A case of sugammadex-induced anaphylactic shock in a pregnant woman

We present a case of anaphylaxis in a 35-year-old woman who was 13 weeks of gestation. She underwent laparoscopic oophorocystectomy under combined general and thoracic epidural anesthesia The operation was completed uneventfully and her trachea was extu-bated after sugammadex administration. However, she developed life-threatening anaphylactic shock immediately after extubation. She complained of dyspnea and her Spo₂ decreased to 90%. Moreover, her systolic blood pressure decreased to 70 mmHg. Her symptoms did not improve despite administration of ephedrine and phenylephrine. Therefore, we performed tracheal intubation and started continuous administration of dopamine and noradrenaline. At 40 min after sugammadex administration, erythema appeared over her entire body and she was diagnosed with anaphylaxis. She was treated with intramuscular adrenaline and moved to the ICU, where she recovered without any complications. However, her fetus died the following day. A basophil activation test performed on her peripheral blood sample showed a positive reaction to sugammadex. Maternal anaphylaxis can lead to significant fetal mortality secondary to compromised uterine perfusion and maternal oxygenatioa Although anaphylaxis during pregnancy is rare, it is important for physicians to be aware of the possibility of its occurrence so that they can promptly and accurately diagnose and treat it.