• Br J Anaesth · Feb 2020

    Multicenter Study Comparative Study Observational Study

    Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study.

    In Japan, Sugammadex anaphylaxis occurs in ~1 in 5,000 exposures.

    • Masaki Orihara, Tomonori Takazawa, Tatsuo Horiuchi, Shinya Sakamoto, Kazuhiro Nagumo, Yukinari Tomita, Akihiro Tomioka, Nagahide Yoshida, Akihiko Yokohama, and Shigeru Saito.
    • Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan.
    • Br J Anaesth. 2020 Feb 1; 124 (2): 154-163.

    BackgroundAlthough cases of anaphylaxis caused by sugammadex have been reported, its incidence remains uncertain. Conversely, no studies have evaluated the incidence of anaphylaxis to neostigmine.MethodsThis was a retrospective multicentre observational study of patients who underwent surgery under general anaesthesia between 2012 and 2016 to compare the incidence of anaphylaxis with sugammadex with that of neostigmine at four tertiary hospitals in Japan. To ensure the quality of diagnosis, only cases with a clinical history suggestive of anaphylaxis, along with positive results from in vitro or in vivo testing, were assessed.ResultsFrom a total of 49 532 patients who received general anaesthesia included in this study, 18 cases of anaphylaxis were reported, of which six were attributable to sugammadex and none to neostigmine. There were no fatalities attributable to anaphylaxis. The incidence of anaphylaxis caused by all drugs or by sugammadex was calculated as 0.036% (95% confidence interval [CI]: 0.022-0.057%) and 0.02% (of the number of sugammadex cases) (95% CI: 0.007-0.044%), respectively.ConclusionsThe results suggest that neostigmine might be safer than sugammadex when assessing only the incidence of anaphylaxis. We believe that there is room for reconsideration of the choice of reversal agent for neuromuscular blocking agents by all anaesthetists.Clinical Trial RegistrationUMIN000022365; UMIN000033561.Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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    This article appears in the collection: Sugammadex anaphylaxis: all that glitters?.



    In Japan, Sugammadex anaphylaxis occurs in ~1 in 5,000 exposures.

    Daniel Jolley  Daniel Jolley

    Sugammadex anaphylaxis risk is greater than for neostigmine.

    Daniel Jolley  Daniel Jolley
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