title: Paradoxical reactions in children associated with midazolam use during endoscopy.
abstract: All 2,617 children who received midazolam and meperidine for a variety of endoscopic procedures were monitored for the development of adverse behavioral problems. Thirty-six (1.4%) of the children (ages 1-17 years) experienced a paradoxical behavioral reaction, which consisted of inconsolable crying, combativeness, disorientation, dysphoria, tachycardia, agitation, and restlessness. The reaction occurred at a mean of 17 minutes after the administration of midazolam. Following treatment with flumazenil, the reaction dissipated within a mean of 14 minutes. Three of the 36 patients underwent additional endoscopic procedures utilizing only meperidine. No similar reaction was observed in these patients. Awareness of the reaction and prompt administration of flumazenil decreased the duration of the reaction.
authors.affiliation: Department of Pediatrics, College of Medicine, University of South Florida, USA.
authors.forename: M
authors.initials: M
authors.lastname: Massanari
authors.forename: J
authors.initials: J
authors.lastname: Novitsky
authors.forename: L J
authors.initials: LJ
authors.lastname: Reinstein
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects*; D000374:Aggression / Q000187:drug effects; D017109:Akathisia, Drug-Induced / Q000209:etiology; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D000931:Antidotes / Q000627:therapeutic use; D002648:Child; D002652:Child Behavior / Q000187:drug effects*; D002675:Child, Preschool; D003448:Crying; D016903:Drug Monitoring; D004724:Endoscopy; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D007223:Infant; D018730:Infant Behavior / Q000187:drug effects*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D009949:Orientation / Q000187:drug effects; D011595:Psychomotor Agitation / Q000209:etiology; D013610:Tachycardia / Q000139:chemically induced; D013997:Time Factors
chemical_list: D000759:Adjuvants, Anesthesia; D014151:Anti-Anxiety Agents; D000931:Antidotes; D018757:GABA Modulators; D006993:Hypnotics and Sedatives; D005442:Flumazenil; D008614:Meperidine; D008874:Midazolam