Timing of sugammadex administration:a case report

Sugammadex is a relatively new drug used to reverse the effects of rocuronium, a nondepolarizing muscle relaxing agent to hasten emergence from general anesthesia. Unlike neostigmine and atropine, its use is not associated with re-curarization or cardiac arrhythmias. Sugammadex carries a small risk of allergic reactions including anaphylactic shock. We present a case report of a 67 years old woman who underwent an urgent operation for small bowel operation. Due to atrial fibrillation [AF] the anesthesiologist administered Sugammadex just before skin closure. Soon after the injection, peak inspiratory pressures [PIP] increased precipitously followed by hypotension and increasing tachycardia. For anticipated cardioversion, the chest was exposed and it revealed urticarial. There was severe bronchospasm on auscultation. Treatment of anaphylactic shock was initiated, the patient improved dramatically and fully recovered. This case is presented to alert practitioners to the importance of a sudden rise in PIP after Sugammadex administration in the early diagnosis of an anaphylactic reaction, and to suggest that due to the risk of anaphylaxis, it may be advisable to initiate sugammadex only when the patient can be fully exposed without compromising the sterility of the operating field

Association between Hypophosphatemia and Cardiac Arrhythmias in the Early Stage of Sepsis: Could Phosphorus Replacement Treatment Reduce the Incidence of Arrhythmias?

It is well known that new-onset arrhythmias are common in septic patients. It is thought that hypophosphatemia in the early stages of sepsis may contribute to the development of new arrhythmias. In this study, we hypothesized that intravenous (IV) phosphorus replacement may reduce the incidence of arrhythmias in critically ill patients. 34 adult septic patients with hypophosphatemia admitted to the general intensive care unit were treated with IV phosphorus replacement per ICU protocol, and the incidence of new arrhythmias were compared with 16 patients from previously published data. IV phosphorus replacement was associated with a significantly reduced incidence of arrhythmias (38% vs. 63%, p=0.04). There were no differences in observed mortality between subgroups, which may be due to the small sample size. This study demonstrated that IV phosphorus replacement might be effective in reducing the incidence of new arrhythmias in septic patients.