PMID- 3592209
OWN - NLM
STAT- MEDLINE
DCOM- 19870629
LR  - 20131121
IS  - 0003-2417 (Print)
IS  - 0003-2417 (Linking)
VI  - 36
IP  - 3
DP  - 1987 Mar
TI  - [Therapy of paradoxical reactions to midazolam in regional anesthesia].
PG  - 143-6
AB  - Many patients fear being awake in the operating room, and the acceptance of 
      regional anesthesia is often made dependent on the promise of adequate sedation. 
      With the introduction of the short-acting benzodiazepine (bzdp) midazolam, it 
      seemed possible to achieve induction and maintainance of sleep throughout an 
      operative procedure. This substance may, however, occasionally result in a 
      "paradoxical reaction" (PR) characterized by agitated excitement, mental 
      confusion, and uncooperativeness. We have treated this condition successfully 
      with physostigmine, as documented here in two case reports where a possible 
      interaction between promethazine and midazolam may have been responsible for the 
      PR. The symptoms resemble some of those seen in the central anticholinergic 
      syndrome, as further implied by the therapeutic effect of physostigmine, but an 
      etiological difference may exist. A direct anticholinergic effect of bzdp's is 
      described only following excessive doses. An indirect effect may result from the 
      impact on GABA-receptors, which have been identified as structurally related to 
      the bzdp receptors. Physostigmine itself is not bound at the bzdp receptor, but 
      has been shown to block the binding of bzdp's to their receptors and to reverse 
      sedation from midazolam, perhaps through an indirect stimulatory effect. Previous 
      case reports have indicated the effect of physostigmine in reversing PR following 
      various bzdp's. Without treatment, a PR during regional anesthesia frequently 
      makes general anesthesia necessary in order to immobilize the patient 
      sufficiently to make surgery possible.(ABSTRACT TRUNCATED AT 250 WORDS)
FAU - Knaack-Steinegger, R
AU  - Knaack-Steinegger R
FAU - Schou, J
AU  - Schou J
LA  - ger
PT  - Case Reports
PT  - English Abstract
PT  - Journal Article
TT  - Therapie der paradoxen Reaktion nach Midazolam zur Regional-Anaesthesie.
PL  - Germany
TA  - Anaesthesist
JT  - Der Anaesthesist
JID - 0370525
RN  - R60L0SM5BC (Midazolam)
SB  - IM
MH  - Adult
MH  - Anesthesia, Conduction/*adverse effects
MH  - Female
MH  - Humans
MH  - Male
MH  - Mental Disorders/*chemically induced/therapy
MH  - Midazolam/*adverse effects
MH  - Middle Aged
MH  - Preanesthetic Medication
EDAT- 1987/03/01 00:00
MHDA- 1987/03/01 00:01
CRDT- 1987/03/01 00:00
PHST- 1987/03/01 00:00 [pubmed]
PHST- 1987/03/01 00:01 [medline]
PHST- 1987/03/01 00:00 [entrez]
PST - ppublish
SO  - Anaesthesist. 1987 Mar;36(3):143-6.