Flumazenil used for antagonizing the central effects of midazolam and diazepam in outpatients

Jensen, Svend Borup; Knudsen, Lone; Kirkegaard, L; Kruse, Andrew C.; Knudsen, Eric B.

doi:10.1111/j.1399-6576.1989.tb02854.x

Cited by 29 publications

(8 citation statements)

References 7 publications

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“…In previous reports, resedation was not observed when the sedation level was assessed by the investigator's subjective assessment. 14,15 However, in psychomotor tests, impairments were observed even 3 hours after the administration of flumazenil. 16,17 It was also reported that standing independently was more sensitive than both spontaneous eye opening and response to a verbal command.…”

Section: Discussionmentioning

confidence: 99%

Effect of Flumazenil on Disturbance of Equilibrium Function Induced by Midazolam

Miyagawa

Miyawaki

Higuchi

et al. 2008

Anesthesia Progress

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Benzodiazepines in intravenous sedation are useful, owing to their outstanding amnesic effect when used for oral surgery as well as dental treatments on patients with intellectual disability or dental phobia. However, compared with propofol, the effect of benzodiazepine lasts longer and may impede discharge, especially when it is administered orally because of fear of injections. Although flumazenil antagonizes the effects of benzodiazepine quickly, its effect on the equilibrium function ( EF) has never been tested. Since EF is more objective than other tests, the purpose of this study is to assess the sedation level and EF using a computerized static posturographic platform. The collection of control values was followed by the injection of 0.075 mg/kg of midazolam. Thirty minutes later, 0.5 mg or 1.0 mg of flumazenil was administered, and the sedation level and EF were measured until 150 minutes after flumazenil administration. Flumazenil antagonized sedation, and there was no apparent resedation; however, it failed to antagonize the disturbance in EF. This finding may be due to differences in the difficulty of assessing the sedation level and performing the EF test, and a greater amount of flumazenil may effectively antagonize the disturbance in EF.

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Section: Discussionmentioning

confidence: 99%

Effect of Flumazenil on Disturbance of Equilibrium Function Induced by Midazolam

Miyagawa

Miyawaki

Higuchi

et al. 2008

Anesthesia Progress

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“…There was a significantly faster recovery of the patients after the injection of flumazenil than after placebo. Patients were awake shortly after flumazenil, but remained drowsy or asleep after placebo administration (164,165). By contrast, another placebo-controlled randomized trial including patients undergoing upper gastrointestinal endoscopy under diazepam sedation reported no significant differences between groups with regard to either…”

Section: Sedation During Upper Gastro-intestinal Endoscopymentioning

confidence: 94%

The Randomized Controlled Clinical Trial in Gastroenterology: The Danish Contributions from 1970 to 1994

Lauritsen¹,

Christensen²

1996

Scandinavian Journal of Gastroenterology

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Lauritsen K, Christensen E. The randomized controlled clinical trial in gastroenterology: The Danish contributions from 1970 to 1994. Scand J Gastroenterol 1996;31 Suppl 216:181-98. More than 200 Danish randomized controlled clinical trials in gastroenterology published from 1970 to 1994 were retrieved by electronic media, by hand-searching relevant journals, and by direct requests to Danish gastroenterologists. With the historical perspective through a quarter of a century, these papers are outlined to provide a survey of the pieces of information that Danish gastroenterologists have contributed to the present knowledge of therapeutics. The presented randomized controlled clinical trials constitute an impressive sum of knowledge within a diversity of topics. A cautious analysis of the time pattern for the publications in addition to the contents of the reports discloses that the discipline of planning and executing relevant controlled clinical trials is now in blossom in Danish gastroenterology. Denmark Ifax: +45 65 91 74 81) Scand J Gastroenterol Downloaded from informahealthcare.com by Mcgill University on 12/09/14 For personal use only. Scand J Gastroenterol Downloaded from informahealthcare.com by Mcgill University on 12/09/14 For personal use only.

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“…An initial dose of 0.2-0.5 mg iv followed by doses of 0.1-0.2 mg every minute until the patient is awake or to a total dose of I mg significantly reduces the degree of sedation common to patients sedated or anesthetized with BZDs. 32,34,38,39,[45][46][47] Failure of a patient with unconsciousness of unknown origin to respond to intravenous doses of ftumazenil >5 mg may indicate the involvement of agents other than BZDs, or the presence of another etiology. Once administered, the duration of a single dose offtumazenil should not be expected to exceed one hour, For cases in which prolonged activity is desired, either repeated intravenous administration or the initiation of an infusion (0.1-0.5 mg/h) may be implemented.v-P-"…”

Section: Drug Doseand Administrationmentioning

confidence: 99%

Flumazenil: A Benzodiazepine Antagonist

Karavokiros¹,

Tsipis²

1990

DICP

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Although benzodiazepines have been proven safe and effective for the induction and maintenance of sedation, some instances require the reversal of these events prior to the natural process of metabolism and elimination. Flumazenil, a 1,4-imidazobenzodiazepine, is an antagonist that can reduce or terminate benzodiazepine effects in a dose-dependent manner. The antagonist acts by the competitive inhibition of benzodiazepines at their central nervous system receptor sites. When administered intravenously in incremental doses, flumazenil allows for optimal patient response on an individual basis. Despite its short elimination half-life, small doses of flumazenil are usually effective in producing benzodiazepine reversal. Flumazenil's short duration of activity is due to its rapid hepatic metabolism and elimination. Intravenous antagonist doses of 0.2 mg followed by 0.1 mg/min to a total dose of 1 mg have produced significant results in reversing benzodiazepine sedation. As much as 5 mg of flumazenil have been necessary when treating benzodiazepine or mixed-agent intoxications. In such situations, response rarely exceeds a duration of one hour. If resedation occurs, additional doses or an infusion of the antagonist may provide the desired response. Flumazenil is well tolerated locally as well as systemically. Nausea and vomiting occurring after anesthesia is the most documented adverse effect in both placebo and treatment populations. However, there has been no significant difference in the occurrence of vomiting in placebo compared with flumazenil-treated subjects. Careful observation and slow reversal of central nervous system depression is crucial in the avoidance of benzodiazepine withdrawal in those patients dependent upon these agents. Flumazenil appears to provide a mechanism for the safe and effective reversal of benzodiazepine-induced sedation.(ABSTRACT TRUNCATED AT 250 WORDS)

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Flumazenil used for antagonizing the central effects of midazolam and diazepam in outpatients

Cited by 29 publications

References 7 publications

Effect of Flumazenil on Disturbance of Equilibrium Function Induced by Midazolam

Effect of Flumazenil on Disturbance of Equilibrium Function Induced by Midazolam

The Randomized Controlled Clinical Trial in Gastroenterology: The Danish Contributions from 1970 to 1994

Flumazenil: A Benzodiazepine Antagonist

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