title: Emergence delirium with transient associative agnosia and expressive aphasia reversed by flumazenil in a pediatric patient.
abstract: Multiple factors may contribute to the development of emergence delirium in a child. We present the case of a healthy 12-year-old girl who received preoperative midazolam with the desired anxiolytic effect, underwent a brief general anesthetic, and then exhibited postoperative delirium, consisting of a transient associative agnosia and expressive aphasia. Administration of flumazenil led to immediate and lasting resolution of her symptoms. We hypothesize that γ-aminobutyric acid type A receptor-mediated effects, most likely related to an atypical offset of midazolam, are an important subset of emergence delirium that is amenable to pharmacologic therapy with flumazenil.
authors.affiliation: From the Departments of *Anesthesiology and Critical Care Medicine and ‡Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and †Department of Anesthesiology and Critical Care, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Drobish
authors.forename: Max B
authors.initials: MB
authors.lastname: Kelz
authors.forename: Patricia M
authors.initials: PM
authors.lastname: DiPuppo
authors.forename: Scott D
authors.initials: SD
authors.lastname: Cook-Sather
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects*; D000377:Agnosia / Q000139:chemically induced*; D000768:Anesthesia, General; D001039:Aphasia, Broca / Q000139:chemically induced*; D002648:Child; D003693:Delirium / Q000139:chemically induced* / Q000188:drug therapy; D005260:Female; D005442:Flumazenil / Q000627:therapeutic use*; D058787:GABA-A Receptor Antagonists / Q000627:therapeutic use*; D006801:Humans; D008874:Midazolam / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000759:Adjuvants, Anesthesia; D058787:GABA-A Receptor Antagonists; D005442:Flumazenil; D008874:Midazolam