Autonomic and hormonal responses after the use of midazolam and flumazenil

Midazolam, like other benzodiazepine agonists, reduces the autonomic and hormonal responses to emotional or surgical stress. This can be seen as a reduction in catecholamine levels after benzodiazepine treatment. The endocrine response with a reduction in cortisol values is mediated by a decrease in ACTH. The adrenal glands are immediately responsive to exogenous ACTH administration as well as to spontaneous recovery from the benzodiazepine action. Flumazenil given alone does not affect the response to emotional stress, neither does it cause any cardiovascular changes. Following benzodiazepine treatment, flumazenil given in a titrated fashion reverses the inhibitory effects of the agonists.