Flumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy.
BACKGROUND
Flumazenil is a competitive benzodiazepine antagonist that acts to reverse their sedative and hypnotic effects. It is indicated in the management of benzodiazepine overdose, but its role in the routine reversal of endoscopic conscious sedation has not been defined.


METHODS
Patients undergoing diagnostic upper endoscopy who received sedation with either diazepam or midazolam alone were given flumazenil 0.2 mg incrementally immediately following the procedure until awake. They were then asked to repeat three psychomotor tests measuring cognitive and motor skills, with their baseline scores compared with postprocedure scores over a 3-hour period.


RESULTS
Full psychomotor function was restored to baseline values within 30 minutes after flumazenil in 79% of patients, with no differences in the reversal of psychomotor skill impairment observed between diazepam and midazolam sedation. There was no evidence of rebound sedation seen for up to 3 hours. No significant anterograde amnesia was evident in 78% of individuals.


CONCLUSIONS
These results demonstrate that flumazenil's effects on reversing psychomotor impairment are similar when midazolam or diazepam are used for conscious sedation. However, the potential usefulness of routine flumazenil reversal of conscious sedation will require further evaluation of specific psychomotor performance skills (such as driving a car) before we lift the admonition against leaving the endoscopic suite unattended, driving a vehicle, or operating complicated machinery for several hours.
Division of Gastroenterology, Georgetown University Medical Center, Washington, D.C., USA.
A
A
Kankaria
J H
JH
Lewis
G
G
Ginsberg
J
J
Gallagher
F H
FH
al-Kawas
C C
CC
Nguyen
D E
DE
Fleischer
S B
SB
Benjamin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017109:Akathisia, Drug-Induced / Q000188:drug therapy* / Q000209:etiology; D018686:Anesthetics, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D000931:Antidotes / Q000008:administration & dosage / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016292:Procedural Sedation / Q000009:adverse effects; D003975:Diazepam / Q000009:adverse effects* / Q000627:therapeutic use; D004384:Duodenoscopy / Q000379:methods; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005442:Flumazenil / Q000008:administration & dosage / Q000627:therapeutic use*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008874:Midazolam / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D000931:Antidotes; D005442:Flumazenil; D003975:Diazepam; D008874:Midazolam