Severe benzodiazepine withdrawal syndrome followed by anesthesia in elderly patient: A rare case report

Abstract

Benzodiazepine dependence is a potentially clinically serious condition and its withdrawal syndrome is complex and often protracted in time course. However, the relationship between anesthesia and benzodiazepine withdrawal syndrome is unclear. Here, we presented a 79 year-old-female who had the history of major depression and had taken hypnotic benzodiazepines for five years. The patient received total hip replacement under spinal anesthesia and during the operation, the hypnotic benzodiazepines were discontinued. One day later, the patient was suddenly dropped to coma. Brain magnetic resonance (MR) imaging demonstrated no significant finding except to brain-tissue loss over the bilateral anterior frontal lobes. Accordingly, tracheostomy was performed and ventilator dependent. Interestingly, forty days later, the patient’s consciousness became alert. To increase physicians' awareness that old age, anesthesia, and cortical dysfunction may exacerbate benzodiazepine withdrawal syndrome, we presented our experience in treating one patient who rapidly stopped the hypnotic benzodiazepines. Key words: Benzodiazepine withdrawal syndrome, anesthesia.