The effects of midazolam and flumazenil on psychomotor function and alertness in human volunteers

Coulthard, P.; Sano, K.; Thomson, P.; Coulthard, Paul

doi:10.1038/sj.bdj.4800470a

Cited by 8 publications

(10 citation statements)

References 14 publications

(19 reference statements)

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“…In addition the self‐reported measure of alertness clearly displays a decrease in alertness compared with baseline. This supports earlier work [10–12] and confirms that midazolam impairs the patient's ability to recall information imparted during or immediately following the administration of the sedative.…”

Section: Discussionsupporting

confidence: 90%

A randomised, controlled trial of cognitive and psychomotor recovery from midazolam sedation following reversal with oral flumazenil

Girdler¹,

Lyne²,

Wallace

et al. 2002

Anaesthesia

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Flumazenil is traditionally administered intravenously to reverse the adverse effects of over sedation with benzodiazepines. The aim of this study was to test postoperative cognitive and psychomotor recovery from midazolam conscious sedation, following reversal with orally administered flumazenil. It was hypothesised that when administered by the oral route, flumazenil may enhance recovery over a prolonged period, thus increasing safety. Eighteen patients requiring intravenous midazolam sedation for dental treatment completed a randomised, double-blind, crossover trial. Following treatment the patients' sedation was reversed using either flumazenil or saline (as placebo), administered orally, on alternate appointments. Assessment of mood and cognitive function were undertaken using ClinPhone.cdr(R), a highly sensitive and specific computerised battery of cognitive tests administered by telephone prior to sedation and every hour for seven hours post reversal. Results indicate that within 20 min of administration, oral flumazenil is capable of partially reversing some cognitive and psychomotor impairments but the attentional and stimulus discrimination effects of midazolam sedation still remain.

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Section: Discussionsupporting

confidence: 90%

A randomised, controlled trial of cognitive and psychomotor recovery from midazolam sedation following reversal with oral flumazenil

Girdler¹,

Lyne²,

Wallace

et al. 2002

Anaesthesia

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show abstract

“…In addition the self-reported measure of alertness clearly displays a decrease in alertness to baseline. This supports earlier work 12,18 and confirms the evidence that midazolam impairs the patients' ability to recall information imparted during or immediately after the administration of the sedative.…”

Section: Discussionsupporting

confidence: 80%

A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period

et al. 2002

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335 RESEARCHA randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period Objective: To study the post-operative cognitive and psychomotor recovery from midazolam conscious sedation, after reversal with the benzodiazepine antagonist flumazenil over a prolonged recovery period. Design: A prospective, double-blind, randomised, crossover trial. Setting: Out-patient Sedation Department, Newcastle Dental Hospital and School Method: Eighteen patients, ASA I or II, received midazolam on two separate occasions to undergo equivalent dental treatment. Following treatment patients were reversed with intravenous flumazenil or saline (placebo) at alternate appointments. Assessment of mood and cognitive function was undertaken using a highly sensitive and specific computerised battery of cognitive tests administered by telephone. Cognitive and psychomotor tests were administered prior to sedation and every hour for 6 hours post reversal. Results: Results indicated no significant effect of flumazenil on simple reaction time and choice reaction time but did show a trend of reversing the effects of midazolam on numeric working memory and word recognition. Conclusion:The cognitive and psychomotor effects of the sedation were not fully reversed by flumazenil. Cognitive impairments were still present up to 6 hours post-reversal, despite patients appearing clinically more alert. This has important implications for treatment protocols and discharge instructions.

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“…The literature has documented that flumazenil does not fully reverse the effects of midazolam on psychomotor or cognitive ability. [7][8][9][10][11] Initial onset of action is very rapid, often within one minute of administration. As recommended by the Roche data sheet 12 care should be taken to assess the patient for any complications for an adequate period of time following flumazenil administration.…”

Section: Discharge Of Patients Following Flumazenil Administrationmentioning

confidence: 99%

“…The importance of providing post-operative instructions and aftercare advice to both the escort and patient has been reported and is widely accepted. 7,8,[12][13][14] Once again, despite the administration of flumazenil, emphasis is given to the importance of the clinician's assessment of the patient's cognitive and physical capabilities before discharge; the potential for residual sedation and the effects of flumazenil in ambulatory patients should be considered.…”

Section: Discharge Of Patients Following Flumazenil Administrationmentioning

confidence: 99%

The use of flumazenil after midazolam-induced conscious sedation

Henthorn¹,

Dickinson

2010

Br Dent J

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Incident 8-Incomplete reversal During IVS procedure pt re-sedated. Flumazenil given at 1420-flumazenil has a shorter half-life than midazolam. Pt woke for about 40 minutes then re-sedated. SATS initially normal (brought back from waiting room to surgery). Dentist went for advice from Day Surgery Unit while Dental Nurse managed SPO2 drop by managing airway. Pt recovered consciousness shortly afterwards.' 1

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The effects of midazolam and flumazenil on psychomotor function and alertness in human volunteers

Cited by 8 publications

References 14 publications

A randomised, controlled trial of cognitive and psychomotor recovery from midazolam sedation following reversal with oral flumazenil

A randomised, controlled trial of cognitive and psychomotor recovery from midazolam sedation following reversal with oral flumazenil

A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period

The use of flumazenil after midazolam-induced conscious sedation

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