Remimazolam-Induced Anaphylaxis and Cardiovascular Collapse: A Narrative Systematic Review of Eleven Cases
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
- Patient Assessment
- Conduct a thorough medical history and allergy assessment before administration.
- Identify patients with a history of drug allergies, asthma, or other risk factors for anaphylaxis.
- Dosage and Administration: Adhere strictly to the recommended dosages.
- Use 6 mg/kg/h or 12 mg/kg/h for induction and 1–2 mg/kg/h for maintenance during general anesthesia with continuous infusion. For procedural sedation, administer 5 mg intravenously over a minimum of 1 min, with supplementary doses of 2.5 mg over at least 15 s with 2 min intervals.
- Avoid rapid administration of maximum doses to reduce the risk of adverse reactions.
- Monitoring
- Continuously monitor the cardiovascular and respiratory status, including the blood pressure, heart rate, and oxygen saturation.
- Utilize electrocardiography (ECG) to monitor the cardiac function, especially in patients with cardiovascular risk factors.
- Preparedness for Anaphylaxis
- C.
- Have emergency equipment and medications readily available, including epinephrine, antihistamines, corticosteroids, and resuscitation equipment.
- D.
- Train all medical staff in the recognition and management of anaphylaxis.
- Immediate Response
- E.
- At the first sign of anaphylaxis, immediately discontinue remimazolam and administer epinephrine intramuscularly (0.01 mg/kg, up to 0.5 mg for adults) or intravenously in cases of cardiovascular collapse.
- F.
- Follow with antihistamines and corticosteroids to manage symptoms.
- Post-Reaction Management
- Measure serum tryptase levels to confirm anaphylaxis and document the reaction.
- Provide intensive care and continuous monitoring until the patient stabilizes.
- Documentation and Reporting
- Document all adverse reactions thoroughly and report them to relevant health authorities to improve incidence tracking and pharmacovigilance.
5. Conclusions
6. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
RIA | Remimazolam-Induced Anaphylaxis |
PA | Perioperative Anaphylaxis |
WAO | World Allergy Organization |
IV | Intravenous |
IM | Intramuscular |
PRISMA | Preferred Reporting Items for Systematic reviews and Meta-Analyses |
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Variable | Value | |
---|---|---|
Age (years) | 55.6 (19.6) | |
Female/Male | 2 (18.2)/9 (81.8) | |
Country | ||
China | 1 (9.1) | |
Japan | 5 (45.5) | |
Korea | 5 (45.5) | |
Type of anesthesia | ||
General anesthesia | 10 (90.9) | |
Monitored anesthetic care | 1 (9.1) | |
Specific medical history | ||
Allergic history | 1 (9.1) | |
Autoimmune disease | 1 (9.1) | |
Use of remimazolam on induction | ||
Bolus only | 2 (18.2) | |
Continuous infusion | 5 (45.5) | |
Combination (bolus + continuous) | 4 (36.4) |
Variable | Value | |
---|---|---|
Cutaneous system | ||
Erythema | 2 (18.2) | |
Rash | 3 (27.3) | |
Edema | 2 (18.2) | |
Respiratory system | ||
Desaturation | 4 (36.4) | |
Stridor or wheezing | 2 (18.2) | |
Bronchospasm | 1 (9.1) | |
Cardiovascular system | ||
Hypotension | 9 (81.8) | |
Tachycardia | 6 (54.5) | |
Cardiac arrest | 2 (18.2) | |
ST change | 2 (18.2) |
Reference | Type | Age (Year) | Sex | Height (cm) | Weight (kg) | Medical History | Total Dose (mg) | Induction Dose | Route of Epinephrine | Acute Phase Test | Skin Test for Anaphylaxis |
---|---|---|---|---|---|---|---|---|---|---|---|
Hasushita [20] | GA | 72 | Male | 166.0 | 61.0 | Allergy (+) * | 72 | 12 mg + 10 mg/kg/h | BIV + CIV | T (A/B) | (+): R (−): D |
Hu [21] | MAC | 41 | Male | 165.0 | 63.0 | None | 10 | 10 mg | BIV | H | (+): M (−): R, D |
Kim [19] | GA | 65 | Male | 177.3 | 75.0 | None | 98.8 | 12 mg/kg/h | CIV | T (A/B) | (−): R, M UC: D |
Kim [19] | GA | 69 | Male | 167.3 | 64.3 | None | 78 | 12 mg/kg/h | CIV | T (A/B) | No process |
Kim [19] | GA | 66 | Male | 165.3 | 53.2 | None | 57.4 | 12 mg/kg/h | BIV | T (A/B) | (−): R, M UC: D |
Kim [19] | GA | 23 | Female | 161.6 | 65.7 | Crohn’s disease | 26 | 12 mg/kg/h | BIV | T (A/B) | (−): R, M UC: D |
Kim [19] | GA | 33 | Female | 168.3 | 60.1 | None | 8.44 | 2 mg/kg/h | BIV | T (A/B) | (−): R, M UC: D |
Tsurumi [17] | GA | 32 | Male | 162.0 | 60.0 | None | 15 | 12 mg + 6 mg/kg/h | BIM + BIV | T (A) | (+): R, M UC: D |
Uchida [18] | GA | 74 | Male | 157.0 | 78.0 | None | UC | 4 mg + 1 mg/kg/h | BIV | T (A/B) | No process |
Uchida [18] | GA | 59 | Male | 176.0 | 52.0 | None | 9 | 9 mg | BIV | T (A/B) | (−): R UC: D |
Yamaoka [22] | GA | 78 | Male | 148.0 | 55.0 | None | 11 | 11 mg + 12 mg/kg/h | BIM + CIV | T (A/B) | (+): R UC: D |
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Lee, J.; Kim, S.-H. Remimazolam-Induced Anaphylaxis and Cardiovascular Collapse: A Narrative Systematic Review of Eleven Cases. Medicina 2024, 60, 971. https://doi.org/10.3390/medicina60060971
Lee J, Kim S-H. Remimazolam-Induced Anaphylaxis and Cardiovascular Collapse: A Narrative Systematic Review of Eleven Cases. Medicina. 2024; 60(6):971. https://doi.org/10.3390/medicina60060971
Chicago/Turabian StyleLee, Jaemoon, and Seong-Hyop Kim. 2024. "Remimazolam-Induced Anaphylaxis and Cardiovascular Collapse: A Narrative Systematic Review of Eleven Cases" Medicina 60, no. 6: 971. https://doi.org/10.3390/medicina60060971