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Treatment of anaphylactic shock was initiated, the patient improved dramatically and fully recovered. Sugammadex was administered when the operation was still going on, but the muscle relaxation was no longer needed. There was severe bronchospasm on auscultation. For anticipated cardioversion, the chest was exposed and it revealedurticarial.

When using traditional reversing agents, it is customary to start them as soon as muscle relaxation is no longer required. This case suggests that the timing of reversing neuromuscular blockade with sugammadex should differ from the timing of reversal with traditional agents. In our case presented here, delaying reversal would have led to earlier diagnosis, and treatment could have been initiated before desaturation and collapse. Because sugammadex acts very quickly, and is free from residual curarization, waiting the extra minute or two should not materially affect operating room utilization or case turnover rate. The usual timing enables extubation immediately after skin closure, rapid turn over the patients and better utilization of resources.

The development of laryngeal edema may make re-intubation difficult or even impossible. Unlike neostigmine and atropine, what is are we officially dating about its use is not associated with re-curarization or cardiac arrhythmias.

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Efficacy and safety of Sugammadex in reversing deep neuromuscular block induced by rocuronium or vecuronium in Japanese patients. Sugammadex carries a small risk of allergic reactions including anaphylactic shock. The resulting delay in diagnosis could have been disastrous.

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However, due to the risk of anaphylaxis, it seems unwise to follow the same practice with sugammadex. Consequently, it eliminates the risk of post-operative residual curarization associated with the traditional competitive reversing agents. Consequently, it was decided to attempt cardioversion.

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Consequently the patient was still covered by sterile sheets, and observation of the skin was impossible. Rocuronium was used for muscle relaxation on induction. Soon after induction she developed atrial fibrillation with rapid ventricular response, however, there was no hemodynamic compromise. In addition, it allows longer observation against post-operative residual curarization.