2023 Volume 51 Issue 1 Pages 13-15
Many cases of anaphylactic shock and arrhythmias after the administration of sugammadex have been reported. In this report, we describe a case of sinoatrial block or sinus arrest after the administration of sugammadex during ambulatory anesthesia. The patient was a 21-year-old male with autism spectrum disorder. Intensive dental treatment under general anesthesia was planned. The anesthesia was performed using a slow induction with sevoflurane, followed by the use of an intravenous route and nasal intubation after the administration of 50 mg of rocuronium. After the completion of treatment, 200 mg of sugammadex was administered upon awakening, and a sudden bradyarrhythmia appeared immediately after sugammadex administration. The patient’s heart rate decreased to 30 beats per minute and then recovered to 80 beats per minute after the administration of 0.5 mg of atropine sulfate. An electrocardiogram obtained immediately after the administration of sugammadex suggested a sinoatrial block or sinus arrest. Appropriate monitoring using a muscle relaxation monitor is necessary when administering rocuronium bromide and sugammadex. The need for sugammadex administration, the time elapsed since the administration of rocuronium bromide, and the possible occurrence of adverse effects should also be taken into consideration. Sugammadex must be administered appropriately taking its possible adverse effects into consideration. Although the exact mechanism is unknown, severe electrocardiographic changes can occur within a few minutes after sugammadex administration even when sugammadex is used appropriately ; therefore, preparations for the possibility of cardiac arrest should be made if an improvement in cardiac function does not occur.
