Paradoxical reactions to benzodiazepines in intravenous sedation: a report of 2 cases and review of the literature.
Paradoxical reactions to benzodiazepines have been thoroughly reported since the introduction of this type of drug. The mechanism of benzodiazepine action is through the gamma-aminobutyric acid receptors. Properties of benzodiazepine include sedation, anxiolysis, amnesia, anticonvulsion, and muscle relaxation. Unfortunately, adverse paradoxical reactions can be stimulated by benzodiazepines and are difficult to predict and diagnose. Two cases of paradoxical reactions associated with the use of intravenous midazolam are presented, and the management of this complication and its different etiologies are reviewed. The relationship of the paradoxical reaction to alteration of the cholinergic homeostasis, serotonin levels, the role of genetics, and gamma-aminobutyric acid receptor configuration is discussed.
Robin
Christian
C
Montefiore Medical Center, Albert Einstein College of Medicine, Larchmont, New York 10538, USA. drcrobin@sympatico.ca
Trieger
Norman
N
D000328:Adult; D000766:Anesthesia, Dental / Q000009:adverse effects; D014151:Anti-Anxiety Agents / Q000009:adverse effects*; D000931:Antidotes / Q000627:therapeutic use; D016292:Procedural Sedation / Q000009:adverse effects; D016854:Dental Anxiety / Q000139:chemically induced / Q000517:prevention & control; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use; D018757:GABA Modulators / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007275:Injections, Intravenous; D008874:Midazolam / Q000009:adverse effects*; D014081:Tooth Extraction
D014151:Anti-Anxiety Agents; D000931:Antidotes; D018757:GABA Modulators; D006993:Hypnotics and Sedatives; D005442:Flumazenil; D008874:Midazolam