• Kota Tsurumi, Shinji Takahashi, Yoshiyuki Hiramoto, Kazuhiro Nagumo, Tomonori Takazawa, and Yoichiro Kamiyama.
• Department of Anesthesiology and Pain Medicine, School of Medicine, Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
• J Anesth. 2021 Aug 1; 35 (4): 571-575.

AbstractAnaphylactic 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.© 2021. Japanese Society of Anesthesiologists.

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