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Remimazolam anaphylaxis during anesthesia induction

Abstract

Anaphylactic shock is a potentially lethal complication during anesthesia and requires appropriate management to save the patient’s life. We report a 32-year-old man who developed anaphylaxis during induction of general anesthesia with remimazolam for hand surgery. He received general anesthesia with midazolam 4 weeks before. This time facial flushing followed by a decrease of peripheral oxygen saturation (SpO2) and blood pressure occurred 2 min after starting continuous remimazolam infusion at 6 mg/kg/h. Hypotension and SpO2 were recovered by repeated administration of adrenaline. Despite no increase of serum tryptase levels, intradermal allergy tests 4 weeks postoperatively revealed that remimazolam and midazolam were positive, suggesting remimazolam as a causative agent for anaphylaxis. In the previous surgery, midazolam, which has a similar structure to remimazolam, may have caused sensitization. This is probably the first case report of anaphylaxis caused by remimazolam.

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Acknowledgements

The authors would like to thank Forte (www.forte-science.co.jp) for English language editing.

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KT acquired the data and prepared the article. ST acquired the data, prepared the article, and designed this report. YH acquired the data. KN acquired and analyzed the skin test. TT acquired the data and reviewed the article. YK reviewed the article. The article has been read and approved by all the authors.

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Correspondence to Shinji Takahashi.

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Tsurumi, K., Takahashi, S., Hiramoto, Y. et al. Remimazolam anaphylaxis during anesthesia induction. J Anesth 35, 571–575 (2021). https://doi.org/10.1007/s00540-021-02934-8

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Keywords

  • Anaphylaxis
  • Remimazolam
  • Anaphylactic shock
  • Anesthesia