Flumazenil in the outpatient A study following midazolam as sedation for upper gastrointestinal endoscopy

Andrews, Pjd; Wright, Dominic; Lamont, M

doi:10.1111/j.1365-2044.1990.tb14330.x

Cited by 36 publications

(16 citation statements)

References 8 publications

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“…These findings are in accordance with previous data suggesting that midazolam causes significant impairment of memory and motor reactions 60 min after the end of the procedure [9,25]. Accordingly, central nervous system impairment may persist for o3.5 h after antagonism of midazolam sedation with flumazenil, although patients may have a subjective feeling of alertness, which might have dangerous consequences [29].…”

Section: Discussionsupporting

confidence: 92%

Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial

Stolz¹,

Kurer²,

Meyer³

et al. 2009

European Respiratory Journal

109

115

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Combined sedation with a benzodiazepine and an opiate has been proposed as standard sedation for bronchoscopy. Propofol is a sedative-hypnotic with a rapid onset of action and fast recovery time, but carries the potential risk of respiratory failure.Consecutive patients (n5200) were randomly allocated to receive either the combination midazolam and hydrocodone or intravenous propofol. The primary end-points were the mean lowest arterial oxygen saturation during bronchoscopy and the readiness-for-discharge score 1 h after the procedure.The mean lowest arterial oxygen saturation during bronchoscopy did not differ across treatment groups (p50.422), and the number of patients recording an arterial oxygen saturation of f90% on at least one occasion was similar in both groups (p50.273). The median (interquartile range) readiness-for-discharge score 1 h after the procedure was significantly higher in the propofol group than in the combined sedation group (8 (6-9) versus 7 (5-9); p50.035). Patients assigned propofol exhibited less tachycardia during bronchoscopy and for o1 h after the examination. Minor procedural complications were noted in 71 (35.5%) patients and exhibited a similar incidence in both treatment arms (p50.460).Propofol is as effective and safe as combined sedation in patients undergoing flexible bronchoscopy, thus representing an appealing option if timely discharge is a priority.

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Section: Discussionsupporting

confidence: 92%

Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial

Stolz¹,

Kurer²,

Meyer³

et al. 2009

European Respiratory Journal

109

115

View full text Add to dashboard Cite

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“…14,15 However, in psychomotor tests, impairments were observed even 3 hours after the administration of flumazenil. 16,17 It was also reported that standing independently was more sensitive than both spontaneous eye opening and response to a verbal command. 18 Therefore, the difference in sensitivity may lead to a gap in the recovery pattern between the assessment of the sedation level and the EF test.…”

Section: Discussionmentioning

confidence: 99%

“…Among them, only the critical flicker fusion threshold did not show a significant antagonistic effect of flumazenil. 16,22 This raises a possibility that the effects of flumazenil may be specific to a part of the effect of benzodiazepines in psychomotor tests as well.…”

Section: Discussionmentioning

confidence: 99%

Effect of Flumazenil on Disturbance of Equilibrium Function Induced by Midazolam

Miyagawa

Miyawaki

Higuchi

et al. 2008

Anesthesia Progress

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Benzodiazepines in intravenous sedation are useful, owing to their outstanding amnesic effect when used for oral surgery as well as dental treatments on patients with intellectual disability or dental phobia. However, compared with propofol, the effect of benzodiazepine lasts longer and may impede discharge, especially when it is administered orally because of fear of injections. Although flumazenil antagonizes the effects of benzodiazepine quickly, its effect on the equilibrium function ( EF) has never been tested. Since EF is more objective than other tests, the purpose of this study is to assess the sedation level and EF using a computerized static posturographic platform. The collection of control values was followed by the injection of 0.075 mg/kg of midazolam. Thirty minutes later, 0.5 mg or 1.0 mg of flumazenil was administered, and the sedation level and EF were measured until 150 minutes after flumazenil administration. Flumazenil antagonized sedation, and there was no apparent resedation; however, it failed to antagonize the disturbance in EF. This finding may be due to differences in the difficulty of assessing the sedation level and performing the EF test, and a greater amount of flumazenil may effectively antagonize the disturbance in EF.

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“…32 Attention should be paid to aspiration, delayed arousal, and the possibility of falls as a result of the body's inhibited defense reflex. 33 Flumazenil reverses drowsiness and relieves respiratory depression induced by midazolam. The effect manifests approximately 120 s after i.v.…”

Section: Sedationmentioning

confidence: 99%

“…33 Flumazenil reverses drowsiness and relieves respiratory depression induced by midazolam. The effect manifests approximately 120 s after i.v.…”

mentioning

confidence: 99%

Basic principles and practice of gastric cancer screening using high‐definition white‐light gastroscopy: Eyes can only see what the brain knows

Gotoda

Uedo

Yoshinaga³

et al. 2016

Digestive Endoscopy

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Endoscopic diagnosis of gastrointestinal tumors consists of the following processes: (i) detection; (ii) differential diagnosis; and (iii) quantitative diagnosis (size and depth) of a lesion. Although detection is the first step to make a diagnosis of the tumor, the lesion can be overlooked if an endoscopist has no knowledge of what an earlystage 'superficial lesion' looks like. In recent years, image-enhanced endoscopy has become common, but white-light endoscopy (WLI) is still the first step for detection and characterization of lesions in general clinical practice. Settings and practice of routine esophagogastroduodenoscopy (EGD) such as use of antispasmodics, number of endoscopic images taken, and observational procedure are customarily decided in each facility in each country and are not well standardized. Therefore, in the present article, we attempted to outline currently available evidence and actual Japanese practice on gastric cancer screening using WLI, and provide tips for detecting EGC during routine EGD which could become the basis of future research.Key words: gastric atrophy, gastric cancer, Helicobacter pylori, Kimura-Takemoto classification, screening gastroscopy MEDICAL INTERVIEW PRIOR TO ESOPHAGOGASTRODUODENOSCOPY M EDICALINTERVIEW BEFORE esophagogastroduodenoscopy (EGD) is important in terms of the following two points. One is to confirm indication of the EGD and the other is to assess risk of examinees. Whether indication for EGD is to screen for early gastric cancer (EGC) or to make a diagnosis of a patient's symptoms or abnormal findings in other diagnostic examinations should be distinguished. In the screening endoscopy, the entire gastric mucosa is thoroughly observed to detect any suspicious findings for neoplasia, whereas only the presence of apparent lesions that may cause symptoms or abnormal image findings are investigated. Although endoscopy is usually intended to make a diagnosis of symptoms or abnormal findings in other diagnostic images, EGC are often found in patients with neither obvious symptoms nor abnormal findings in other diagnostic tests.1 Therefore, in high-risk patients, it is important to screen for EGC unrelated to symptoms or abnormal find-ings of other diagnostic tests during EGD. The examinee should be asked about status and history of eradication therapy of Helicobacter pylori (H. pylori), 2-4 family history of gastric cancer, smoking and drinking habits. [5][6][7][8] Another reason for the medical interview is to reduce 10 and an anti-foaming agent 11 reduces time and effort for washing out mucus or bubbles to improve quality of observation. A mixture of 4 mL anti-foaming agent (dimethicone, Gascon ® 20 mg/mL; Horii Pharmaceutical Industry, Osaka Japan), 20 000 U mucolytic agent (Pronase MS ® ; Kaken Pharmaceutical, Tokyo, Japan), and 1 g sodium bicarbonate dissolved in 50 mL water is given 10 min before the examination. 12Usefulness of a topical pharyngeal anesthetic is controversial although it is commonly used before gastroscopy. 13,14 UK data show that to...

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Flumazenil in the outpatient A study following midazolam as sedation for upper gastrointestinal endoscopy

Cited by 36 publications

References 8 publications

Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial

Propofol versus combined sedation in flexible bronchoscopy: a randomised non-inferiority trial

Effect of Flumazenil on Disturbance of Equilibrium Function Induced by Midazolam

Basic principles and practice of gastric cancer screening using high‐definition white‐light gastroscopy: Eyes can only see what the brain knows

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