Flumazenil in ketamine and midazolam anaesthesia

Restall, J.; Johnston, Ian; Robinson, Dallas N.

doi:10.1111/j.1365-2044.1990.tb14623.x

Cited by 13 publications

(8 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The benzodiazepines diazepam (Kothary and Zsigmond 1977;Tucker et al 1984), ßunitrazepam (Freuchen et al 1976), lorazepam Lilburn et al 1978), and midazolam (White 1982;Cartwright and Pingel 1984;Toft and Romer 1987;Restall et al 1988) have been reported to reduce the emergence phenomena. Further, administration of the benzodiazepine receptor antagonist, ßumazenil, increases emergence phenomena in patients treated with midazolam and ketamine (Restall et al 1990). Benzodiazepines have also been reported to reduce the psychotogenic e¤ects of PCP intoxication (Smith et al 1978).…”

Section: Introductionmentioning

confidence: 97%

Interactive effects of subanesthetic ketamine and subhypnotic lorazepam in humans

et al. 1998

View full text Add to dashboard Cite

Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with psychotogenic and dissociative effects in healthy humans. These cognitive and perceptual effects in humans are reportedly reduced by benzodiazepine premedication. This study assessed the interactive effects of a ketamine (i.v. bolus of 0.26 mg/kg followed by an infusion of 0.65 mg/kg per hour) and lorazepam 2 mg., PO, in humans. Twenty-three healthy subjects completed 4 test days involving the oral administration of lorazepam or matched placebo 2 h prior to the i.v. infusion of ketamine or placebo. Ketamine: 1) produced behaviors similar to the positive and negative symptoms of schizophrenia as assessed by the Brief Psychiatric Rating Scale (BPRS); 2) evoked perceptual alterations as measured by the Clinician-Administered Dissociative States Scale (CADSS); 3) impaired performance on the Wisconsin Card Sorting Test (WCST) and other tests sensitive to frontal cortical impairment; and 4) had amnestic effects. Lorazepam produced attention impairments, concrete proverb interpretations, and recall impairments. Lorazepam reduced ketamine-associated emotional distress and there was a non-significant trend for it to decrease perceptual alterations produced by ketamine. However, it failed to reduce many cognitive and behavioral effects of ketamine, including psychosis. Further, lorazepam exacerbated the sedative, attention-impairing, and amnestic effects of ketamine. There was no evidence of pharmacokinetic interaction between these medications. These data suggest that subhypnotic lorazepam and ketamine show a spectrum of interactive effects, ranging from antagonism to potentiation.

show abstract

Section: Introductionmentioning

confidence: 97%

Interactive effects of subanesthetic ketamine and subhypnotic lorazepam in humans

et al. 1998

View full text Add to dashboard Cite

show abstract

Section: Midazolam/ Ketaminementioning

confidence: 99%

“…Ketamine causes increased sympathetic activity with a major increase in systemic vascular resistance and pressures in the cardiovascular system, and also severe unpleasant dysphoric effects (59)(60)(61)(62). Both effects are ameliorated by BZDs (61,62). Arguably, induction of anaesthesia with a combination of midazolam and ketamine (24) is one of the best combinations in critically ill patients, where a rise in arterial pressure may precipitate acute left ventricular failure, but a fall in pressure is also undesirable, and potentially fatal.…”

Section: Midazolam/ Ketaminementioning

confidence: 99%

Flumazenil and midazolam in anaesthesia

Whitwam

1995

Acta Anaesthesiol Scand

177

View full text Add to dashboard Cite

Flumazenil, the first benzodiazcpinr antagonist, is currently used widely as an emergency drug, and has also been utilized in planned procedurrs, tn time arousal intra-or post-operatively. It is known that flumazenil, used at the end of a procedure, causcs instant rrcovery by reversing the residual effects of, for example. midazolam. An agonist-antagonist concept, midazolam-flumazenil, where benzodiazepine sedation or anaesthesia i s terminated at will, is, therefore, finding incrcasing application. In neuroanaesthesia, for example, it facilitates immediate recovery, cardiovascular stabilization and the use of midazolam as an alternative to thiopentone and inhalational agents, and in ear, nose and throat rndoscopies, it permits more rapid turnover of patients and is a good choice for haemodynamic stability in patients with a high cardiovascular risk factor. There continues to be debate over the term used to describe the level of sedation remaining after the effects of the antagonist have worn off. 'Resedation' i s often used incorrectly tn drsrribe what is in reality residual sedation, Givcn thc corr'cct usc of midazolam or the exploitation of synergism using opioids, flumazenil will cause arousal, while maintaining thc benefit of opioid analgesia. Such a technique may eliminate the need for formal recovery facilities in many ambulatory patients, thereby reducing dependencc on trolleys, beds and nurses. This has major implications for health economics, particularly in relation to endoscopy clinics and when co-induction of anaesthesia is employrd.

show abstract

“…[10][11][12][13] In these species, flumazenil has two major effects: (a) improvement in benzodiazepine-induced respiratory depression [14][15][16][17] and (b) enhanced recovery from general anaesthesia. [18][19][20] However, no studies have specifically examined the use and effects of flumazenil in horses.…”

Section: Introductionmentioning

confidence: 99%

The effects of flumazenil on ventilatory and recovery characteristics in horses following midazolam‐ketamine induction and isoflurane anaesthesia

Douglas

Hopster

Cerullo

et al. 2020

Equine Veterinary Journal

View full text Add to dashboard Cite

Background: Flumazenil antagonises the actions of benzodiazepines. There has been no prior research specifically investigating this anaesthetic reversal agent for horses.Objectives: To determine the effects of flumazenil administration in horses on (a) ventilatory parameters after midazolam-ketamine induction and maintenance with isoflurane in oxygen and on (b) the characteristics of recovery from general anaesthesia.Study design: Blinded, randomised, crossover experiment.Methods: Six horses were randomly assigned to receive high-dose flumazenil (F high , 20 µg/kg), low-dose flumazenil (F low , 10 µg/kg) and saline (control). Cardioventilatory parameters were monitored. After 90 minutes of isoflurane anaesthesia, a bolus of F high , F low or saline was administered i.v. The horses were recovered using head and tail rope assistance. The times to first movement, to achievement of sternal recumbency, to the first attempt to stand and the total recovery time were determined.The recovery quality was evaluated using a 115-point recovery scoring system. The cardioventilatory parameters and recovery times were analysed using mixed-effects regression analyses. Intraclass correlation (ICC) analysis was used to evaluate the recovery scores. A Mann-Whitney U test assessed the relationship between recovery score and flumazenil administration.Results: A significant difference with flumazenil administration was found for SpO 2 , mean arterial pressure, I:E ratio, minute volume of ventilation (MV) and peak inspiratory pressure. There was a significant difference with flumazenil administration for the time to sternal recumbency, the time to the first attempt to rise and the total recovery time. There was no significant difference in total recovery score with flumazenil administration.Main limitations: Plasma levels of midazolam and flumazenil were not obtained.Conclusions: Flumazenil has a dose-dependent effect on MV and recovery time, which may make it useful in cases for which a prolonged anaesthetic recovery is undesirable.

show abstract

Flumazenil in ketamine and midazolam anaesthesia

Cited by 13 publications

References 6 publications

Interactive effects of subanesthetic ketamine and subhypnotic lorazepam in humans

Interactive effects of subanesthetic ketamine and subhypnotic lorazepam in humans

Flumazenil and midazolam in anaesthesia

The effects of flumazenil on ventilatory and recovery characteristics in horses following midazolam‐ketamine induction and isoflurane anaesthesia

Contact Info

Product

Resources

About