Facial edema and pruritus after intravenous injection of midazolam

Midazolam is a short-acting benzodiazepine commonly used for conscious sedation for a variety of procedures. Severe adverse reactions, including respiratory depression, respiratory arrest, and anaphylactoid reaction, have been described by manufacturers. We report a patient who developed facial edema after iv injection of midazolam during caesarian section. A 26-year-old woman with a history of atopy and pollen allergy was scheduled for caesarian section. Spinal anesthesia was induced with bupivacaine without significant medical problems. Shortly after receiving 2 mg of iv midazolam 15 minutes after delivery for conscious sedation, she developed pruritus and severe facial edema. Airway obstruction did not occur and no specific medical treatment was necessary. However she was not able to open her eyes for 8 hours because of severe eyelid swelling. We should be more careful in administering midazolam which is generally regarded as safe and well tolerated.