Anaphylactic shock caused by intramuscular injection of midazolam during the perioperative period: a case report

Kim, Kyu Nam; Kim, Dong Won; Sin, Yeong Hun; Lee, Soo Kyung

doi:10.4097/kjae.2016.69.5.510

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…Approximately, 85% of the reported cases presented with generalized skin symptoms. Kim et al described a case in which a 59-year-old male scheduled to undergo an orthopedic procedure presented with urticarial skin rashes of the upper and lower extremities 30 minutes following the administration of midazolam [ 9 ]. The serum tryptase level was measured confirming anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

Delayed Anaphylactic Reaction to Midazolam in the Absence of Immediate Respiratory or Skin Manifestations

Winegarner,

Kendall,

Stephen

et al. 2023

Case Reports in Anesthesiology

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Anaphylaxis, a type 1 hypersensitivity reaction, is a feared but uncommon complication of medications administered in the perioperative period. The incidence of perioperative hypersensitivity reactions has been reported to range from 1 in 20,000 to 1 in 1,361. Anesthesiologists are well aware of common causes of hypersensitivity such as paralytics and antibiotics; however, less common triggers of anaphylaxis need to be considered as well. Midazolam, a short acting benzodiazepine metabolized by cytochrome P450 enzymes, is considered very safe with a minimal risk profile. Previous reports have described adverse reactions to occur within seconds to minutes following the administration of midazolam. We describe a patient with no known history of asthma or allergies who underwent elective hydrocelectomy with spinal analgesia without incident until 42 minutes later at the conclusion of the procedure, when they experienced circulatory collapse necessitating immediate emergency treatment. This case emphasizes the necessity to improve knowledge and awareness of delayed hypersensitivity reactions following the administration of perioperative medications such as midazolam.

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Section: Discussionmentioning

confidence: 99%

Delayed Anaphylactic Reaction to Midazolam in the Absence of Immediate Respiratory or Skin Manifestations

Winegarner,

Kendall,

Stephen

et al. 2023

Case Reports in Anesthesiology

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“…A total of 2 cases of allergic reactions caused by intravenous injection have been reported worldwide, [ 5 , 6 ] an anaphylactoid reaction caused by intravenous injection, [ 7 ] 1 case of allergic reaction caused by intramuscular injection. [ 8 ] There are no reports of allergies in penehyclidine and prednisolone.…”

Section: Discussionmentioning

confidence: 99%

Serious bronchospasm induced by cisatracurium besylate

Wang

Zhang

et al. 2021

Medicine

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Rationale: Cis-atracurium as an intermediate-acting non-depolarizing neuromuscular blocker is widely used clinically with less causing cyclic fluctuations and less histamine release. As the use rate increases, allergic reactions and anaphylactoid reactions caused by cis-atracurium increase. Patient concerns: A 23-year-old woman underwent laparoscopic bariatric surgery. Airway spasm occurred after anesthesia induction and the operation was suspended. After adjustment, the anesthesia was performed with the same anesthetic scheme again. After induction, skin flushing and airway resistance increased, then the symptoms were relieved. When the cis-atracurium was given again, the symptoms of airway spasm reappeared immediately, and after communicating with the family, the operation was successfully completed with rocuronium. Diagnoses: Serious bronchospasm induced by cisatracurium besylate. Interventions: The patient was undergone assisted ventilation with continuous positive airway pressure (CPAP) and aminophylline 250 mg, methylprednisolone 80 mg were given intravenously. Outcomes: There was no any obvious discomfort in the patient's self-report during the next day's visit. The patient was discharged 7 days later. No abnormalities were observed during following 4 weeks. Lessons: Although the anaphylactoid reactions caused by cis-atracurium are rare, the bronchospasm and anaphylactic shock caused by it greatly increase the risk of anesthesia, which should be taken seriously by clinicians. Increased vigilance in diagnosis, and treatment are essential to prevent aggravation and further complication.

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“…Midazolam, farklı klinik alanlarda sedasyon amacıyla kullanılabilen kısa etkili bir benzodiazepindir (1). Kısa yarı ömürlü olması ve antidotunun (flumazenil) bulunması nedeniyle küçük girişimsel işlemlerde daha çok tercih edilmektedir.…”

Section: çOcuk Hematoloji-onkoloji Servisinde Midazolam Anafilaksisi unclassified

“…Midazolamla anafilaksi çok nadirdir ve birkaç olgu sunumunda bildirilmiştir. Bu bildirilerde anafilaksi ya da anafilaksi benzeri tepki erişkin hastalarda görülmüştür ve ameliyathanelerde gelişmiştir (1,3,5). Ancak bizim olgumuzda anafilaksi Çocuk Hematoloji-Onkoloji Servisi'nde gelişmiştir ve tedaviyle bulgular hızla düzelmiştir.…”

Section: çOcuk Hematoloji-onkoloji Servisinde Midazolam Anafilaksisi unclassified

Anaphylaxis with midazolam in pediatric hematologyoncology unit: a case report

et al. 2018

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Anaphylactic shock caused by intramuscular injection of midazolam during the perioperative period: a case report

Cited by 8 publications

References 14 publications

Delayed Anaphylactic Reaction to Midazolam in the Absence of Immediate Respiratory or Skin Manifestations

Delayed Anaphylactic Reaction to Midazolam in the Absence of Immediate Respiratory or Skin Manifestations

Serious bronchospasm induced by cisatracurium besylate

Anaphylaxis with midazolam in pediatric hematologyoncology unit: a case report

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