title: Completion of upper endoscopic procedures despite paradoxical reaction to midazolam: a role for flumazenil?
abstract: Paradoxical excitation after benzodiazepine administration is well described. Although it is relatively uncommon, its occurrence can severely impede or even prevent the performance of upper endoscopy. We describe three cases in which paradoxical reactions to midazolam responded so well to flumazenil administration that the procedure was successfully completed in each instance. We review the limited literature on this topic and suggest that flumazenil may have greater utility in the management of this particular problem than is considered at present.
authors.affiliation: Department of Internal Medicine, Case Western Reserve University at Metrohealth Medical Center, Cleveland, Ohio 44109-1998, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Fulton
authors.forename: K D
authors.initials: KD
authors.lastname: Mullen
mesh_terms: D000328:Adult; D017109:Akathisia, Drug-Induced / Q000188:drug therapy / Q000209:etiology*; D000931:Antidotes / Q000008:administration & dosage*; D016292:Procedural Sedation; D016145:Endoscopy, Digestive System; D005260:Female; D005442:Flumazenil / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D000931:Antidotes; D006993:Hypnotics and Sedatives; D005442:Flumazenil; D008874:Midazolam