Delayed Postoperative Agitation in a Child After Preoperative Midazolam

We present a case report of a 5-year-old boy who had severe agitation after PACU discharge after midazolam premedication for minor otologic surgery. He was treated over several hours in the emergency department with several doses of midazolam and phenobarbital, without resolution of the agitation. Finally, a single dose of flumazenil (0.2 mg) effectively reversed the child's agitation. The incidence and potential mechanisms for postoperative agitation are discussed, with a focus on the potential for midazolam-induced behavioral reactions. This information has nursing implications for postoperative discharge instructions and follow-up.