Jeon Yeon Su, Shim JinWoo, Jun Eun Hwa, Choi Seung Tae, Jung Hong Soo
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;98(41):e17405. doi: 10.1097/MD.0000000000017405.
Midazolam 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.
A 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.
Midazolam anaphylaxis was presumptively diagnosed by clinical symptoms and was confirmed by an intradermal test after 9 weeks.
The patient was treated with 100% oxygen, large volume of fluid, epinephrine, phenylephrine, ephedrine, dexamethasone and prednisolone, ranitidine, and flumazenil.
Severe 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.
Midazolam 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.
咪达唑仑被认为是一种安全的药物，广泛用作镇静剂和麻醉辅助剂。因此，人们缺乏对咪达唑仑可引起过敏反应的认识。咪达唑仑过敏反应罕见，仅有少数病例报道，但这种风险始终存在。在本研究中，我们报告了一例在全身麻醉期间俯卧位静脉注射咪达唑仑引起过敏反应的病例。
一名62岁女性在全身麻醉期间静脉注射了1毫克咪达唑仑，随后出现突然严重低血压、支气管痉挛、血氧饱和度下降、红斑和腹泻。
根据临床症状初步诊断为咪达唑仑过敏反应，并在9周后经皮内试验确诊。
患者接受了100%氧气、大量液体、肾上腺素、去氧肾上腺素、麻黄碱、地塞米松和泼尼松龙、雷尼替丁以及氟马西尼治疗。
过敏反应发生后20分钟内严重低血压和血氧饱和度下降得到缓解，患者3天后出院，无任何后遗症。
咪达唑仑过敏反应非常罕见，但确实可能发生。因此，应考虑咪达唑仑引起过敏反应的可能性，并始终做好治疗准备。
