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Before flumazenil administration, we examined the patient’s airway and assessed the presence of contraindications for flumazenil administration.

The chest x-ray showed focal segmental atelectasis on the left lung field. A 67-year-old woman came to our hospital unconscious 19.5 hours after clonazepam overdose, due to delayed detection. However, careful attention and repetitive evaluations before and after flumazenil administration may be needed in benzodiazepine overdose because resedation occurs in approximately 30% of total flumazenil-treated cases, which suggests that the risk of aspiration or incidental death after flumazenil administration might be significant without careful monitoring. Proper use of flumazenil, a potent antidote of benzodiazepine, seems to accelerate the recovery from the toxicity after benzodiazepine overdose. Although most benzodiazepine overdoses are known to be safe and nonfatal without co-ingestions, morbidity or mortality after benzodiazepine overdose is closely related with the duration of unconsciousness or depth of compromised airway.

Benzodiazepines are frequently prescribed for many diseases and are also most commonly involved in drug overdose.