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An Unusual Case of Delayed Midazolam Anaphylaxis and a Review of the Current Literature
Nicholas C Cochran-Caggiano1, Deborah Mann1, Peter J Aiello2,3
1Upstate University Hospital, Department of Emergency Medicine, Syracuse, NY (NCC, DM).
Insights
Anaphylaxis after intranasal midazolam is rare but possible. This case highlights the importance of recognizing this severe allergic reaction in children, even with commonly used medications.
Area of Science:
- Emergency Medicine
- Pediatric Sedation
- Pharmacology
Background:
- Midazolam is a widely used sedative and anxiolytic, particularly in pediatric emergency care.
- Intranasal administration offers a safe and effective route for midazolam, especially in children.
- Adverse drug reactions, including anaphylaxis, are rare but possible with midazolam.
Purpose of the Study:
- To report a rare case of anaphylaxis following intranasal midazolam administration in a child.
- To emphasize the importance of considering anaphylaxis in the differential diagnosis of adverse reactions to midazolam.
Main Methods:
- Case report of a 10-year-old patient.
- Administration of intranasal midazolam for computed tomography (CT) scan sedation.
- Clinical observation and management of anaphylaxis.
Main Results:
- The patient experienced anaphylaxis after receiving intranasal midazolam.
- Prompt recognition and management were crucial for patient recovery.
Conclusions:
- Anaphylaxis to midazolam, though uncommon, can occur via the intranasal route.
- Awareness of this potential adverse reaction is vital for timely diagnosis and treatment in pediatric patients.
Abstract:
Midazolam is a commonly used, well-tolerated, anxiolytic, sedative, anesthesia induction agent, and an adjunct for procedural sedation that is used widely in the emergency department. The ability to administer midazolam via multiple routes, including intranasal, makes it a particularly common choice for use in children. Intranasal administration is safe, easy, and well tolerated and has been shown to be an effective method of obtaining anxiolysis and/or sedation. Adverse drug reactions, including allergic reactions, can occur with any medication. However, anaphylaxis is an uncommon phenomenon from midazolam. Despite being one of the most common medications used in the emergency department and operating room, there are only a handful of unequivocal cases of anaphylaxis secondary to midazolam. The rarity of this presentation may lead to delays in care and potential adverse outcomes as a result. We present one such case of a 10-year-old patient who experienced anaphylaxis after administration of intranasal midazolam to facilitate a computed tomography scan.
