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Flumazenil for Midazolam Oversedation — NDEB AFK MCQ

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ModeratePain & Anxiety ControlFlumazenil for Midazolam OversedationNDEB AFK

A patient receiving IV sedation with midazolam becomes over-sedated (deep sedation with loss of verbal response). After stopping the midazolam infusion and supporting the airway, what pharmacological intervention is most appropriate?

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Correct answer: B — Flumazenil 0.2 mg IV, titrated to effect

Flumazenil is the specific benzodiazepine antagonist used to reverse midazolam over-sedation. Initial dose is 0.2 mg IV over 15 seconds; if no response after 45 seconds, repeated doses of 0.2 mg can be given at 1-minute intervals (max 1 mg for initial reversal). Flumazenil has a shorter half-life (40-80 min) than midazolam (1.5-2.5 hours), so re-sedation can occur, requiring monitoring for at least 2 hours after reversal. Flumazenil is contraindicated in patients on chronic benzodiazepines (seizure risk) or with mixed overdose (benzodiazepine + TCA).

Reference: Malamed – Sedation: A Guide to Patient Management, 6th ed., 2018