Steroidal Nondepolarizing Neuromuscular Blocker Induced Allergic Reactions and Role of Sugammadex in Treatment

Year 2013, , 63 - 67, 01.01.2013

Yakup Tomak Başar Erdivanlı Ahmet Şen

https://doi.org/10.5505/abantmedj.2013.96268

Abstract

More than half of the anaphylactic and anaphylactoid reactions during general anesthesia occur due to neuromuscular blocking agents. Traditional resuscitation is the mainstay therapy in these reactions, which have a high morbidity and mortality due to delay in diagnosis and specific treatment. However, prompt removal of the offending agent from circulation may greatly improve the outcome. Sugammadeks is a drug that is the structure of γ-cyclodextrin. It's designed specifically to encapsuate steroidal nondepolarizing neuromuscular blockers and facilitate their excretion through kidneys. There are case reports in the literature suggesting that anaphylactic reactions due to rocuronium, unresponsive to rutin anaphylactic therapy, respond promptly to sugammadex. In our opinion traditonal anaphylaxis treatment may benefit from sugammadex in removal of the offending agent from circulation.

Keywords

Neuromuscular Nondepolarizing Agents, Sugammadex, Anaphylaxis, Drug Allergy

Steroid Yapılı Nondepolarizan Nöromüsküler Blokerlere Bağlı Allerjik Reaksiyonlar ve Tedavide Sugammadeksin Rolü

Abstract

Genel anestezi sırasında gelişen anafilaktik ve anafilaktoid reaksiyonların yarıdan fazlası kas gevşetici ajanlar nedeniyle oluşur. Teşhis ve uygun tedavide gecikme nedeniyle yüksek mortalite ve morbiditeyle sonuçlanan bu tür reaksiyonların önlenmesinde geleneksel destek tedavisi esastır. Fakat dolaşımdaki allerjenin hızla vücuttan uzaklaştırılması resüsitasyona büyük katkı sağlayabilir. Sugammadeks, γ-siklodekstrin yapısında bir ilaçtır. Steroid yapılı nondepolarizan nöromüsküler blokerleri selektif olarak bağlayarak, böbrek yoluyla vücuttan uzaklaştırmak üzere tasarlanmıştır. Literatürde, roküronyuma bağlı geliştiği saptanan, fakat rutin anafilaksi tedavisine yanıt vermeyen durumlarda, sugammadeks ile etkin düzelme sağlandığını bildiren vaka sunumları vardır. Nondepolarizan nöromusküler blokerlere bağlı gelişen anafilaksinin geleneksel tedavisinde, dolaşımdaki allerjeni elimine etmeye yönelik sugammadeksten faydalanılabileceği kanaatindeyiz.

Keywords

Nöromusküler Nondepolarizan Ajanlar, Sugammadeks, Anafilaksi, İlaç allerjisi

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