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Benzodiazepine Allergy With Anesthesia Administration: A Review of Current Literature
Elliot HaybargerDMD,
Andrew S. YoungDDS, and
Joseph A. Giovannitti JrDMD
Article Category: Research Article
Volume/Issue: Volume 63: Issue 3
Online Publication Date: Jan 01, 2016
DOI: 10.2344/16-00019.1
Page Range: 160 – 167

Serious complications during surgery have been shown to occur rather infrequently (0.4% of 83,844 cases), but anesthesia-related complications contribute to more than one third of these events. 1 Allergic reactions to medications are among the major factors affecting morbidity and mortality peri- and postoperatively. 1 , 2 The relative allergenicity of benzodiazepines, arguably the most commonly used anxiolytic premedication and a cornerstone in moderate to deep sedation, is explored in an attempt to quantify its allergic history

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Figure 2.; Dose-response curve for benzodiazepines.
Mark Donaldson,
Gino Gizzarelli, and
Brian Chanpong
Figure 2.
Figure 2.

Dose-response curve for benzodiazepines.

A Comparison of Fospropofol to Midazolam for Moderate Sedation During Outpatient Dental Procedures
Philip YenDDS, MS,
Simon PriorBDS, MS, PhD,
Cara RileyDMD, MS,
William JohnstonMS, PhD,
Megann SmileyDMD, MS, and
Sarat ThikkurissyDDS, MS
Article Category: Other
Volume/Issue: Volume 60: Issue 4
Online Publication Date: Jan 01, 2013
DOI: 10.2344/0003-3006-60.4.162
Page Range: 162 – 177

agent, midazolam, as an intravenous (IV) moderate sedation medication. Midazolam provides anxiolysis, sedation, anterograde amnesia, and skeletal muscle relaxation with a wide therapeutic index, and can be administered by a variety of routes. A key feature that confers a greater degree of safety is the availability of an antagonist drug in the form of flumazenil, which can help reverse the effects of benzodiazepine overdose. The major drawbacks with midazolam are its slow onset, inadequate alleviation of procedure-related discomfort, increased depth of

Figure 3.; Biotransformation of various benzodiazepines. Parent drugs and their active metabolites vary in their elimination half-lives: L, >24 hours; I, 6–24 hours; and S, <6 hours (derived from Mihic and Harris7).
Daniel E. Becker
Figure 3.
Figure 3.

Biotransformation of various benzodiazepines. Parent drugs and their active metabolites vary in their elimination half-lives: L, >24 hours; I, 6–24 hours; and S, <6 hours (derived from Mihic and Harris7).

Figure 1.  ; Schematic of GABAA receptor depicting competitive antagonism between flumazenil and midazolam at the benzodiazepine (BZD) binding site. Flumazenil acts as a negative allosteric modulator of GABA by facilitating closure of the chloride ion (Cl−) channel and preventing the influx of Cl− ions.
Michelle Wong
<bold>Figure 1. </bold>
Figure 1. 

Schematic of GABAA receptor depicting competitive antagonism between flumazenil and midazolam at the benzodiazepine (BZD) binding site. Flumazenil acts as a negative allosteric modulator of GABA by facilitating closure of the chloride ion (Cl−) channel and preventing the influx of Cl− ions.

Figure 2.; The GABAA receptor complex. The GABAA receptor complex consists of several protein subunits, with each comprised further of subunit families. These subunits provide myriad sites or receptors at which drugs may bind. While GABA and its precise receptor is the normal “commander” of the chloride channel, benzodiazepines can potentiate its influence. Additional drugs such as propofol and barbiturates not only potentiate the influence of GABA but are able to open the channel directly.
Daniel E. Becker
Figure 2.
Figure 2.

The GABAA receptor complex. The GABAA receptor complex consists of several protein subunits, with each comprised further of subunit families. These subunits provide myriad sites or receptors at which drugs may bind. While GABA and its precise receptor is the normal “commander” of the chloride channel, benzodiazepines can potentiate its influence. Additional drugs such as propofol and barbiturates not only potentiate the influence of GABA but are able to open the channel directly.

Figure 1. ; Duration of surgery.
Philip Yen,
Simon Prior,
Cara Riley,
William Johnston,
Megann Smiley, and
Sarat Thikkurissy
<bold>Figure 1.</bold>
Figure 1.

Duration of surgery.

Figure 2. ; Supplemental doses to induce.
Philip Yen,
Simon Prior,
Cara Riley,
William Johnston,
Megann Smiley, and
Sarat Thikkurissy
<bold>Figure 2.</bold>
Figure 2.

Supplemental doses to induce.

Figure 3. ; Onset to sedation.
Philip Yen,
Simon Prior,
Cara Riley,
William Johnston,
Megann Smiley, and
Sarat Thikkurissy
<bold>Figure 3.</bold>
Figure 3.

Onset to sedation.

Figure 4. ; Supplemental doses after 30 minutes.
Philip Yen,
Simon Prior,
Cara Riley,
William Johnston,
Megann Smiley, and
Sarat Thikkurissy
<bold>Figure 4.</bold>
Figure 4.

Supplemental doses after 30 minutes.