Intraoperative anaphylaxis to sugammadex and a protocol for intradermal skin testing

Anaesth Intensive Care. 2014 Jan;42(1):93-6. doi: 10.1177/0310057X1404200116.


Sugammadex is a selective binding agent for aminosteroid neuromuscular blockers whose use is increasing in anaesthetic practice. We present three cases of severe anaphylaxis coincident with sugammadex administration. Subsequent intradermal testing confirmed sugammadex as the triggering agent, with all patients having positive skin responses to a 1:100 dilution of the standard 100 mg/ml solution and two out of three having a positive response to a 1:1000 dilution. As all patients were administered sugammadex to reverse neuromuscular blockade with rocuronium, we considered that sugammadex-rocuronium complexes were a potential unique allergen. In the two patients who were additionally tested with a rocuronium-sugammadex (3.6:1 molecular ratio) mixture, the wheal-and-flare response was significantly attenuated.

Keywords: allergy; anaphylaxis; skin-testing protocol; sugammadex.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Anaphylaxis / chemically induced*
  • Androstanols / administration & dosage
  • Clinical Protocols
  • Female
  • Humans
  • Intradermal Tests
  • Intraoperative Complications / chemically induced*
  • Neuromuscular Blockade
  • Rocuronium
  • Sugammadex
  • gamma-Cyclodextrins / administration & dosage
  • gamma-Cyclodextrins / adverse effects*


  • Androstanols
  • gamma-Cyclodextrins
  • Sugammadex
  • Rocuronium