Advertisement

Serial monitoring of sedation scores in benzodiazepine overdose

  • Yeon Young Kyong
    Affiliations
    Department of Emergency Medicine, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
    Search for articles by this author
  • Jeng Tak Park
    Affiliations
    Department of Emergency Medicine, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
    Search for articles by this author
  • Kyoung Ho Choi
    Correspondence
    Corresponding author at: Department of Emergency Medicine, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea. Gumoh-dong 65-1, Uijeongbu-si, Gyeonggi-do, 480-130, Republic of Korea. Tel.: +82 31 820 3027x3948; fax: +82 31 847 9945.
    Affiliations
    Department of Emergency Medicine, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
    Search for articles by this author
Published:April 14, 2014DOI:https://doi.org/10.1016/j.ajem.2014.04.004
      Benzodiazepines are widely used for many diseases, and benzodiazepine overdose is globally increasing in proportion to its prescriptions. Although most benzodiazepine overdoses are known to be safe and nonfatal without coingestions, morbidity or mortality after benzodiazepine overdose is closely related with the duration of unconsciousness or depth of compromised airway. Proper use of flumazenil, a potent antidote of benzodiazepine, seems to accelerate the recovery from the toxicity after benzodiazepine overdose. However, as the case we present demonstrates, careful attention and repetitive evaluations before and after use of flumazenil may be needed in benzodiazepine overdose because resedation occurs in approximately 30% of total flumazenil-treated cases, which suggests that the risk of aspiration or incidental death after administrating flumazenil might be significant without careful monitoring.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Miller N.S.
        • Gold M.S.
        Benzodiazepines: a major problem. Introduction.
        J Subst Abuse Treat. 1991; 8: 3-7
      1. The flumazenil in benzodiazepine intoxication multicenter study group. Treatment of benzodiazepine overdose with flumazenil.
        Clin Ther. 1992; 14: 978-995
        • Spivey W.H.
        • Roberts J.R.
        • Derlet R.W.
        A clinical trial of escalating doses of flumazenil for reversal of suspected benzodiazepine overdose in the emergency department.
        Ann Emerg Med. 1993; 22: 1813-1821
        • Chern C.H.
        • Chern T.L.
        • Hu S.C.
        • et al.
        Complete and partial response to flumazenil in patients with suspected benzodiazepine overdose.
        Am J Emerg Med. 1995; 13: 372-375
        • Weinbroum A.
        • Rudick V.
        • Sorkine P.
        • et al.
        Use of flumazenil in the treatment of drug overdose: a double-blind and open clinical study in 110 patients.
        Crit Care Med. 1996; 24: 199-206
        • Chern C.H.
        • Chern T.L.
        • Wang L.M.
        • et al.
        Continuous flumazenil infusion in preventing complications arising from severe benzodiazepine intoxication.
        Am J Emerg Med. 1998; 16: 238-241
        • Waring W.S.
        • Sandilands E.A.
        Coma blisters.
        Clin Toxicol (Phila). 2007; 45: 808-809
        • Verwey B.
        • Eling P.
        • Wientjes H.
        • et al.
        Memory impairment in those who attempted suicide by benzodiazepine overdose.
        J Clin Psychiatry. 2000; 61: 456-459
        • Sessler C.N.
        • Grap M.J.
        • Ramsay M.A.
        Evaluating and monitoring analgesia and sedation in the intensive care unit.
        Crit Care. 2008; 12: S2https://doi.org/10.1186/cc6148