{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:54:49Z","timestamp":1787500489486,"version":"build-2736575974"},"reference-count":19,"publisher":"The Korean Society of Anesthesiologists","issue":"3","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["anesth-pain-med.org"],"crossmark-restriction":true},"short-container-title":["Anesth Pain Med"],"published-print":{"date-parts":[[2026,7,31]]},"abstract":"<jats:p>Background: Reports of remimazolam formulation-associated anaphylaxis are increasing as its use expands. Between 2023 and 2025, we identified two severe reactions among 1,592 patients who received remimazolam at our institution.Case: A 65-year-old man (American Society of Anesthesiologists physical status [ASA PS] III) with end-stage renal disease developed profound hypotension without cutaneous signs after induction with 10 mg of remimazolam and peri-induction cefazedone administration. Surgery was cancelled due to persistent hypotension. Serum tryptase measured 6 h after the event was 38.0 \u03bcg\/L; however, delayed skin testing was negative. Subsequent propofol-based anesthesia without cefazedone re-administration was uneventful. A 50-year-old woman (ASA PS I) developed hypotension and facial flushing within 2 min of receiving 10 mg of remimazolam. Although serum tryptase levels remained within the normal range (5.3 and 5.1 \u03bcg\/L), delayed skin testing for remimazolam was positive.Conclusions: Diagnosis of remimazolam formulation-associated hypersensitivity may remain inconclusive when based on a single diagnostic test. Accurate evaluation requires integrating timed tryptase, delayed skin testing, and careful evaluation of exposure history.<\/jats:p>","DOI":"10.17085\/apm.26622","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:21:04Z","timestamp":1784784064000},"page":"368-374","update-policy":"https:\/\/doi.org\/10.17085\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Suspected remimazolam formulation-associated peri-induction anaphylaxis: two cases highlighting diagnostic complexity - Two case reports -"],"prefix":"10.17085","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3016-6450","authenticated-orcid":true,"given":"Hyun-Seong","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2019-4161","authenticated-orcid":true,"given":"Min Woo","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8064-9904","authenticated-orcid":true,"given":"Daeseok","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2573","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-020-01299-8"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1101728"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2147\/dddt.s490179"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.17085\/apm.21115"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1097\/eja.0000000000001794"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60060971"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.waojou.2020.100472"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1111\/all.13820"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-025-02915-5"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2021.02.012"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.04.044"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.01.031"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.07.047"},{"key":"ref14","first-page":"841","volume-title":"Remimazolam and serious adverse events: a scoping review","author":"Kempenaers","year":"2023"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2007.01347.x"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16206"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2021.04.010"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.014"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2023.02.018"}],"container-title":["Anesthesia and Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-26622.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.26622","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-26622.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T06:50:16Z","timestamp":1785307816000},"score":1,"resource":{"primary":{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.26622"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.17085\/apm.26622","relation":{},"ISSN":["1975-5171","2383-7977"],"issn-type":[{"value":"1975-5171","type":"print"},{"value":"2383-7977","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"assertion":[{"value":"2026-03-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-23","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-31","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}