{
  "abstract": "Background and Aims We present the case of a patient who developed anaphylaxis during remimazolam sedation under spinal anaesthesia, despite having undergone a same surgery with the same drug and dosage just two weeks prior without complications.Methods A 65-year-old female underwent right total knee replacement (TKR) under spinal anaesthesia with continuous remimazolam infusion. The procedure was uneventful, and the anaesthesia plan for her left TKR two weeks later followed the same protocol. Spinal anaesthesia was administered. After a second-level check, remimazolam infusion was initiated. However, within 10 minutes, the patient’s blood pressure dropped significantly, and oxygen saturation declined, necessitating an urgent conversion to general anaesthesia. Due to time constraints, the possibility of a high-level block could not be precisely assessed. A bolus dose of remimazolam (10 mg IV) was administered, followed by rocuronium (40 mg IV) for endotracheal intubation. Unexpectedly, the patient experienced cardiac arrest. After approximately 25 minutes of cardiopulmonary resuscitation, return of spontaneous circulation was achieved under ECMO support.Results Given the suspicion of anaphylaxis, drug hypersensitivity skin testing was conducted, confirming an allergic reaction to remimazolam. This case highlights the potential for severe hypersensitivity reactions upon subsequent exposure, even in patients who previously tolerated the drug without adverse effects.Abstract P008 Figure 1Vital signs flow in the operating roomConclusions In patients undergoing spinal anaesthesia-induced sympathetic blockade, diagnosing and managing drug hypersensitivity can be particularly challenging. Clinicians must remain vigilant for anaphylaxis, as reactions may not manifest during initial exposure but could become life-threatening upon re-exposure.",
  "authors": [
    {
      "affiliations": [
        "Chungnam National University, Daejeon, Republic of Korea"
      ],
      "name": "Yumin Jo"
    },
    {
      "affiliations": [
        "Chungnam National University, Daejeon, Republic of Korea"
      ],
      "name": "Chahyun Oh"
    },
    {
      "affiliations": [
        "Chungnam National University, Daejeon, Republic of Korea"
      ],
      "name": "Yoonhee Kim"
    },
    {
      "affiliations": [
        "Chungnam National University, Daejeon, Republic of Korea"
      ],
      "name": "Yongsup Shin"
    },
    {
      "affiliations": [
        "Chungnam National University, Daejeon, Republic of Korea"
      ],
      "name": "Chaeseong Lim"
    }
  ],
  "title": "P008 Anaphylaxis during remimazolam sedation under spinal anaesthesia: a case report",
  "uid": "82ec6486-859c-5970-8082-fe4b5d3c55d5"
}