Profound Bradycardia and Hypotension after Sugammadex Administration

We report a case of a 46-year-old female patient who underwent subtotal gastrectomy and developed profound bradycardia and hypotension after administration of sugammadex. She had no previous medical history and preoperative tests were normal, except for multiple atrial premature beats seen on an electrocardiography. Three minutes after sugammadex injection, she developed severe bradycardia and hypotension, which improved after administration of atropine. No rash or urticaria was observed, and airway pressure was not increased. In addition, because neuromuscular blockade was not reversed after sugammadex administration, pyridostigmine was administered to reverse it. After her muscular strength recovered completely, extubation was performed, and she was transferred to the postoperative care unit. In conclusion, the risk of severe adverse effects due to sugammadex should be considered, and close monitoring is recommended after sugammadex administration.