Key result
Administration of sugammadex resulted in sudden ST elevation and cardiac arrest due to severe coronary vasospasm, which was successfully resolved with intra-coronary nitroglycerin.
Why the study?
Although sugammadex is generally regarded as safe for reversing aminosteroid neuromuscular blockades, concerns have emerged regarding serious complications.
Case Report (n=1)
Sugammadex administration may trigger severe coronary vasospasm leading to cardiac arrest, highlighting the need for vigilance during its use.
Sugammadex may precipitate coronary vasospasm and arrest; this single case leaves open causality and warrants vigilance without practice change.
BACKGROUND: Sugammadex is a widely used medication for the reversal of aminosteroid neuromuscular blockades. Although sugammadex is generally regarded to be safe, concerns about the risk of serious complications have emerged. CASE: A 57-year-old man without a history of coronary disease was scheduled for general anesthesia to undergo cardiac radiofrequency catheter ablation due to symptomatic persistent atrial fibrillation and flutter. At the end of the procedure, he was given 400 mg of sugammadex. A little later, the electrocardiogram showed a sudden ST elevation on the inferior leads, followed by cardiac arrest. The urgent coronary angiography demonstrated total collapse of the right coronary artery. After two injections of intra-coronary nitroglycerin, the vasospasm of the right coronary artery was completely resolved. The patient recovered without sequelae and was discharged on postoperative day 5. CONCLUSIONS: Clinicians should pay close attention to the potential risk of coronary vasospasm, even cardiac arrest, after sugammadex administration.
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Boo et al. (2022) conducted a case report in Symptomatic persistent atrial fibrillation and flutter (n=1). Sugammadex was evaluated on Coronary vasospasm and cardiac arrest. Administration of sugammadex resulted in sudden ST elevation and cardiac arrest due to severe coronary vasospasm, which was successfully resolved with intra-coronary nitroglycerin.
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