• Yeon Su Jeon, JinWoo Shim, Eun Hwa Jun, Seung Tae Choi, and Hong Soo Jung.
• Department of Anesthesiology and Pain Medicine, St's Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
• Medicine (Baltimore). 2019 Oct 1; 98 (41): e17405e17405.

RationaleMidazolam is known as a safe drug and is widely used as a sedative and an anesthetic adjuvant. Therefore, there is a lack of awareness that midazolam can cause anaphylaxis. Midazolam anaphylaxis is rare, and only a few cases have been reported, but such a risk is always present. In this study, we report a case of midazolam anaphylaxis by an intravenous injection, in the prone position, during general anesthesia.Patient ConcernsA 62-year-old woman was intravenously administered 1 mg midazolam during general anesthesia, and sudden severe hypotension, bronchospasm, decreased oxygen saturation, erythema, and diarrhea occurred.DiagnosisMidazolam anaphylaxis was presumptively diagnosed by clinical symptoms and was confirmed by an intradermal test after 9 weeks.InterventionsThe patient was treated with 100% oxygen, large volume of fluid, epinephrine, phenylephrine, ephedrine, dexamethasone and prednisolone, ranitidine, and flumazenil.OutcomesSevere hypotension and decreased oxygen saturation were resolved within 20 minutes of the onset of anaphylaxis, and the patient was discharged after 3 days without any sequelae.LessonsMidazolam anaphylaxis is very rare, but it can happen always. Therefore, the possibility of anaphylaxis due to midazolam should be considered and always be prepared for treatment.

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