, acute respiratory insufficiency and death. Sugammadex is the first selective reversal drug for steroidal NMBAs; it has been shown to give full and rapid recovery of muscle strength, thus minimizing the occurrence of residual curarization. Although rare, adverse drug reactions (ADRs) to Sugammadex have been documented, the most threatening being severe bradycardia and asystole, occurred almost exclusively in elderly patients. We present the case of a 23 y.o. trauma patient admitted to the hospital with a fracture of the middle third of the clavicle, that underwent surgery under general anesthesia. When Sugammadex was administered, the almost immediate drop in blood pressure and severe bradycardia seriously threatened the patient’s life, but the ADRs were promptly treated and resolved with a bolus of Atropine. In our opinion, all evidence points at Sugammadex as the most probable cause of the severe bradycardia and subsequent arterial pressure drop, events that could have been catastrophic, especially if they had occurred in an elderly end fragile patient. This highlights the necessity of increased pharmacovigilance and further studies to examine Sugammadex safety, and possibly demand an update in the Sugammadex data sheet regarding the speed of the drug’s recommended administration.