Respiratory depression in children receiving diazepam for acute seizures: a prospective study

Abstract

The aim of this study was to determine the incidence of respiratory depression following the use of diazepam in children presenting with seizures. All children presenting with seizures to a children's A & E department over a period of 9 months were studied prospectively. Respiratory depression was defined as a fall in respiratory rate or oxygen saturation, or apnoea resulting in ventilation or resuscitation with bag-and-mask oxygen. There were 130 patient episodes involving 97 children who received treatment for their seizures before admission and/or in the A & E department. Administration of diazepam resulted in 122 patient episodes. The route of administration was rectal in 91 episodes, intravenous in 12 episodes, and both rectal and intravenous in 19 episodes. Eleven children had respiratory depression in relation to diazepam administration. Eight of these children required ventilation. The overall incidence of respiratory depression following the use of diazepam was 9%. The incidence of respiratory depression following diazepam given intravenously or rectally is high. The use of diazepam as first-line therapy for children with acute seizures needs to be reviewed.

Inappropriate emergency management of status epilepticus in children contributes to need for intensive care

“…Compared to a prospective study of children presenting to A&E with seizures, our study reports a similar proportion of children requiring ventilation for respiratory depression associated with administration of benzodiazepines (64% v 57%). 18 The association of more than two doses of benzodiazepine with respiratory depression has been noted previously. 19 Our data, which show a strong association between prehospital treatment and the administration of more than two doses of benzodiazepine, and between prehospital treatment and the risk of respiratory depression, support the hypothesis that physicians who disregard prehospital treatment may give more doses of benzodiazepine than those who do take prehospital treatment into account.…”

Buccal, intranasal or intravenous lorazepam for the treatment of acute convulsions in children in Malawi: An open randomized trial

“…Historically, diazepam has been used; it is widely available, inexpensive and acts rapidly but it is short acting, breakthrough seizures are common and can cause respiratory depression. [11][12][13][14] Midazolam can be given by buccal, intranasal and intramuscular routes. Buccal midazolam is as effective as rectal diazepam 7,15-18 but it is short acting 19 and consequently associated with seizure recurrence.…”

Determination of midazolam and its major metabolite 1′-hydroxymidazolam by high-performance liquid chromatography-electrospray mass spectrometry in plasma from children

“…However, diazepam has several disadvantages, such as incomplete and erratic absorption following intramuscular (i.m.) administration [2], and accumulation on repeated administration that may lead to fatal respiratory depression [3,4]. Intravenous (i.v.)…”