Flumazenil Reverses Paradoxical Reaction to Midazolam in a Child

Thakker, P; Tm, Gallagher

doi:10.1177/0310057x9602400419

Cited by 26 publications

(9 citation statements)

References 28 publications

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“…6 The other case was an 11-year-old who became agitated 40 minutes after a similar dose given before an esophagoscopy. 11 Reports suggest that side effects of midazolam occur more commonly after high doses (0.75-1 mg/kg oral), 14,15 such as in our case; however, as described above, severe agitation can occur after lower doses as well. It was unknown whether the child in this case had received midazolam in similar or smaller doses for previous surgeries.…”

Section: Discussionsupporting

confidence: 54%

“…18 Two previous cases of delayed-onset severe agitation have been reported in children who received midazolam. 6,11 In one, a 26-month-old received 0.5 mg/kg of oral midazolam for a brief procedure in the ED and became severely agitated 90 minutes later after discharge. 6 The other case was an 11-year-old who became agitated 40 minutes after a similar dose given before an esophagoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…7,11,14,16,23 Although return of tranquil behavior was noted within seconds in most cases, 24 Massanari reported a mean time to recovery of 14 Ϯ 12 minutes. 7 Interestingly, flumazenil has been reported to reverse paradoxical reactions to midazolam without reversing its sedative or amnestic effects.…”

Section: Discussionmentioning

confidence: 99%

“…been purported to reverse such adverse reactions, [11][12][13][14] common knowledge of this use is not evident in the clinical setting. This report describes a child who had a delayed paradoxical reaction to preoperative midazolam and its treatment, and discusses the risk factors, potential etiologies, and treatment of this phenomenon.…”

mentioning

confidence: 99%

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Delayed Postoperative Agitation in a Child After Preoperative Midazolam

Voepel‐Lewis¹,

Mitchell²,

Malviya³

2007

Journal of PeriAnesthesia Nursing

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Delayed Postoperative Agitation in a Child After Preoperative Midazolam

Voepel‐Lewis¹,

Mitchell²,

Malviya³

2007

Journal of PeriAnesthesia Nursing

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“…This is usually managed by eliminating other causes of distress, protecting the child from injury and unnecessary stimulation, reassuring the parents and awaiting spontaneous improvement. Paradoxically, there may be a role for sedation although recently flumazenil has been used in cases where a benzodiazepine has been implicated as a cause ( 13).…”

Section: Recovery Distressmentioning

confidence: 99%

Distress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics

Carlin

1998

Pediatric Anesthesia

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This study analysed the frequency of distress at induction (DAI) in 2122 paediatric patients. The data were analysed to assess predictors of DAI and to examine associations between predictors of DAI and recovery characteristics. Patient age, preoperative behaviour, premedication (oral midazolam, n = 480) and venue for anaesthesia induction were associated with changes in the incidence of DAI. Distressed preoperative behaviour was a good predictor of DAI in all age groups. Premedication reduced the incidence of DAI in children aged 0.5-2 years old, and in older children who were distressed preoperatively. Induction in the Day Surgery Unit was associated with a reduction of the incidence of DAI in younger children. Children with DAI were more likely to suffer from distress at arousal (P = 0.001). Average early recovery time was prolonged 4.4 minutes and average discharge time in day patients was delayed 36 minutes by the use of oral midazolam premedication. Premedication was not significantly associated with arousal distress. We conclude that a policy of optimizing nonpharmacological approaches for minimizing induction distress, combined with selective premedication with oral midazolam, can produce a low incidence of induction distress and adverse effects.

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Benzodiazepines for Sedation in Infants and Children

Shah

2006

Sleep and Sleep Disorders

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Benzodiazepines are commonly used to provide sedation for infants and children undergoing intensive care or diagnostic and therapeutic procedures in a variety of clinical settings. This chapter focuses on Midazolam as representative of this class of drug. Midazolam provides sedation by altering the neuroinhibitory pathway mediated by gammaaminobutyric acid. It is primarily metabolized by the hepatic cytochrome P450 enzyme subfamily and eliminated via the renal route. Plasma clearance of midazolam is affected by the degree of hepatic and renal immaturity in the newborn period. In addition, there is a large inter-individual variability in midazolam metabolism in neonates and children, leading to heterogeneity in drug handling.Pediatric patients, especially neonates, are therefore susceptible to adverse effects associated with the use of midazolam. Transient neurologic, respiratory and cardiovascular reactions have been reported. Although most appeared to be transient, some studies suggest that neonates exposed to midazolam may have longer-term adverse neurodevelopmental effects. Furthermore, in review of literature to date, even though midazolam infusion is efFicacious in sedating critically ill infants and children undergoing intensive care, the use of midazolam for procedural sedation in the pediatric population may be less efficacious than alternatives such as ketamine and may not be appropriate in all clinical circumstance. Therefore, until further research is done on the safety and efficacy of midazolam administration in infants and children, cautious use of this medication in this population is recommended.

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Flumazenil Reverses Paradoxical Reaction to Midazolam in a Child

Cited by 26 publications

References 28 publications

Delayed Postoperative Agitation in a Child After Preoperative Midazolam

Delayed Postoperative Agitation in a Child After Preoperative Midazolam

Distress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics

Benzodiazepines for Sedation in Infants and Children

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