背景:雷马唑仑是最近开发的,用作全身麻醉药的超短作用苯二氮卓类药物。已经报道了一些瑞米唑仑过敏反应的病例,但是它的特征还没有被完全理解。我们提供了一个有趣的病例报告和文献综述,以更好地了解雷米咪唑仑过敏反应。
方法:一名拟行机器人辅助胃切除术的75岁男性患者,在全身麻醉诱导过程中给予瑞米唑仑。插管后,观察到低呼气末CO2,高气道压力和并发循环衰竭。支气管镜检查显示明显的气管和支气管水肿,我们诊断为过敏反应。患者在支气管镜检查后心脏骤停,但通过静脉注射肾上腺素和胸部按压立即康复。我们对诱导过程中使用的药物进行了皮肤点刺试验,除了雷米唑仑,考虑到瑞米唑仑全身不良反应的高风险。我们诊断为雷米唑仑过敏反应,因为麻醉期间使用的其他药物的皮肤点刺试验结果为阴性,在随后的手术中,这些药物可以在没有过敏反应的情况下使用。此外,该患者一年前接受心脏手术时经历了严重的过敏性反应,在使用咪达唑仑的时候,但当时人们认为它不是过敏原。基于这些发现,怀疑与瑞马唑仑和咪达唑仑有交叉反应性.然而,该患者先前接受了另一种苯二氮卓类药物,溴替唑仑,他并不过敏,这表明利马唑仑的交叉反应性可能在苯二氮卓类药物之间有所不同。在这篇文章中,我们回顾了文献中描述的11例瑞米唑仑过敏反应。
结论:雷马唑仑是一种超短作用的镇静剂;然而,会引起危及生命的过敏反应.此外,其与其他苯二氮卓类药物的交叉反应性尚未完全了解。为了增加这种药物的安全性,需要进一步的研究和更多的使用经验。
BACKGROUND: Remimazolam is a recently developed, ultrashort-acting
benzodiazepine that is used as a general anesthetic. Some cases of remimazolam anaphylaxis have been reported, but its characteristics are not fully understood. We present an interesting
case report and review of the literature to better understand remimazolam anaphylaxis.
METHODS: A 75-year-old man scheduled for robot-assisted gastrectomy was administered remimazolam for the induction of general anesthesia. After intubation, low end-expiratory CO2, high airway pressure and concurrent circulatory collapse were observed. Bronchoscopy revealed marked tracheal and bronchial edema, which we diagnosed as anaphylaxis. The patient suffered cardiac arrest after bronchoscopy but recovered immediately with intravenous adrenaline administration and chest compressions. We performed skin prick tests for the drugs used during induction except for remimazolam, considering the high risk of systemic adverse reactions to remimazolam. We diagnosed remimazolam anaphylaxis because the skin prick test results for the other drugs used during anesthesia were negative, and these drugs could have been used without allergic reactions during the subsequent surgery. Furthermore, this patient had experienced severe anaphylactic-like reactions when he underwent cardiac surgery a year earlier, in which midazolam had been used, but it was not thought to be the allergen at that time. Based on these findings, cross-reactivity to remimazolam and midazolam was suspected. However, the patient had previously received another
benzodiazepine, brotizolam, to which he was not allergic, suggesting that cross-reactivity of remimazolam may vary among benzodiazepines. In this article, we reviewed the 11 cases of remimazolam anaphylaxis that have been described in the literature.
CONCLUSIONS: Remimazolam is an ultrashort-acting sedative; however, it can cause life-threatening anaphylaxis. In addition, its cross-reactivity with other benzodiazepines is not fully understood. To increase the safety of this drug, further research and more experience in its use are needed.