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Laryngeal edema following remimazolam-induced anaphylaxis: a rare clinical manifestation
Xiawei Hu1, Yaning Tang1, Xiangming Fang2
1Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Background:
Remimazolam is an ultra-short-acting intravenous benzodiazepine, which has been used as sedative/anesthetic in procedural sedation and anesthesia. Although peri-operative anaphylaxis due to remimazolam has been reported recently, the spectrum of the allergic reactions is still not fully known.
Case Presentation:
We describe a case of anaphylaxis following remimazolam administration in a male patient undergoing colonoscopy under procedural sedation. The patient presented complex clinical signs including airway changes, skin symptoms, gastrointestinal manifestations and hemodynamic fluctuations. Different from other reported cases, laryngeal edema was the initial and main clinical feature of remimiazolam-induced anaphylaxis.
Conclusions:
Remimazolam-induced anaphylaxis has a rapid onset and complex clinical features. This case reminds anesthesiologists should be particularly alert to the unknown adverse reactions of new anesthetics.
Insights
Remimazolam, an ultra-short-acting anesthetic, can cause anaphylaxis with rapid onset and complex symptoms, including laryngeal edema. Anesthesiologists must remain vigilant for these rare adverse reactions in patients receiving this new drug.
Area of Science:
- Anesthesiology
- Pharmacology
- Allergy and Immunology
Background:
- Remimazolam is an ultra-short-acting intravenous benzodiazepine used for procedural sedation and anesthesia.
- While effective, peri-operative anaphylaxis has been reported, but the full spectrum of allergic reactions remains unclear.
Observation:
- A case of anaphylaxis following remimazolam administration during a colonoscopy is presented.
- The patient exhibited complex signs: airway compromise, skin symptoms, gastrointestinal issues, and hemodynamic instability.
- Notably, laryngeal edema was the primary initial manifestation, distinguishing it from previously reported cases.
Findings:
- Remimazolam-induced anaphylaxis presents with rapid onset and diverse clinical features.
- Laryngeal edema can be the predominant initial symptom.
Implications:
- This case highlights the importance of recognizing uncommon adverse reactions to new anesthetic agents.
- Anesthesiologists should maintain a high index of suspicion for remimazolam-induced anaphylaxis.
- Awareness of potential allergic responses is crucial for patient safety during procedural sedation and anesthesia.
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