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Clinical Pediatrics
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Paradoxical Reactions in Children Associated with Midazolam Use During Endoscopy

Marc Massanari, PharmD, FCCP

Department of Pediatrics, College of Medicine, University of South Florida; College of Pharmacy, University of Florida; Department of Pharmacy, All Children's Hospital, St. Petersburg, Fl

Janie Novitsky, RN, BSN, CGRN3

Special Procedures Unit, All Children's Hospital, St. Petersburg, FL

L. Julio Reinstein, MD

Department of Pediatric Gastroenterology, All Children's Hospital, St. Petersburg, FL

All 2,617 children who received midazolam and meperidine for a variety of endoscopic procedures were monitored for the development of adverse behavioral problems. Thirty-six (1.4%) of the children (ages 1-17 years) experienced a paradoxical behavioral reaction, which consisted of inconsolable crying, combativeness, disorientation, dysphoria, tachycardia, agitation, and restlessness. The reaction occurred at a mean of 17 minutes after the administration of midazolam. Following treatment with flumazenil, the reaction dissipated within a mean of 14 minutes. Three of the 36 patients underwent additional endoscopic procedures utilizing only meperidine. No similar reaction was observed in these patients. Awareness of the reaction and prompt administration of flumazenil decreased the duration of the reaction.

Clinical Pediatrics, Vol. 36, No. 12, 681-684 (1997)
DOI: 10.1177/000992289703601202
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