Introduction: Anaphylaxis in the perioperative and operative period is a potentially life-threatening reaction to medications or substances, most commonly neuromuscular blocking agents (NBMAs), antibiotics, disinfectants, and latex. The most frequently used NBMAs are succinylcholine and rocuronium, but sugammadex - typically used for rocuronium reversal and controversially touted as a possible treatment for rocuronium-induced anaphylaxis - has been increasingly reported in the literature as an anaphylaxis trigger itself. Description: A 44 year-old male with a past medical history significant for traumatic brain injury (TBI) and cerebral palsy presented with skin changes around his baclofen pump. He was admitted and taken to the operating room for pump explantation. There were no issues with induction of anesthesia. After pump explantation, 200mg of sugammadex was administered for reversal of rocuronium. Four minutes later, the patient’s blood pressure (BP) dropped to 58/32mmHg. The patient’s hypotension persisted despite boluses of epinephrine, phenylephrine, ephedrine, and albumin. For presumed anaphylactic reaction, the patient was given 100mg of hydrocortisone and further doses of epinephrine. A tryptase level was also sent. The patient became hemodynamically stable during his first day in the intensive care unit. The tryptase level down-trended from 44.9 micrograms/liter (mcg/L) initially to 6.8mcg/L after two days (normal: 2.2-13.2 mcg/L). The patient was safely discharged on hospital day 9. Discussion: Sugammadex-induced anaphylaxis is an emerging, life-threatening complication experienced during anesthesia. Management includes airway and hemodynamic support (with epinephrine), withdrawal of the offending agent, and serum tryptase measurements as a marker of mast cell activation in anaphylaxis. While NBMA-associated anaphylaxis is commonly peri-intubation and sugammadex reactions are typically peri-extubation, patients can also be allergic to the sugammadex-rocuronium complex, further complicating attempts to distinguish between the two for future avoidance. As research is devoted towards understanding sugammadex anaphylaxis and possible alternative approaches, providers will have more information for determining the risks and benefits of different anesthetic methods in patients.