Elisabeth M H Mathus-Vliegen1, Linda de Jong, Hedwig A Kos-Foekema. 1. Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, e.mathus-vliegen@amc.uva.nl.
Abstract
BACKGROUND: Endoscopy under midazolam sedation requires a 2-h recovery facility. AIM: To study the potential of shortening patients' stay without jeopardizing patients' safety by the use of the benzodiazepine-antagonist flumazenil in the everyday practice and to investigate the feasibility of a study comparing midazolam with recovery with midazolam-flumazenil and immediate discharge. METHODS: Consecutive ambulatory patients referred for endoscopy under midazolam sedation with ASA I or II, escorted by a person, were eligible. Flumazenil was given on arrival in the recovery room. Patients were discharged when adequate Aldrete scores and physical mobility were present. The next day, they were contacted by telephone. RESULTS: A total of 1,506 patients participated. They received 5 mg midazolam, while 887 patients also received 50 mcg fentanyl. The median dose of flumazenil was 0.2 mg. Oxygen desaturation (sO2 <92%) occurred in 15% during the procedure without an effect on recovery and discharge times. Patients left the department 65 min after the last midazolam administration. The majority (82.7%) were fully alert during their journey home. At home, 2.7% went to bed, 45.2% took a nap, and 40% undertook activities. Almost every patient (98.8%) liked the shortened recovery time. Three patients had an incident (fainting, fall, and near-fall) without consequences. Based on this low incidence, a non-inferiority comparison of midazolam-flumazenil with midazolam-recovery would require a total of 32,650 patients. CONCLUSIONS: Administration of flumazenil resulted in a safe shortening of the recovery period and offers the possibility for substantial savings in time, space, and nurse resources. A non-inferiority comparison will not be practicable.
BACKGROUND: Endoscopy under midazolam sedation requires a 2-h recovery facility. AIM: To study the potential of shortening patients' stay without jeopardizing patients' safety by the use of the benzodiazepine-antagonist flumazenil in the everyday practice and to investigate the feasibility of a study comparing midazolam with recovery with midazolam-flumazenil and immediate discharge. METHODS: Consecutive ambulatory patients referred for endoscopy under midazolam sedation with ASA I or II, escorted by a person, were eligible. Flumazenil was given on arrival in the recovery room. Patients were discharged when adequate Aldrete scores and physical mobility were present. The next day, they were contacted by telephone. RESULTS: A total of 1,506 patients participated. They received 5 mg midazolam, while 887 patients also received 50 mcg fentanyl. The median dose of flumazenil was 0.2 mg. Oxygen desaturation (sO2 <92%) occurred in 15% during the procedure without an effect on recovery and discharge times. Patients left the department 65 min after the last midazolam administration. The majority (82.7%) were fully alert during their journey home. At home, 2.7% went to bed, 45.2% took a nap, and 40% undertook activities. Almost every patient (98.8%) liked the shortened recovery time. Three patients had an incident (fainting, fall, and near-fall) without consequences. Based on this low incidence, a non-inferiority comparison of midazolam-flumazenil with midazolam-recovery would require a total of 32,650 patients. CONCLUSIONS: Administration of flumazenil resulted in a safe shortening of the recovery period and offers the possibility for substantial savings in time, space, and nurse resources. A non-inferiority comparison will not be practicable.
Authors: J M Dumonceau; A Riphaus; J R Aparicio; U Beilenhoff; J T A Knape; M Ortmann; G Paspatis; C Y Ponsioen; I Racz; F Schreiber; P Vilmann; T Wehrmann; C Wientjes; B Walder Journal: Endoscopy Date: 2010-11-11 Impact factor: 10.093
Authors: A Kankaria; J H Lewis; G Ginsberg; J Gallagher; F H al-Kawas; C C Nguyen; D E Fleischer; S B Benjamin Journal: Gastrointest Endosc Date: 1996-10 Impact factor: 9.427
Authors: Lawrence B Cohen; Julie S Wecsler; John N Gaetano; Ariel A Benson; Kenneth M Miller; Valerie Durkalski; James Aisenberg Journal: Am J Gastroenterol Date: 2006-05 Impact factor: 10.864
Authors: T M Bauer; R Ritz; C Haberthür; H R Ha; W Hunkeler; A J Sleight; G Scollo-Lavizzari; W E Haefeli Journal: Lancet Date: 1995-07-15 Impact factor: 79.321
Authors: Frédérik Rousseau-Blass; Alastair E Cribb; Francis Beaudry; Daniel Sj Pang Journal: J Am Assoc Lab Anim Sci Date: 2021-03-05 Impact factor: 1.232
Authors: Troy G Seelhammer; Eric M DeGraff; Travis J Behrens; Justin C Robinson; Kristen L Selleck; Darrell R Schroeder; Juraj Sprung; Toby N Weingarten Journal: Braz J Anesthesiol Date: 2018-04-07