The routine use of a flumazenil infusion following percutaneous endoscopic gastrostomy placement to reduce early post-procedure mortality.
OBJECTIVE
Percutaneous endoscopic gastrostomy (PEG) insertion offers secure enteral nutrition, but there is a significant mortality associated with the procedure. We reviewed our sedation practice and the effect of yearly protocol changes to establish if the routine reversal of midazolam with a flumazenil infusion improved mortality.


METHODS
Since 2003 yearly protocol changes have been introduced, including pre-assessment and sedation reversal. We retrospectively audited one-week and one-month mortality and aspiration rates.


RESULTS
The average one-week mortality rate was 9.2%. The pooled death rates within the first week for patients prior to routine sedation reversal (n=522) was 10.7% and for patients who received routine reversal (n=144) was 5.4% (p=0.087). Within the first month, death rates were 26.3% prior to reversal and 21.4% in the sedation reversal group (p=0.30).


CONCLUSIONS
The routine use of flumazenil infusion in appropriate patients is safe. Flumazenil infusion may have a role to play in selected patients at highest risk of aspiration. A prospective, randomised study is warranted.
Department of Gastroenterology, Mid Staffordshire NHS Foundation Trust, Weston Road, Stafford ST163SA, UK. nickbosanko@doctors.net.uk
N C
NC
Bosanko
D
D
Barrett
C
C
Emm
W
W
Lycett
S
S
O'Toole
K
K
Evans
S D
SD
Hearing
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000401:mortality; D005260:Female; D005442:Flumazenil / Q000008:administration & dosage*; D018757:GABA Modulators / Q000008:administration & dosage*; D005774:Gastrostomy / Q000379:methods* / Q000401:mortality*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
D018757:GABA Modulators; D005442:Flumazenil