Rectal Flumazenil to Reverse Midazolam Sedation in Children

To the Editor: Because pediatric patients may not have an intravenous line, midazolam has been given rectally to sedate these children. Flumazenil, a benzodiazepine antagonist, has not been studied widely in children [1-3]. Here we report our experience in six patients who received rectal flumazenil to reverse the sedative effects of midazolam. The children we treated were seen as outpatients and were very sedated after midazolam administration Table 1. Midazolam was given rectally in Patients 1 through 5 and sublingually in Patient 6. They did not have an intravenous line. Patients 1, 5, and 6 were also given a 50% nitrous oxide-oxygen mixture for analgesia. These patients were unfortunately sedated to a level deeper than we expected. Flumazenil was given by the rectal route between 25 and 85 min after midazolam administration Table 1. The drug was given undiluted and administration was performed using a short, air-washed cannula. All patients were observed for 150 min after arousal and no resedations were noted. There were no changes in heart rate, respiratory rate, or arterial blood pressure, nor were there any signs of local intolerance.Table 1: Patient Characteristics and Reactions to Rectal Flumazenil to Reverse Midazolam SedationIn conclusion, we have observed that rectal flumazenil was effective for the complete reversal of midazolam-induced sedation in six children and was not associated with changes in cardiorespiratory variables.