{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:40:18Z","timestamp":1792269618833,"version":"4.4.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":262,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Anesthesiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Sugammadex is widely used for rapid and predictable reversal of aminosteroid neuromuscular blockade and has a favorable safety profile. However, rare cardiovascular adverse events, including severe hypotension, bradycardia, and asystole, have been reported. We describe a case of a 39\u2010year\u2010old healthy male who developed profound hypotension without bradycardia approximately six minutes after receiving sugammadex for reversal of moderate neuromuscular blockade following uncomplicated orthopedic surgery. His blood pressure decreased from 95\/51\u2009mmHg at baseline to 68\/33\u2009mmHg six minutes after sugammadex administration, reaching a nadir of 50\/29\u2009mmHg at 17\u2009min, with a heart rate of 117\u2009beats\/min. The patient had stable intraoperative hemodynamics and no evidence of bronchospasm, cutaneous manifestations, or airway compromise at the time of the event. Hypotension was refractory to repeated boluses of phenylephrine and ephedrine, with subsequent improvement following norepinephrine administration. The patient recovered without further complications and was discharged the same day. Although causality cannot be definitively established, the temporal relationship raises concern for sugammadex\u2010associated hypotension without bradycardia, possibly related to an atypical hypersensitivity reaction. This case highlights that severe hypotension may occur even in low\u2010risk patients in the absence of bradycardia or other classic features of anaphylaxis, requiring prompt recognition and early potent vasopressor support.<\/jats:p>","DOI":"10.1155\/cria\/4061273","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:14:00Z","timestamp":1789967640000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sudden, Severe, Refractory Hypotension Following Sugammadex Administration During Low\u2010Risk Orthopedic Surgery in a Healthy Young Adult: A Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7951-8685","authenticated-orcid":false,"given":"Bibek","family":"Devkota","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3459-1061","authenticated-orcid":false,"given":"Marcus","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6920-232X","authenticated-orcid":false,"given":"Babita","family":"Bhattarai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"e_1_2_8_1_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200510000-00007"},{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2016.06.018"},{"key":"e_1_2_8_3_2","article-title":"Efficacy and Safety of Sugammadex Versus Neostigmine in Reversing Neuromuscular Blockade in Adults","volume":"8","author":"Hristovska A. M.","year":"2017","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_8_4_2","volume-title":"I. Dosing for Bridion","author":"Merck & Co.","year":"2026"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2019.1649393"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-011-1196-z"},{"key":"e_1_2_8_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57010079"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.77666"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjane.2018.09.006"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000026796"},{"key":"e_1_2_8_11_2","doi-asserted-by":"publisher","DOI":"10.4097\/kja.19344"},{"key":"e_1_2_8_12_2","doi-asserted-by":"publisher","DOI":"10.2344\/24-0013"},{"key":"e_1_2_8_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2253-14-92"},{"key":"e_1_2_8_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057x1404200115"},{"key":"e_1_2_8_15_2","unstructured":"KooB. S. A Suspected Sugammadex-Induced Anaphylactic Shock: A Case Report."},{"key":"e_1_2_8_16_2","doi-asserted-by":"publisher","DOI":"10.4097\/kja.22335"},{"key":"e_1_2_8_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.waojou.2020.100472"},{"key":"e_1_2_8_18_2","doi-asserted-by":"publisher","DOI":"10.4103\/joacp.joacp_573_20"},{"key":"e_1_2_8_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2024.07.042"},{"key":"e_1_2_8_20_2","volume-title":"Sugammadex Sodium G Cases by Reactions, FDA Adverse Events Monitoring System (AEMS) Public Dashboard for Drugs and Biologics","author":"2026 U.F.","year":"2026"},{"key":"e_1_2_8_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2024.111509"}],"container-title":["Case Reports in Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/cria\/4061273","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/cria\/4061273","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/cria\/4061273","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:14:08Z","timestamp":1789967648000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/cria\/4061273"}},"subtitle":[],"editor":[{"given":"Anjan","family":"Trikha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/cria\/4061273"],"URL":"https:\/\/doi.org\/10.1155\/cria\/4061273","archive":["Portico"],"relation":{},"ISSN":["2090-6382","2090-6390"],"issn-type":[{"value":"2090-6382","type":"print"},{"value":"2090-6390","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"4061273"}}