Midazolam anaphylaxis during general anesthesia

Jeon, Young‐Woo; Shim, JinWoo; Jun, Eun Hwa; Choi, Seung Tae; Jung, Hoon

doi:10.1097/md.0000000000017405

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…It might also be advisable to avoid other benzodiazepines such as midazolam or diazepam as there is a suspicion of cross-antigen responses [5]. Midazolam-induced anaphylaxis has been reported to be successfully managed by standard anaphylaxis treatment as well as additional flumazenil administration [6].…”

Section: Discussionmentioning

confidence: 99%

Remimazolam anaphylaxis confirmed by serum tryptase elevation and skin test

Yamaoka

Kuroda

Matsumoto

et al. 2022

Anaesthesia Reports

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Summary Anaphylactic reactions during the induction of general anaesthesia are rare. Anaesthetists should determine the pathogenesis of anaphylaxis in order to establish appropriate treatment and prevent recurrence. Very little clinical information has been published to date about anaphylaxis induced by the recently launched drug remimazolam. A 78‐year‐old man, scheduled for elective surgery for colon cancer, became profoundly hypotensive and hypoxic shortly following the induction of general anaesthesia with remimazolam, remifentanil and rocuronium. His physiological derangement was successfully managed with adrenaline, vasopressors and intravenous fluid resuscitation. His serum tryptase level was significantly elevated and an intradermal test with diluted remimazolam revealed a positive reaction, confirming the diagnosis of anaphylaxis. We believe this is the first case report of remimazolam‐induced anaphylactic shock diagnosed with a serum tryptase elevation and positive skin test.

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Section: Discussionmentioning

confidence: 99%

Remimazolam anaphylaxis confirmed by serum tryptase elevation and skin test

Yamaoka

Kuroda

Matsumoto

et al. 2022

Anaesthesia Reports

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“…Midazolam anaphylaxis only occurs rarely (1.4% according Kim 7 ) and is sparingly described in the literature. 13,14 The current study highlights that rare adverse reactions such as anaphylactic shock do occasionally occur and that emergency equipment should be available everywhere in the hospital, even in the consultation wards. Moreover, special needs patients should be carefully monitored because they often have confounding medical disabilities and because they have difficulties expressing themselves especially when something is wrong.…”

Section: Discussionmentioning

confidence: 88%

Morbidity and Mortality Review in a University Dental Hospital: A Necessary Tool to Improve Quality of Care

et al. 2021

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Objective The study aimed to describe and to analyze the first morbidity and mortality review (MMRs) set up within a Dental University Hospital using detailed case reports to highlight the benefits of MMRs for patients, practitioners, teachers and to implement appropriate protocols to prevent recurrence. Materials and Methods The MMRs were performed within the dentistry departments of the hospital over the 1-year study period. Each case was reviewed according to a protocol based on a tool defined by the Clinical Risk Unit and the Association of Litigation and Risk Management (ALARM). Results Four cases were selected based on an oral report by a doctor from the dental service, a downstream service, or by the attending physician. The first case report related to a patient who suffered a breathing shock. The second concerned a tooth inhalation by a young disabled boy. The third was a therapeutic failure instigated by a student during a tooth preparation, and the fourth case involved an unexpected face-to-face meeting between a prisoner accompanied by police guards and an ancient victim at the dental hospital. Discussion Clinical incidents were investigated with the ALARM protocol. This process is also less focused on the individual who makes the error and more on contributing systemic factors. The systematic analysis of cases associated with bibliographic reviews improves learning and performance outcomes. Clear answers were given in response to the problems raised during these MMRs. Conclusion In dental hospitals, the culture of MMRs needs to be integrated into resident training like in medical hospitals.

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“…However, in connection with a buccal administration of midazolam, a grade 2 anaphylactic reaction had to be treated after a seizure, which did not result in further injury or require intensive medical treatment. This side effect has been published repeatedly ( 27 , 28 ) and is considered as a rare complication of midazolam ( 29 ). Our experience appears to be consistent with the limited data available in the literature.…”

Section: Discussionmentioning

confidence: 95%

Out-of-Hospital Emergencies in Children Under Palliative Home Care

Hauch¹,

Mohaui²,

Wolff

et al. 2021

Front. Pediatr.

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Introduction: Specialized palliative home care (SPHC) enables children and adolescents with life-limiting illnesses and complex needs to receive care at home. In addition to controlling symptoms and stabilizing the psychosocial situation, crisis anticipation is a component of SPHC. Since the establishment of the reporting SPHC team, parents have called for additional help from emergency medical services (EMS) in emergency situations with unexpected frequency. Children with life limiting diseases could undergo invasive procedures and unhelpful treatments with uncertain consequences. The questions arose as to which factors led to the involvement of the EMS in a palliative situation, what therapy was performed and what outcome could be reached.Methods: Records of the pediatric SPHC patients and EMS call-outs in these children of the reporting SPHC-team in the central region of Hesse, Germany (population: 1.1 million) were retrospectively analyzed from 01.11.2014 to 01.05.2021. The causes of the call-outs, the existence of an emergency agreement, the National Advisory Committee for Aeronautics (NACA) score, EMS therapy and outcome were examined. Patient data included age, palliative-justifying diagnosis, duration and intensity of care, place of death and median overall survival (MOS) and palliative SHPC treatment.Results: In total, 172 patients were analyzed during the study period. There were 27 EMS calls for a total of 20 patients/families (= EMS group). Palliative illness or a complication was the most frequent cause of call-outs. The patients in the EMS group were significantly less likely to have a DNR order, required more home visits and telephone calls and were under SPHC care for longer. There was a significantly higher proportion of crisis interventions at home visits. The children in the EMS group died less often from the underlying disease. Of the remaining 152 patients (= non-EMS group), a significantly higher proportion had a European home country.Conclusions: Despite the introduction of the SPHC, parents still call the EMS. Good cooperation and joint training should be sought to prepare all those involved for future call-outs.

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Midazolam anaphylaxis during general anesthesia

Cited by 9 publications

References 13 publications

Remimazolam anaphylaxis confirmed by serum tryptase elevation and skin test

Remimazolam anaphylaxis confirmed by serum tryptase elevation and skin test

Morbidity and Mortality Review in a University Dental Hospital: A Necessary Tool to Improve Quality of Care

Out-of-Hospital Emergencies in Children Under Palliative Home Care

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