185 Anaphylaxis after Anesthetic Reversal

Background Sugammadex is a new drug used for the reversal of neuromuscular blockade by rocuronium or vecuronium, a muscle relaxant used as fast acting. Methods We performed a review of a case of a patient scheduled for osteosynthesis of the ankle with a history of bronchial asthma and sensitization to Dermatophagoides pteronyssinus. After the surgery the patient suffered anaphylaxis, a minute after the use of sugammadex. Results We evaluated the drugs used during anesthesia Prick and intradermal, and we obtained positive results with Sugammadex at 1 month, 3 and 6 months. We performed the basophil activation test giving a positive result. Tests show IgE-mediated sensitization with positive skin tests and basophil activation test. Conclusions It is believed that prior sensitization may have occurred due to ingestion of cyclodextrins which is present in many foods. The atopic status of this patient may have had some awareness of cyclodextrins. This case has been published as the first documented case of anaphylaxis by sugammadex with normal doses. Our case raises clear that the underlying mechanism of this reaction was an IgE-mediated sensitization.