Completion of upper endoscopic procedures despite paradoxical reaction to midazolam: A role for flumazenil?

Paradoxical excitation after benzodiazepine administration is well describe d. Although it is relatively uncommon, its occurrence can severely impede o r even prevent the performance of upper endoscopy. We describe three cases in which paradoxical reactions to midazolam responded so well to flumazenil administration that the procedure was successfully completed in each insta nce. We review the limited literature on this topic and suggest that flumaz enil may have greater utility in the management of this particular problem than is considered at present. (Am J Gastroenterol 2000;95:809-811. (C) 200 0 by Am. Coll. of Gastroenterology).