Between benzodiazepine over-sedation and neurological damage

1-OHMG is known to have sedative properties [2,3]. Although the method described (i.e. high-performance liquid chromatography coupled to mass spectrometric detection) might be highly specific and sensitive to detect and quantify the presence of the 1-OHMG, the presence of an active substance irrespective of its quantity can never be solely indicative of a given (patho-)physiological response. Development of drug tolerance is a basic principle in clinical pharmacology, the benzodiazepines being a paradigmatic example. Making dose–response relationship assessment in vivo is thus very problematic. It is dangerous to rely on parameters (1-OHMG), even if very carefully measured, without considering the physiological component/response, as potentially important decisions could result from a diagnosis such as neurological damage in the setting of critical illness. In this regard, flumazenil, a selective benzodiazepine receptor antagonist, will remain indispensable. Letter Between benzodiazepine over-sedation and neurological damage Jordan Kountchev, Romuald Bellmann and Michael Joannidis