Pharmacoeconomic evaluation of flumazenil for routine outpatient EGD.
BACKGROUND
Flumazenil is a benzodiazepine antagonist indicated for reversal of the sedative effects of benzodiazepines. Previous studies suggest that flumazenil may shorten recovery time after endoscopy, but there are few data on actual recovery room times and charges.


METHODS
Fifty patients undergoing routine upper endoscopy were sedated with midazolam alone in the usual titrated manner. Patients were randomized in a double-blind fashion to receive either flumazenil or saline immediately after procedure. Assessments of responsiveness, speech, facial expression, and ptosis (Observer's Assessment of Alertness/Sedation [OAA/S] scale) were made before procedure, immediately after procedure and every 15 minutes thereafter. The patient was discharged from the recovery room when vital signs and OAA/S scale reached preprocedure levels. Recovery room times and charges were recorded.


RESULTS
The flumazenil group demonstrated shorter recovery room times and recovery room charges than the placebo group (p < 0.001). The difference in recovery room charges was not statistically different when flumazenil charges were included (p = 0.09).


CONCLUSIONS
The routine use of flumazenil after midazolam sedation for upper endoscopy significantly shortened recovery time and charges but did not statistically reduce overall charges.
Wille
R T
RT
University of Michigan Hospitals, Ann Arbor, Michigan, USA.
Chaffee
B W
BW
Ryan
M L
ML
Elta
G H
GH
Walter
V
V
Barnett
J L
JL
D000328:Adult; D000553:Ambulatory Care; D000762:Anesthesia Recovery Period; D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005442:Flumazenil / Q000008:administration & dosage / Q000191:economics; D017722:Hospital Charges; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D017060:Patient Satisfaction; D011997:Recovery Room / Q000191:economics; D013997:Time Factors
D006993:Hypnotics and Sedatives; D005442:Flumazenil; D008874:Midazolam