In this highly controlled setting, the use of flumazenil (Anexate) was shown to be safe and effective in aiding recovery from benzodiazepine facilitated bronchoscopy and as such provides an additional level of safety for this procedure.
Exercise-induced asthma (EIA) is a common symptom among young asthmatics. The hypothesis that asymptomatic day-to-day wide fluctuations in lung function and asymptomatic persistent airflow obstruction are risk factors for the development of EIA was studied. The study population was a cohort of known asthmatic children aged 9-14 years attending a residential asthma camp. The method involved the observation of baseline expiratory peak flow recordings (PEFR) for 5 days while the children were receiving their usual maintenance therapy. The method also included the determination of FEV1 pre- and post- 15 min of continuous aerobic exercise. Exercise-induced asthma was expressed as the Lability index (LI). The findings were that LI was significantly correlated (P < 0.01) with the mean PEFR as a per cent of each child's predicted PEFR. The lability index also correlated (P < 0.01) with the degree of day-to-day variability in PEFR expressed as the coefficient of variance (CV). It is concluded that there is a significant correlation between baseline asthma control and the development of EIA. In addition to recommending pre-exercise prophylaxis, practitioners should investigate overall asthma control in children reporting EIA.
Methods A double-blind, randomized, placebo controlled trial of the efficacy of flumazenil was conducted in 22 consecutive patients admitted for bronchoscopy.Sedation was induced by inhvidually titrated amounts of intravenous diazepam (meanf s.d., 15.75 k4.4 mg). Post bronchoscopy, patients received up to 1 mg of the benzohazepine antagonist flumazenil (Anexate@) or placebo intravenously. Clinical scores for the degree of sedation, orientation in time and space, co-operation and anterograde amnesia were used. These, together with three psychometric tests were performed twice prior to bronchoscopy and on eight occasions in the following 24 h. The psychometric tests were: Tapping Test (TT), Simple Reaction Time (SRT) and Critical Flicker Fusion (CFF) and these were carried out using the automated Multipsy test system. Restilts The level of co-operation, orientation in time and space and anterograde amnesia were similar in both groups pre-and-post procedure. However compared with the pre-bronchoscopy assessment, the maximum degree of apparent sedation was significantly less in the flumazenil group in the first 4 h. In support of this, the patients in the flumazenil group also showed a significantly greater proficency with the TT and CFF test post bronchoscopy ( P < 0.05). There was no difference in the incidence of side effects and flumazenil was well tolerated.Conclusions In this highly controlled setting, the use of flumazenil (Anexate@) was shown to be safe and effective in aiding recovery from benzodiazepine facilitated bronchoscopy and as such provides an additional level of safety for this procedure.
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