Successful Flumazenil Reversal of Paradoxical Reaction to Midazolam in a Child

Abstract Background Greater attention to and management of anxiety and pain in pediatric patients signifies a healthy evolution in the care of children in emergency departments (EDs). Interventions to address such distress may involve unanticipated adverse effects. Midazolam, a benzodiazepine common...

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Bibliographic Details
Published in:The Journal of emergency medicine 2015-03, Vol.48 (3), p.e67-e72
Main Authors: Jackson, Benjamin F., MD, Beck, Leigh Arden, MSN, APRN, CPNP, Losek, Joseph D., MD
Format: Article
Language:English
Subjects:
Akathisia, Drug-Induced - drug therapy
Anti-Anxiety Agents - adverse effects
Antidotes - therapeutic use
anxiolysis
Child, Preschool
Delirium - chemically induced
Delirium - drug therapy
Emergency
Female
flumazenil
Flumazenil - therapeutic use
Humans
midazolam
Midazolam - adverse effects
paradoxical reaction
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Summary:Abstract Background Greater attention to and management of anxiety and pain in pediatric patients signifies a healthy evolution in the care of children in emergency departments (EDs). Interventions to address such distress may involve unanticipated adverse effects. Midazolam, a benzodiazepine commonly administered to children for anxiolysis, may precipitate paradoxical agitation and delirium, a rare but alarming effect that warrants prompt identification and treatment. Case Report The case presented is that of a 4-year-old girl who received oral midazolam and developed a paradoxical reaction, which was reversed successfully with flumazenil. This is the first such case report in an ED involving a child. Why Should an Emergency Physician Be Aware of This? Emergency physicians must stay abreast of the adverse and unintended effects of the treatments provided. The literature on benzodiazepine-induced paradoxical reactions is reviewed, and flumazenil as well as other treatment options and anxiolytic alternatives are presented.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2014.09.062