A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period

Abstract

335 RESEARCHA randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period Objective: To study the post-operative cognitive and psychomotor recovery from midazolam conscious sedation, after reversal with the benzodiazepine antagonist flumazenil over a prolonged recovery period. Design: A prospective, double-blind, randomised, crossover trial. Setting: Out-patient Sedation Department, Newcastle Dental Hospital and School Method: Eighteen patients, ASA I or II, received midazolam on two separate occasions to undergo equivalent dental treatment. Following treatment patients were reversed with intravenous flumazenil or saline (placebo) at alternate appointments. Assessment of mood and cognitive function was undertaken using a highly sensitive and specific computerised battery of cognitive tests administered by telephone. Cognitive and psychomotor tests were administered prior to sedation and every hour for 6 hours post reversal. Results: Results indicated no significant effect of flumazenil on simple reaction time and choice reaction time but did show a trend of reversing the effects of midazolam on numeric working memory and word recognition. Conclusion:The cognitive and psychomotor effects of the sedation were not fully reversed by flumazenil. Cognitive impairments were still present up to 6 hours post-reversal, despite patients appearing clinically more alert. This has important implications for treatment protocols and discharge instructions.

Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?

“…1,3,6,[8][9][10][12][13][14][15][16][17] Multiple investigators have reported transient cognitive impairment after administration of midazolam in different clinical settings, including gastrointestinal endoscopy, 1,12,13,17 pediatric anesthesia, 6,14-16 and outpatient OMS. 3,10,11 However, most of these studies used various psychomotor assessments as their primary outcome measurement and did not specifically assess recovery room LOS, as was performed in the present study.…”

“…[4][5][6][7] Transient postoperative cognitive impairment caused by midazolam has been well described in the literature and this remains a relevant concern in any ambulatory care setting. 6,8,9 Recently, some evidence has suggested that IV midazolam might be associated with prolonged recovery time when administered for outpatient anesthesia for various oral surgical procedures. 10,11 In addition, unpublished data from the Department of Anesthesiology at the Mayo Clinic (Rochester, MN) have identified midazolam administration as an independent risk factor for prolonged stay in the postanesthesia care unit after general anesthesia for different surgical procedures, including OMS.…”

Sedation for middle ear surgery: prospective clinical trial comparing propofol and midazolam

“…Nevertheless, flumazenil was not administered because the sedative action of midazolam subsided spontaneously [23].…”

A randomised placebo‐controlled trial of the effects of midazolam premedication on children's postoperative cognition

“…Moreover, in ambulatory care settings where post-discharge 'street-fitness' becomes relevant, further concern attaches to the potential adverse effects of midazolam upon cognitive function. However, whilst the adverse effects of midazolam upon adult functioning are well established [4,5], relatively little is known of its effects upon children's cognition.…”