Rescue of rocuronium-induced refractory anaphylax is with sugammadex in a laparoscopic hysterecto my: A case report-ZENTIME PUBLISHING CORPORATION LIMITED

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Rescue of rocuronium-induced refractory anaphylax is with sugammadex in a laparoscopic hysterecto my: A case report

Rahul Kumar Chaudhary, Prajwal Bista*, Lalit Kumar Rajbanshi*, Kanak Khanal*

Department of Anesthesiology and Critical Care, Birat Medical College Teaching Hospital, Morang, 56613, Nepal.

*The authors contribute equally.

Address correspondence to: Rahul Kumar Chaudhary, Department of Anesthesiology and Critical Care, Birat Medical College Teaching Hospital, Tankisinuwari, Dharan Road, Morang, 56613, Nepal. E-mail: rahulkr9991@gmail.com.

DOI: https://doi.org/10.61189/655401cvkjpp

Received June 24, 2025; Accepted August 29, 2025; Published September 30, 2025

Highlights

● Anaphylaxis is a potentially life-threatening event during general anesthesia, with a rare incidence estimated at 1 in 10,000 to 1 in 20,000 cases.

● Neuromuscular blocking agents, antibiotics, and latex are the primary triggers of perioperative anaphylaxis, with rocuronium being one of the most commonly implicated drugs.

● Sugammadex is a valuable drug for reversing rocuronium-induced refractory anaphylaxis.

Abstract

Neuromuscular blocking agents, particularly rocuronium, are a major cause of perioperative anaphylaxis. This report presents a rare and severe case of rocuronium-induced anaphylaxis in a 50-year-old woman undergoing an elective total laparoscopic hysterectomy at a tertiary care center in Eastern Nepal. Despite multiple doses of intravenous epinephrine, the patient did not achieve adequate hemodynamic recovery. However, a single bolus of sugammadex resulted in the rapid and complete resolution of symptoms. This case highlights the potential of sugammadex as a life-saving adjunct in treating NMBA-induced anaphylaxis that is unresponsive to standard inter ventions.

Keywords: Rocuronium, sugammadex, anaphylaxis, epinephrine, refractory

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