Danger of flumazenil use in pediatric status epilepticus

Benzodiazepines are an important class of drugs in the management of acute pediatric seizure disorders such as status epilepticus. They are used both in the community and in the hospital; however, one of their major side effects is respiratory depression. If ventilation is needed for benzodiazepine-induced respiratory depression during seizure management, pressures to facilitate extubation may lead to the use of the specific reversal agent for this class of drugs, flumazenil. Three cases of seizure recurrence after flumazenil use in this context are reported, and the pharmacology is discussed. Irrespective of pressure to extubate such children, physicians must be alert to the potential risk of flumazenil in the clinical scenario.