Remimazolam anaphylaxis during anesthesia induction

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 (SpO.sub.2) and blood pressure occurred 2 min after starting continuous remimazolam infusion at 6 mg/kg/h. Hypotension and SpO.sub.2 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.
Author(s): Kota Tsurumi [sup.1], Shinji Takahashi [sup.1], Yoshiyuki Hiramoto [sup.1], Kazuhiro Nagumo [sup.2], Tomonori Takazawa [sup.2], Yoichiro Kamiyama [sup.1] Author Affiliations: (1) grid.258269.2, 0000 0004 1762 2738, Department of Anesthesiology [...]