A Case Report of Acute Onset and Rapid Resolution of Atrioventricular Block After Sugammadex: Is the Autonomic System Involved?

Administering sugammadex to reverse neuromuscular blockade can cause marked bradycardia and rarely asystole. In this case, a rapid onset, biphasic heart rate response; slowing then speeding, after administering sugammadex was noted while at steady state, 1.3% end-tidal sevoflurane. On review of the...

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Bibliographic Details
Published in:	A&A practice Vol. 17; no. 5; p. e01683
Main Authors:	Abdelrahim, Mohamed T., Kassels, Austin C., Stark, Cain W., Roberts, Christopher J., Vogt, Julia A., Ebert, Thomas J.
Format:	Journal Article
Language:	English
Published:	United States Lippincott Williams & Wilkins 05-05-2023
Subjects:	Atrioventricular Block - chemically induced Bradycardia gamma-Cyclodextrins Humans Neuromuscular Nondepolarizing Agents Rocuronium Sugammadex
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Summary:	Administering sugammadex to reverse neuromuscular blockade can cause marked bradycardia and rarely asystole. In this case, a rapid onset, biphasic heart rate response; slowing then speeding, after administering sugammadex was noted while at steady state, 1.3% end-tidal sevoflurane. On review of the electrocardiogram (ECG), the heart rate slowing coincided with the onset of a second-degree, Mobitz type I block that lasted 45 seconds. No other events, drugs, or stimuli coincided with the event. The acute onset and transient nature of the atrioventricular block without evidence of ischemia implies a brief parasympathetic effect on the atrioventricular node after sugammadex administration.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	2575-3126 2575-3126
DOI:	10.1213/XAA.0000000000001683