Anesth Pain Med.  2019 Jul;14(3):299-304. 10.17085/apm.2019.14.3.299.

Sugammadex associated profound bradycardia and sustained hypotension in patient with the slow recovery of neuromuscular blockade: A case report

• Choi YJ
• Park JW
• Kim SH
• Jung KT

• KMID: 2454815
• DOI: http://doi.org/10.17085/apm.2019.14.3.299

Abstract

BACKGROUND
New complications associated with sugammadex have been increased since its widespread use. We report a case of an 80-year-old male who experienced profound bradycardia and sustained hypotension after administration of sugammadex. CASE: Following administration of 200 mg sugammadex after laparoscopic cholecystectomy, sudden bradycardia (29 beats/min) developed for 10 seconds and his train-of-four (TOF) ratio remained at 0.2 for 5 min. An additional 200 mg sugammadex was administered and profound bradycardia (21-30 beats/min) and hypotension (60/40 mmHg) developed. Atropine at 0.5 mg was administered, but the effect lasted only 30 s. Profound bradycardia occurred four more times at 30 s intervals, and ephedrine and phenylephrine were injected intermittently to increase the patient's heart rate and blood pressure. The TOF ratio became 0.9 about 10 min after administration of additional sugammadex.
CONCLUSIONS
Awareness must be heightened regarding the possibility of sugammadexinduced bradycardia and hypotension, and more attention should be paid to patients with slow recovery times following muscle relaxation, despite the use of sugammadex.

Keyword

Bradycardia; Hypotension; Neuromuscular blockade; Postoperative complications; Sugammadex

MeSH Terms

Aged, 80 and over
Atropine
Blood Pressure
Bradycardia*
Cholecystectomy, Laparoscopic
Ephedrine
Heart Rate
Humans
Hypotension*
Male
Muscle Relaxation
Neuromuscular Blockade*
Phenylephrine
Postoperative Complications
Atropine
Ephedrine
Phenylephrine

Figure

• 

  Fig. 1 Hemodynamic data and trainoffour (TOF) data of the patient. Bradycardia has developed after use of sugammadex shortly. Reversal from neuromuscular blockade was inadequate despite using sugammadex. Profound bradycardia and sustained hypotension were developed after administration of an additional dose of sugammadex. Adequate reversal from neuromuscular blockade was achieved about 10 min after administration of additional use of sugammadex. MBP: mean blood pressure, HR: heart rate, BP: blood pressure.

• 

  Fig. 2 Electrocardiogram of the patient. (A) Preoperative electrocardiogram showed 1st degree AV block (HR 71 beats/min, QT/QTc 418/454 ms). (B) After the use of sugammadex, the postoperative electrocardiogram showed QT prolongation (HR 62 beats/min, QT/QTc 474/481 ms). AV: atrioventricular, HR: heart rate, QTc: corrected QT.

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