Midazolam and flumazenil: the agonist‐antagonist concept for sedation and anaesthesia

Thomson, Dorothy; Geller, Eran; Lauven, P. M.; Whitwam, J. G.

doi:10.1111/j.1399-6576.1990.tb03197.x

Cited by 5 publications

(6 citation statements)

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“…This study is the first specific report of the use of midazolam, reversed with flumazenil, for anaesthesia for cardioversion. It confirms the suitability of midazolam, reversed with flumazenil, for sedation in patients with heart disease undergoing diagnostic and therapeutic procedures on the cardiovascular system [2] and suggests that it is a suitable anaesthetic technique for cardioversion. Gamma-aminobutyric acid A and benzodiazepine receptors have been demonstrated in myocardial muscle fibres of experimental animals; stimulation causes changes in action potential duration and contractility [3] which would support the hypothesis that benzodiazepines have potentially beneficial antiarrhythmic effects.…”

Section: Commentsupporting

confidence: 58%

“…Benzodiazepines cause depression of ventilatory responses to carbon dioxide and hypoxia [5] and, while some authors state that these may not be reversed by flumazenil [5], others have shown an increase in Sp Oj in patients anaesthetized with benzodiazepines after flumazenil [2].…”

Section: Commentmentioning

confidence: 99%

“…Barbiturates, etomidate and propofol are used for anaesthesia during cardioversion where the use of benzodiazepines could be advantageous in terms of haemodynamic stability [1] and .their effect on the myocardium [2,3]. The relatively prolonged recovery after benzodiazepines, including midazolam, can now be terminated with flumazenil and this technique has been investigated in this study.…”

mentioning

confidence: 99%

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Midazolam Sedation Reversed With Flumazenil for Cardioversion

Fennelly

Powell

Galletly

et al. 1992

British Journal of Anaesthesia

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Midazolam was used for anaesthesia in 20 patients undergoing cardioversion; 10 received flumazenil, which caused immediate rapid reversal of anaesthesia, and these patients maintained SpO2 greater than 95%, breathing air, within 5-10 min. In contrast, patients in the placebo group were still partially sedated and required oxygen therapy for up to 2 h to maintain a normal SpO2. Arterial pressure, but not heart rate, also was greater in the flumazenil group in the recovery period.

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Section: Commentsupporting

confidence: 58%

Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

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Midazolam Sedation Reversed With Flumazenil for Cardioversion

Fennelly

Powell

Galletly

et al. 1992

British Journal of Anaesthesia

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“…The central neurological anxiolytic, anticonvulsant, amnestic, sedative, and hypnotic effects are dose-related. 24 Midazolam reduces CMRO 2 and CBF in parallel, such that the CBF/CMRO 2 ratio remains normal.…”

Section: Midazolammentioning

confidence: 99%

“…Finally, it should have no effect on cardiovascular, respiratory, hepatic, or renal function, and no untoward side-effects such as nausea and vomiting, allergic reactions, or psychomotor disturbances. 24 Benzodiazepines were introduced in the 1960s and have assumed an increasing role as anxiolytics and sedative hypnotics, replacing barbiturates in many clinical applications. Because of their safety, as demonstrated by a high therapeutic index (50% lethal dose + 50% effective dose) and a relatively benign adverseeffect profile, they have achieved wide acceptance among clinicians.…”

Section: Drugsmentioning

confidence: 99%

Neuroleptanesthesia: current status

Bissonnette

Swan

Ravussin

et al. 1999

Can J Anesth/J Can Anesth

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FRCPCPurpose: To review the current status and possible future of neuroleptanalgesia/anesthesia, techniques that may be nearly extinct. Souzce: Articles from 1966 to present were obtained from the Current Science and Medline databases. Search terms include neurolepananalgesia/anesthesia, conscious sedation, droperidol, benzodiazepines, propofol, ketamine, and opioids. Information and abstracts obtained from meetings on this topic helped complete the collection of information. Principal findings: Droperidol/fentanyl may still be clinically indicated in the management of surgical seizure therapy for electrocorticography. However, the high incidence of post-operative sedation and restlessness discourage its use for other surgical or diagnostic procedures. Many surgical interventions, once thought ideally suited for neuroleptic agents, now meet better success with newer medications. The use of midazolam and/or propofol, in association with newer opioids, provides ideal anesthetic combinations. Conclusion:The advantages of newer anesthetic agents have redefined the clinical indications for neuroleptanesthesia. In routine modem anesthesia, anxiolysis, sedation, and/or analgesia is better provided, with quicker recovery, by the new pharmacokinetic and pharmacodynamic characteristics of recent medications than by the neuroleptic component of neuroleptanesthesia.Objectif : Fake une revue de I'&at actuel et de I'Evolution possible de la neuroleptanalgEsie qui semble maintenant presque abandonnEe. Souree..s : Des articles de 1966 A aujourd'hui ont ~t6 obtenus A partir d'une consultation de Current Science et de Medline. Les mots-clEs comprenaient : neuroleptanalg&ie, sedation du patient EveillE, dropEridol, benzodiazEpines, propofol, k&amine et opiac&. Les informations et les rEsumEs provenant de sEminaires sur le sujet ont permis de completer la cueillette de donnEes. Constatadons principales : La combinaison de drop&idol et d'alfentanil peut &re indiquEe pour I'Electrocorticographie utilisEe dans le traitement chirurgical de I'Epilepsie. Cependant, I'importante incidence de sedation et d'agitation postop&atoires d&ourage son utilisation pour d'autres interventions chirurgicales ou diagnostiques. Nombre d'interventions chirurgicales o6 on a cru que les neuroleptiques &aient les agents idEaux sont maintenant mieux rEussies avec de nouveaux medicaments. I'emploi de midazolam et/ou de propofol, associ& aux nouveaux opiac&, fournit les meilleures combinaisons. Conclusion : Les avantages des nouveaux anesthEsiques ont amenE A red~finir les indications cliniques de la neuroleptanalg&ie. Dans la pratique de I'anesthEsie moderne, les medicaments r&ents assurent mieux la reduction de I'anxiEtE, la sedation et/ou I'analgEsie et permettent une r6cup&ation plus rapide que les composes utilis& en neuroleptanalg&ie, grace ~ leurs nouvelles caract&istiques pharmacocin&iques et pharmacodynamiques. HE paucity of recent literature on neuroleptanesthesia, once a topic of considerable interest in anesthesia, attests to its current uncertain...

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Effects of flumazenil on cholecystokinin-tetrapeptide-induced panic symptoms in healthy volunteers

et al. 1994

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The neuropeptide cholecystokinin-tetrapeptide (CCK-4) has potent anxiogenic action in human and animal subjects. On the basis of prior work which demonstrated that benzodiazepine (BZD) receptor agonists antagonized CCK-induced excitation of rat hippocampal neurons we studied whether BZD receptors mediated the anxiogenic effect of CCK-4. To examine this possibility we determined whether the BZD receptor antagonist flumazenil could antagonize the effects of CCK-4 (50 micrograms) in healthy volunteers. Thirty subjects (10 females; 20 males) were pretreated with flumazenil (2 mg in saline) or placebo (0.9% NaCl in water) 15 min prior to CCK-4 challenge in a randomized double-blind crossover design. Flumazenil had no impact on the behavioral and cardiovascular effects of CCK-4, suggesting that BZD receptors do not mediate the anxiogenic action of CCK-4. The influence of GABA and non-GABA-related mechanisms on response to CCK-4 remains to be considered.

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Midazolam and flumazenil: the agonist‐antagonist concept for sedation and anaesthesia

Cited by 5 publications

References 0 publications

Midazolam Sedation Reversed With Flumazenil for Cardioversion

Midazolam Sedation Reversed With Flumazenil for Cardioversion

Neuroleptanesthesia: current status

Effects of flumazenil on cholecystokinin-tetrapeptide-induced panic symptoms in healthy volunteers

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