Although anaphylactic shock during the perioperative period is rare, it can be lethal due to severe cardiovascular and respiratory collapse. Midazolam is generally used as premedication for relieving anxiety about the operation, and the danger of anaphylactic shock after intramuscular injection is not widely recognized. We report the first case of anaphylactic shock occurring during the perioperative period after intramuscular injection of midazolam. Since anaphylactic shock after intramuscular injection can be of slow onset, the operation should be delayed if an anaphylactic reaction is suspected, even if the symptoms are limited. In addition, anesthesiologists should be prepared for the occurrence of anaphylaxis at any time in the perioperative period.
Anaphylaxis* ; Anxiety ; Injections, Intramuscular* ; Midazolam* ; Perioperative Period* ; Premedication

BACKGROUND: The primary outcome of sugammadex reversal for rocuronium-induced neuromuscular block (NMB) is a train-of-four ratio (TOFR) of 0.9, not first twitch (T1) height. We investigated whether the recovery of TOFR or T1 differs based on the reversal of NMB with neostigmine or sugammadex. METHODS: The acceleromyographic responses from 0.6 mg/kg of rocuronium were monitored supramaximally in 80 patients after induction of anesthesia. The TOFR and T1 height were recorded, and saved in a personal computer using TOF-Watch SX Monitor software in all patients. Patients were randomly assigned to 2 groups to receive either neostigmine 50 µg/kg with glycopyrrolate 10 µg/kg (neostigmine group, n = 40) or sugammadex 2.0 mg/kg (sugammadex group, n = 40). The primary objective was to determine the difference of recovery time between TOFR to 0.9 and T1 to 0.9 after sugammadex or neostigmine administration during moderate rocuronium-induced NMB. RESULTS: The recovery pattern of the TOFR 2 min after sugammadex administration was 1.0 or more, but that of T1 was less than 90% (T1 / control value) up to 6 min after drug was injected. The recovery pattern of TOFR and T1 was similar during the 20 min after reversal with neostigmine. CONCLUSIONS: If you have not performed the T1 monitoring, both TOFR and T1 should be considered to confirm suitable recovery during the 6 min after reversal with sugammadex during rocuronium-induced moderate NMB.
Anesthesia ; Depression* ; Glycopyrrolate ; Humans ; Microcomputers ; Neostigmine ; Neuromuscular Blockade* ; Neuromuscular Monitoring

Anaphylaxis during the perioperative period is rare, but it still causes severe cardiovascular and respiratory collapse that can be fatal. In particular, when using antibiotics that have a high risk of hypersensitivity reactions, it is important to establish that intradermal skin tests are negative before using antibiotics. We report a case of anaphylactic shock occurring during general anesthesia after using an intradermal skin test-negative antibiotic. Regrettably, negative results of intradermal skin tests before using antibiotics do not completely eliminate the risk of anaphylaxis. Therefore, anesthesiologists should be prepared for anaphylaxis to occur at any point during the perioperative period.
Anaphylaxis* ; Anesthesia, General* ; Anti-Bacterial Agents ; Hypersensitivity ; Intradermal Tests ; Perioperative Period ; Skin Tests ; Skin*