Delayed Postoperative Agitation in a Child After Preoperative Midazolam

Emergence Delirium with Transient Associative Agnosia and Expressive Aphasia Reversed by Flumazenil in a Pediatric Patient

“…12 Short-duration surgeries, facilitated by anesthesia with insoluble volatile anesthetics leading to rapid emergence, clearly contribute. Rapidly changing volatile drug brain concentrations along with short-acting benzodiazepine offset likely restores primitive arousal networks in the absence of proper reconnection of higher order neural networks required for full cognitive processing.…”

“…Flumazenil has not been reported to treat sevoflurane-associated ED in the absence of benzodiazepine exposure, but it has been reported to reverse paradoxical midazolam reactions. 9–12 Typically only 1 dose is required despite large prior doses of midazolam. Most reports note that flumazenil administration stops disruptive behavior but does not completely reverse sedation or amnesia.…”

“…8–10 Flumazenil, a competitive antagonist at the benzodiazepine binding site of the γ-aminobutyric acid type A (GABA A ) receptor, has been used to successfully treat postoperative ED associated with midazolam exposure. 11–12 Though some recommend midazolam for treatment of ED, 13 additional midazolam may worsen symptoms for this subset of children with ED. 12,14–15 …”

“…11–12 Though some recommend midazolam for treatment of ED, 13 additional midazolam may worsen symptoms for this subset of children with ED. 12,14–15 …”

Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: A case-control study

“…To avoid the fear to mask induction and to ensure that the children had similar baseline levels of anxiety in all study groups, which has been shown to contribute to emergence agitation, we adopt midazolam IV when the children with their parents and propofol to cease the fear to mask induction [17][18][19]. 25% children displayed the emergence agitation in Placebo group, suggesting that the adopting midazolam and propofol as anesthetics during induction cannot decrease the ratio of emergence agitation after tonsillectomy in children.…”