Postoperative expressive aphasia associated with intravenous midazolam administration: a 5-year retrospective case-control study

J Int Med Res. 2020 Aug;48(8):300060520948751. doi: 10.1177/0300060520948751.


Objectives: This study aimed to investigate the epidemiology of intravenous midazolam-induced postoperative expressive aphasia (EA).

Methods: The incidence rate, risk ratio, and contributing factors to intravenous midazolam-induced postoperative EA were analyzed retrospectively in 6756 orthopedic patients. A telephone interview was conducted with patients with EA after surgery.

Results: Patients were allocated to either the midazolam group (n = 6178) or no-midazolam group (n = 578). Twelve patients developed EA in the midazolam group, with an incidence of 0.19%, and no patient developed EA in the no-midazolam group. The mean age of EA patients was 70 years, and 92% were women. Among them, 75% received general anesthesia, and the mean dose of midazolam was 1.8 mg. EA was reversed in nine of 12 (75%) patients within 4 minutes of flumazenil administration, and >60 minutes were required to reverse EA in the other three patients (25%).

Conclusion: Intravenous midazolam administration for preoperative sedation caused transient EA in 0.19% of patients, especially elderly women who received general anesthesia, and EA could be reversed by flumazenil.

Keywords: Midazolam; anesthesia; elderly; expressive aphasia; flumazenil; preoperative sedation.

MeSH terms

  • Aged
  • Aphasia, Broca*
  • Case-Control Studies
  • Double-Blind Method
  • Female
  • Flumazenil / therapeutic use
  • Humans
  • Male
  • Midazolam* / adverse effects
  • Retrospective Studies


  • Flumazenil
  • Midazolam