Association Between Benzodiazepine Administration and Respiratory Depression in Acute Seizure Management

Abstract

Objective:  To assess the correlation between benzodiazepine use and the incidence of respiratory depression in patients treated for acute seizures at Lady Reading Hospital, Peshawar.

Materials and Methods:  This prospective observational study was conducted from May to October 2024 at the Neurology and Emergency Medicine Departments of Lady Reading Hospital. A total of 200 patients, aged 10 years and above, who presented with acute seizures and received benzodiazepines as part of initial management, were enrolled. Respiratory parameters were monitored before and after benzodiazepine administration. Respiratory depression, defined as hypoventilation, oxygen saturation <90%, or the need for assisted ventilation, was recorded and correlated with the type, dosage, and route of benzodiazepine.

Results:  Among 200 patients, 44 (22%) developed respiratory depression. The incidence was higher with intravenous lorazepam compared to intramuscular midazolam. Patients aged >60 years and those with chronic obstructive pulmonary disease had a higher risk. Respiratory depression correlated significantly with higher cumulative benzodiazepine doses (p < 0.05).

Conclusion:  Benzodiazepines are the cornerstone of acute seizure management due to their rapid action, but they carry a measurable risk of respiratory depression. Careful dosing and vigilant monitoring are crucial to minimize complications. AEDs provide long-term seizure prevention but are not substitutes for first-line emergency therapy.