The midazolam-induced paradox phenomenon is reversible by flumazenil. Epidemiology, patient characteristics and review of the literature

Weinbroum, Avi A.; Szold, Oded; Ogorek, Daniel; Flaishon, Ron

doi:10.1046/j.1365-2346.2001.00922.x

Cited by 82 publications

(48 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Midazolam may cause restlessness and disinhibition instead of sedation in some patients, and this is referred to as a paradoxical reaction. 21 Thus, surgery will then become extremely difficult. In our study, no patients experienced a paradoxical reaction with midazolam.…”

Section: Discussionmentioning

confidence: 99%

Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia

Kaya

Yavaşçaoğlu

Türker

et al. 2009

Can J Anesth/J Can Anesth

123

129

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia

Kaya

Yavaşçaoğlu

Türker

et al. 2009

Can J Anesth/J Can Anesth

123

129

View full text Add to dashboard Cite

“…Ancak bu ajanlardan propofol, fazla sedasyon ve oryantasyon bozukluğuna, benzodiazepinler konfüzyona neden olabilirken, opioid ajanlar solunum depresyonu ve oksijen desatürasyonuna yol açmaktadır. Ayrıca, geriatrik hastalarda anestetik ilaçlarla intraoperatif hemodinaminin stabilize edilmesi ve sedasyon derinliğinin sağlanması da daha zordur (13,14 Grup II midazolamın etkisi 3 dakika içinde başlarken, deksmedetomidinin etkisinin en yüksek noktaya ulaşması, infüzyon sırasında 10 dakika içinde olur (16). Bu da, çalışmamızda, deksmedetomidin uygulanan grupta 10. dakikadan itibaren BIS değerlerindeki anlamlı düşüşü açıklamaktadır.…”

Section: Discussionunclassified

Comparison of Dexmedetomidine and Midazolam in Sedation for Percutaneous Hepatic Hydatid Cyst Drainage

Bavullu¹,

Aksoy²,

Abdullayev³

et al. 2013

Turk J Anesth Reanim

View full text Add to dashboard Cite

Özgün Araştırma / Original Article 195Objective: Hydatid cyst still continues to be a public health problem. The basic treatment for the disease is surgery, but USG-guided percutaneous drainage has become an important treatment alternative. Agents preferred for sedation during drainage performed under local anaesthesia must also preserve respiration and haemodynamic stability while providing adequate sedation. We used midazolam, which has a short duration of action, and a selective α 2 adrenergic receptor agonist, dexmedetomidine, and compared them regarding their sedative properties and intraoperative complications. Methods:After approval by the clinical trials ethics committee, 40 patients with similar demographic data were randomized into two groups. All patients received 10 mg metochlopramide and 45.5 mg phenyramine before the procedure. Then midazolam (0.07 mg kg -1 iv bolus followed by 0.01 mg kg -1 h -1 infusion) was administered to Group 1, and dexmedetomidine (1 µg kg -1 loading dose in 10 minutes, followed by 0.2 µg kg -1 h -1 continuous infusion) was administered to Group 2 for sedation. Just before the surgical procedure, all patients received propofol in a subhypnotic dose of 0.5 mg kg -1 iv. Propofol 0.5 mg kg -1 iv was administered to patients in each group if there was no adequate sedation. OAA/S and BIS scales were used to evaluate the sedation level during the procedure. HR, MAP, RR, SpO 2 and ETCO 2 values were monitored before and after induction and every 5 minutes thereafter. The propofol requirement was noted for each group.Results: Sedation in the dexmedetomidine group was as effective and adequate as that observed with the midazolam group. BIS values were significantly low in the dexmedetomidine group, especially after 10 minutes and thereafter. Respiratory rate, SpO 2 , and ETCO 2 values were similar in both groups, whereas clinically insignificant decreases in HR and MAP were observed in the dexmedetomidine group. Propofol requirements were similar in both groups. Conclusion:We conclude that dexmedetomidine can be an appropriate agent in surgical procedures performed under local anaesthesia, providing adequate sedation without respiratory depression.Key Words: Dexmedetomidine, midazolam, sedation Amaç: Kist hidatik hala önemli bir sağlık sorunu olmaya devam etmektedir. Temel tedavisinin cerrahi olması ile birlikte, günümüzde ultrasonografi eşliğinde yapılan perkütan drenaj da önemli bir tedavi alternatifi haline gelmiştir. Lokal anestezi altında yapılan bu işlem sırasında, sedasyon için tercih edilecek ajanlar, hastada yeterli sedasyonu sağlamanın yanı sıra solunumu ve hemodinamiyi en az düzeyde etkileyecek özellikte olmalıdır. Çalışmamızda kısa etkili bir benzodiazepin olan midazolamı ve α 2 selektif adrenerjik reseptör agonisti deksmedetomidini kullanarak, bu ajanları sedasyon derinliği ve intraoperatif komplikasyonlar açısından karşılaştırdık.Yöntemler: Etik kurul onayı ve hasta onamı alındıktan sonra demografik verileri benzer 40 hasta, randomize iki gruba ayrıldı. İşlem öncesi her...

show abstract

“…Midazolam is considered safe even at high doses and, at equipotent doses, it affects (via GABA) the central nervous system in a similar fashion [84]. GABA receptors are found in different parts of the brain.…”

Section: Sedation In Spinal Anesthesia With Intravenous Midazolammentioning

confidence: 99%

“…The ataxia and memory impairment are mediated by GABA receptors in the cerebellar, hippocampal, and forebrain areas. While hypnosis or sedation is always achieved after appropriate individually based doses, anxiolysis is seldom transformed into anxiety, restlessness, rage or a myriad of uncontrolled behaviours (midazolam paradox) [84]. The relationship of the paradoxical reaction to alteration of the cholinergic homeostasis, serotonin levels, the role of genetics, and gamma-aminobutyric acid receptor configuration are suspect [85].…”

Section: Sedation In Spinal Anesthesia With Intravenous Midazolammentioning

confidence: 99%

See 1 more Smart Citation

Midazolam in Spinal Anesthesia — Intrathecal or Intravenous?

Zencirci¹

2014

Topics in Spinal Anaesthesia

View full text Add to dashboard Cite

The midazolam-induced paradox phenomenon is reversible by flumazenil. Epidemiology, patient characteristics and review of the literature

Abstract: Flumazenil completely reverses midazolam-induced paradoxical reactions and they are more frequent in older patients.

Cited by 82 publications

References 27 publications

Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia

Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia

Comparison of Dexmedetomidine and Midazolam in Sedation for Percutaneous Hepatic Hydatid Cyst Drainage

Midazolam in Spinal Anesthesia — Intrathecal or Intravenous?

Contact Info

Product

Resources

About