Reversal of midazolam-induced laryngospasm with flumazenil.
Midazolam is a commonly used benzodiazepine that is ideal for conscious sedation during a variety of procedures. Laryngospasm is listed by the manufacturer as a rare side effect of midazolam. Flumazenil is a competitive inhibitor of the benzodiazepines that is available for reversal at the end of such a procedure or when too much sedation has been achieved. We present a case of a 61-year-old man who was to undergo conscious sedation before cardioversion. Shortly after receiving midazolam, he developed laryngospasm and resultant respiratory distress; the laryngospasm was reversed by a small dose of flumazenil. The symptoms recurred after approximately 25 minutes and were again reversed with flumazenil. Neither midazolam-induced laryngospasm nor its reversal with flumazenil have previously been reported. A brief discussion regarding laryngospasm and the use of flumazenil are included.
Department of Emergency Medicine, University of California at San Diego, USA. shrimptaco@aol.com
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Davis
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Hamilton
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Webster
D014151:Anti-Anxiety Agents / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use*; D016292:Procedural Sedation / Q000009:adverse effects; D004554:Electric Countershock; D005442:Flumazenil / Q000008:administration & dosage / Q000627:therapeutic use*; D018757:GABA Modulators / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D007826:Laryngismus / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male; D008874:Midazolam / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D008875:Middle Aged; D012008:Recurrence; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000188:drug therapy; D019233:Retreatment
D014151:Anti-Anxiety Agents; D000931:Antidotes; D018757:GABA Modulators; D006993:Hypnotics and Sedatives; D005442:Flumazenil; D008874:Midazolam