Reversal of midazolam-induced laryngospasm with flumazenil

Midazolam is a commonly used benzodiazepine that is ideal for conscious sedation during a variety of procedures. Laryngospasm is listed by the manufacturer as a rare side effect of midazolam. Flumazenil is a competitive inhibitor of the benzodiazepines that is available for reversal at the end of such a procedure or when too much sedation has been achieved. We present a case of a 61-year-old man who was to undergo conscious sedation before cardioversion. Shortly after receiving midazolam, he developed laryngospasm and resultant respiratory distress; the laryngospasm was reversed by a small dose of flumazenil. The symptoms recurred after approximately 25 minutes and were again reversed with flumazenil. Neither midazolam-induced laryngospasm nor its reversal with flumazenil have previously been reported. A brief discussion regarding laryngospasm and the use of flumazenil are included.