Tachycardia and Ventricular Arrhythmia Induced by Flumazenil Following Reversal of Benzodiazepine Sedation: A Case Report and Literature Review

Flumazenil, a competitive antagonist at GABAA receptors, rapidly reverses benzodiazepine-induced sedation but carries a risk of precipitating arrhythmias in special populations. We present a fumazenil-reversed remimazolam -induced arrhythmia case, which, to our knowledge, is the first one described in scientifc literature. Case presentation A 66-year-old female patient with frailty and a history of esophageal carcinoma developed tracheoesophageal fistula following postoperative radiotherapy. After successful closure of the fistula, she subsequently developed airway stenosis during a subsequent course of radiotherapy. In response, a tracheal stent was implanted by the respiratory medicine team. During the administration of flumazenil to reverse the sedative effects of remimazolam, the patient experienced transient supraventricular tachycardia accompanied by premature ventricular contractions. Discussion and conclusions: This case reports a rare arrhythmia following flumazenil administration, highlighting the need for thorough pre-treatment evaluation of patients' baseline health and concomitant medications. Caution is warranted in high-risk individuals, with careful risk-benefit assessment and close monitoring recommended.