The Role of Sugammadex in Managing Rocuronium-Induced Anaphylaxis: A Case Report and Review of the Literature

Background: Anaphylactic shock induced by neuromuscular blocking agents is a rare complication, but it accounts for 50% to 70% of perioperative anaphylactic shocks. Although not yet officially recommended, Sugammadex is increasingly being used in the therapeutic arsenal for anaphylactic shock induced by rocuronium. Case Presentation: We report the case of a 46-year-old North African female who experienced grade III anaphylactic shock during a laparoscopic cholecystectomy. Despite standard resuscitation, significant improvement was only observed after administering 1000 mg of Sugammadex. The surgery was completed without further NMBAs, and the patient was stable postoperatively. Methods: A PubMed and Scopus search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include studies reporting patients with an anaphylactic reaction to rocuronium treated with Sugammadex. Results: The search yielded 12 cases of patients with an anaphylactic reaction to rocuronium treated with Sugammadex. All studies were case reports (Level IV of evidence). Different characteristics of these cases are described, including age, time between injection of rocuronium and start of anaphylaxis, the dose of Sugammadex andministred and clinical response. Conclusion: This case, aligned with other reports, suggests Sugammadex’s potential efficacy in such cases, though controlled studies are challenging due to the rarity of these reactions. Therefore, Sugammadex should not replace established resuscitation protocols.