A case of sleeping baby reversed with flumazenil

A 35 year old woman graviditas duplex weighing 57.7 kg received emergency cesarean section at 34 weeks gestation. She had hyperthyroidism and bronchial asthma. Anesthesia was induced with midazolam (6 mg) and thiopental (125 mg). Tracheal intubation was facilitated with d-tubocurarine (3 mg) followed by suxamethonium (100 mg). Pentazocine (7.5 mg) was administered just before the induction of anesthesia. Anesthesia was maintained with 2~3% sevoflurane with 3~4 L · min^-1 nitrous oxide and 2~3 L · min^-1 oxygen. Pentazocine (7.5 mg) was administered again at the start of surgery. The first baby (body weight; 2100 g) was born 9 min after the induction of anesthesia with an Apgar score of 2 at 1 min and 7 at 5 min. The second baby (body weight; 2010 g) was born 10 min after the induction with an Apgar score of 7 at 1 min and 9 at 5 min. Both babies were sleepy even at 5 min after delivery. Both babies received flumazenil (0.02 mg) administered into the umbilical artery. The first baby started to cry within 5 min, and the second baby within 1 min. Subsequently the first baby was intubated because of poor respiration. He remained intubated for three days. Sevoflurane, thiopental, pentazocine, hypoxia or combination there of, caused respiratory depression in the first baby. However, midazolam was thought to be responsible for the sleepiness of both babies, because flumazenil reversed it. In conclusion, midazolam administered to mother for cesarean section can result in sleepy baby at birth, and flumazenil is useful for its reversal.