Fantasies during sedation with intravenous midazolam or diazepam

Details are reported of 41 incidents where women reported fantasies during sedation with IV midazolam or diazepam: 27 of them had some sexual element and 20 were unpleasant experiences. The events occurred in a logical sequence and all were certain of their authenticity. Some led to litigation against the sedationist. Out of 25 verified reports made by patients of incidents occurring during sedation, 17 did not happen and in 9/13 clear descriptions there was some relation between the fantasy and something that really happened under sedation. All occurred with what are now considered large doses of the drugs. During or following sedation lady patients should not be treated or examined without the presence of a responsible third person. The use of the injectable benzodiazepines, diazepam and more recently midazolam, with their sedative, amnesic and relaxing properties have made unpleasant operative procedures, particularly those usually carried out under local analgesia, more acceptable to many patients. These include oral endoscopy and dental procedures and operations under spinal or epidural analgesia. These drugs also provide good sedation during ventilatory support and in the intensive care unit. Over a long period of time these benzodiazepines have proven to be, in appropriate doses, among the safest in medicine for short term use. There have however been a few cases of what can be described as "fantasies" occurring during sedation: events occurring in a logical sequence which are very real to the patient and yet, on the evidence of two or more independent witnesses, did not occur. Many of these have had an element of sexual trespass.(ABSTRACT TRUNCATED AT 250 WORDS)