PARADOXICAL REACTIONS IN CHILDREN ASSOCIATED WITH MIDAZOLAM USE DURING ENDOSCOPY

All 2,617 children who received midazolam and meperidine for a variety of endoscopic procedures were monitored for the development of advers e behavioral problems. Thirty-six (1.4%) of the children (ages 1-17 ye ars) experienced a paradoxical behavioral reaction, which consisted of inconsolable crying, combativeness, disorientation, dysphoria, tachyc ardia, 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 u tilizing-only meperidine. No similar reaction was observed in these pa tients. Awareness of the reaction and prompt administration of flumaze nil decreased the duration of the reaction.