J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

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Case Report

Volume 17, Number 5, May 2026, pages 226-230

Local Urticarial Reaction Above the Site of an Intravenous Cannula: Possible Allergy to Remimazolam in a Fourteen-Year-Old Adolescent

↓ **Table 1.** Previous Reports of Allergic and Anaphylactoid Reactions With Remimazolam
Author and reference	Demographic data and procedure	Reaction noted	Treatment/outcomes
IV: intravenous; ACLS: advanced cardiovascular life support.
Tsurumi et al, 2021 [13]	32-year-old male undergoing hand surgery	Hypotension, hypoxemia, facial flushing	Ephedrine, epinephrine, endotracheal intubation/returned to baseline status
Uchida et al, 2022 [14]	74-year-old male with severe burn injury undergoing debridement and skin grafting	Hypotension, hypoxemia in patient 1	Norepinephrine, epinephrine, crystalloid/returned to baseline in patient 1.
	59-year-old male undergoing laparoscopic-assisted sigmoid colectomy	Hypotension, tachycardia in patient 2	Ephedrine, phenylephrine, epinephrine/returned to baseline in patient 2.
Yamaoka et al, 2022 [15]	78-year-old male with colon cancer undergoing bowel resection surgery	Hypotension, hypoxemia, bronchospasm	Ephedrine, phenylephrine, norepinephrine, IV fluids/returned to baseline
Hasushita et al, 2022 [16]	72-year-old male undergoing video-assisted thoracoscopic left-lung segmentectomy	Abdominal erythema, hypotension, cardiac arrest	Chest compressions, 100% oxygen ventilation, fluid resuscitation, epinephrine/resuscitation successful and return to baseline
Kim et al, 2022 [17]	Case series of five patients with ages ranging 23–69 years undergoing inguinal herniorrhaphy, umbilical herniorrhaphy, ileostomy takedown, ileocecal resection, thyroidectomy	Cardiovascular collapse, ST-segment elevation, cardiac arrest, tachycardia, dyspnea, cough, chest tightness, facial flushing and skin rash	Vasoactive agents, including ephedrine, phenylephrine, and epinephrine; isotonic fluids; standard ACLS resuscitation/returned to baseline in all five patients.
Hu et al, 2023 [18]	41-year-old male undergoing colonoscopy	Facial erythema, periorbital edema, epiglottic edema, hypotension	Epinephrine/returned to baseline
Lee et al, 2023 [19]	51-year-old male undergoing humeral pinning	Hypotension, rash on chest	Dexamethasone, epinephrine infusion/returned to baseline; remimazolam intravenous provocation test positive
Nakai et al, 2024 [20]	75-year-old male with gastric cancer undergoing robot-assisted gastrectomy	Tracheal and bronchial edema, rash on abdomen and thighs, hypotension, cardiac arrest	Ephedrine, phenylephrine, chest compressions/successful resuscitation, returned to baseline
Mani et al, 2024 [21]	77-year-old male with mastocytosis undergoing central line placement	Hypotension, hyperventilation, tachycardia, hypoxia	Dexamethasone, diphenhydramine, famotidine, phenylephrine, high-flow oxygen/returned to baseline
Rita et al, 2025 [22]	61-year-old female undergoing colonoscopy	Erythema of the trunk	Clorfenamine, hydrocortisone/returned to baseline

↓ Table 1. Previous Reports of Allergic and Anaphylactoid Reactions With Remimazolam

Author and reference

Demographic data and procedure

Reaction noted

Treatment/outcomes

IV: intravenous; ACLS: advanced cardiovascular life support.

Tsurumi et al, 2021 [13]

32-year-old male undergoing hand surgery

Hypotension, hypoxemia, facial flushing

Ephedrine, epinephrine, endotracheal intubation/returned to baseline status

Uchida et al, 2022 [14]

74-year-old male with severe burn injury undergoing debridement and skin grafting

Hypotension, hypoxemia in patient 1

Norepinephrine, epinephrine, crystalloid/returned to baseline in patient 1.

59-year-old male undergoing laparoscopic-assisted sigmoid colectomy

Hypotension, tachycardia in patient 2

Ephedrine, phenylephrine, epinephrine/returned to baseline in patient 2.

Yamaoka et al, 2022 [15]

78-year-old male with colon cancer undergoing bowel resection surgery

Hypotension, hypoxemia, bronchospasm

Ephedrine, phenylephrine, norepinephrine, IV fluids/returned to baseline

Hasushita et al, 2022 [16]

72-year-old male undergoing video-assisted thoracoscopic left-lung segmentectomy

Abdominal erythema, hypotension, cardiac arrest

Chest compressions, 100% oxygen ventilation, fluid resuscitation, epinephrine/resuscitation successful and return to baseline

Kim et al, 2022 [17]

Case series of five patients with ages ranging 23–69 years undergoing inguinal herniorrhaphy, umbilical herniorrhaphy, ileostomy takedown, ileocecal resection, thyroidectomy

Cardiovascular collapse, ST-segment elevation, cardiac arrest, tachycardia, dyspnea, cough, chest tightness, facial flushing and skin rash

Vasoactive agents, including ephedrine, phenylephrine, and epinephrine; isotonic fluids; standard ACLS resuscitation/returned to baseline in all five patients.

Hu et al, 2023 [18]

41-year-old male undergoing colonoscopy

Facial erythema, periorbital edema, epiglottic edema, hypotension

Epinephrine/returned to baseline

Lee et al, 2023 [19]

51-year-old male undergoing humeral pinning

Hypotension, rash on chest

Dexamethasone, epinephrine infusion/returned to baseline; remimazolam intravenous provocation test positive

Nakai et al, 2024 [20]

75-year-old male with gastric cancer undergoing robot-assisted gastrectomy

Tracheal and bronchial edema, rash on abdomen and thighs, hypotension, cardiac arrest

Ephedrine, phenylephrine, chest compressions/successful resuscitation, returned to baseline

Mani et al, 2024 [21]

77-year-old male with mastocytosis undergoing central line placement

Hypotension, hyperventilation, tachycardia, hypoxia

Dexamethasone, diphenhydramine, famotidine, phenylephrine, high-flow oxygen/returned to baseline

Rita et al, 2025 [22]

61-year-old female undergoing colonoscopy

Erythema of the trunk

Clorfenamine, hydrocortisone/returned to baseline