Key result
Administration of 200 mg sugammadex resulted in profound atropine-resistant bradycardia (36 bpm) and hypotension, which was successfully treated with adrenaline and attributed to Kounis syndrome.
Why the study?
Profound bradycardia caused by sugammadex has been reported, but its mechanism remains unclear.
Case Report (n=1)
No
Sugammadex can induce profound, atropine-resistant bradycardia and hypotension, potentially mediated by coronary vasospasm (Kounis syndrome), requiring adrenaline for hemodynamic recovery.
Clinicians should consider Kounis syndrome in sugammadex-related bradycardia; single case leaves causality and incidence open.
BACKGROUND: Profound bradycardia caused by sugammadex has been reported, although its mechanism is unclear. Herein, we suggest a possible culprit for this phenomenon. CASE PRESENTATION: A 50-year-old woman without comorbidity except mild obesity underwent a transabdominal hysterectomy and right salpingo-oophorectomy. After surgery, sugammadex 200 mg was intravenously administered. Approximately 4 min later, her heart rate decreased to 36 bpm accompanied by hypotension (41/20 mmHg) and ST depression in limb lead electrocardiogram (ECG). Atropine 0.5 mg was injected intravenously without improving the hemodynamics. Intravenous adrenaline 0.5 mg was added despite the lack of signs suggesting allergic reactions. Her heart rate and blood pressure quickly recovered and remained stable thereafter, although 12-lead ECG taken 1 h later still showed ST depression. CONCLUSIONS: In this case, the significant bradycardia appeared attributable to coronary vasospasm (Kounis syndrome) induced by sugammadex, considering the ECG findings and high incidence of anaphylaxis due to sugammadex.
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Yoshida et al. (2020) conducted a case report in Atropine-resistant bradycardia (n=1). Sugammadex was evaluated on Development of profound bradycardia and hypotension. Administration of 200 mg sugammadex resulted in profound atropine-resistant bradycardia (36 bpm) and hypotension, which was successfully treated with adrenaline and attributed to Kounis syndrome.
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