title: [Extreme duration of action of diazepam as a cause of respiratory insufficiency in a female geriatric patient].
abstract: A 77-year-old woman who had undergone surgery of a non-malignant extracerebral retro-orbital tumor suffered postoperatively from respiratory failure due to impaired respiratory drive and unconsciousness of unknown origin and required artificial ventilation for 14 days. After cerebral and endocrinological causes had been excluded, the residual effects of diazepam were taken into consideration, since the patient had received this substance for premedication and during 3 days postoperatively (total 165 mg). After the application of flumazenil (Anexate), a specific benzodiazepine receptor antagonist, she awoke immediately and was extubated with sufficient spontaneous breathing. The hypothesis that diazepam was the causative agent for the respiratory failure and impaired consciousness was supported by the detection of high serum concentrations of diazepam and its active metabolite desmethyldiazepam. During the following 3 days repetitive injections of flumazenil were necessary to counteract recurring depression of respiration and vigilance. Thereafter further application of flumazenil was not necessary.
authors.affiliation: Zentrum für Anaesthesiologie, Rettungs- und Intensivmedizin, Universität Göttingen, Göttingen.
authors.forename: P
authors.initials: P
authors.lastname: Gröger
authors.forename: M
authors.initials: M
authors.lastname: Sydow
authors.forename: H C
authors.initials: HC
authors.lastname: Michaelis
authors.forename: M
authors.initials: M
authors.lastname: Steinwachs
authors.forename: H
authors.initials: H
authors.lastname: Kolenda
authors.forename: D
authors.initials: D
authors.lastname: Kettler
mesh_terms: D000368:Aged; D003975:Diazepam / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use*; D006801:Humans; D011183:Postoperative Complications; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000188:drug therapy; D013997:Time Factors; D014474:Unconsciousness / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D005442:Flumazenil; D003975:Diazepam