The use of flumazenil after midazolam-induced conscious sedation

Henthorn, K. M.; Dickinson, Christine

doi:10.1038/sj.bdj.2010.1132

Cited by 7 publications

(11 citation statements)

References 9 publications

(9 reference statements)

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“…Although the RRR suggested that administration of flumazenil is indicative of a benzodiazepine overdose, its use in dentistry is for reasons other than to reverse respiratory depression as indicated in all our data, supporting earlier findings (23). Flumazenil can prevent sedation-related accidents after dental procedures in those with mobility problems and severe learning disabilities, who have been shown to be at an increased risk of falls and injury (24).…”

Section: Discussionsupporting

confidence: 87%

Midazolam use for dental conscious sedation: how safe are we?

2018

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This is the accepted version of the paper.This version of the publication may differ from the final published version.Permanent repository link: http://openaccess.city.ac.uk/18479/ Link to published version: http://dx. Title Midazolam use for dental conscious sedation: how safe are we? In brief The use of midazolam for conscious sedation has an excellent safety profile in dentistry comparatively, with a low number of reported incidents  Use of high strength midazolam is still prevalent  Education and training of dentists regarding relevant safety reports and reporting systems is necessary to improve the safety culture of drug administration in conscious sedation. Abstract (200 words)Aim: To explore the safety awareness of midazolam use amongst dentist in the UK. Materials and methods: A cross-sectional study on 203 dentists was undertaken, 146 of whom currently practice conscious sedation using intravenous midazolam. Use of high strength midazolam; awareness of the Rapid Response Report (RRR) and the National Reporting and Learning System (NRLS); and midazolam related incidents were explored. Results: Formal training in conscious sedation was variable with 35.6% holding a postgraduate sedation qualification. Flumazenil administration was common practice (63%) although used very selectively. Use to reverse respiratory depression was minimal (4%). Awareness of the RRR and the NRLS was generally low but higher among those working in general dental practice (p<0.05). Comparative analysis showed that high dose midazolam was administered more frequently in gastroenterology than in dentistry (p<0.001) with higher incidences of overdose (12.4% Vs 4.8%) and death (8.3% Vs 0%) within a 3 year period. Conclusions:High strength midazolam administration remains prevalent in dentistry, despite recommendations by the DoH. Use of flumazenil for reasons other than respiratory depression in dentistry should warrant little concern. The low incidence of reported harm is positive but may be due to a lack of uptake of national reporting systems.ANEXATE, ANNEXATE combined with DENTISTRY, DENTAL, DENTIST. Details of incidents such as type of incident, level of harm and details of incident were analysed and summarised in the results below. Removal of duplicate incidents and inspection of free-text legends confirmed the relevance of the incident for analysis.

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Section: Discussionsupporting

confidence: 87%

Midazolam use for dental conscious sedation: how safe are we?

2018

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“…Flumazenil, a benzodiazepine receptor antagonist, effectively reverses benzodiazepine-induced CNS depression via competitive inhibition at the GABA-A receptor-binding site [2][3][4][5][6][7][8]. Flumazenil has been beneficial for expediting patient recovery from anesthesia [9][10][11] and was previously studied in 519 patients at our center; of which, 15 were diagnosed with alcohol withdrawal [12].…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Flumazenil for Reversal of Iatrogenic Benzodiazepine-Associated Delirium Toxicity During Treatment of Alcohol Withdrawal, a Retrospective Review at One Center

et al. 2014

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“…Flumazenil is a specific benzodiazepine competitive antagonist, which inhibits the central effects of benzodiazepine agonists. Flumazenil is well-tolerated across a wide range of doses and has little side effects ( 38 , 39 ). Furthermore, flumazenil administration following alfaxalone-midazolam anesthesia significantly shortened recovery time and increased recovery quality in R. aegyptiacus in comparison to saline control ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Anesthesia, pain management and surgical approach of ovariectomy or orchiectomy in six Egyptian fruit bats (Rousettus aegyptiacus): A case report

Tal

Shilo‐Benjamini²

2023

Front. Vet. Sci.

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The purpose of this report is to describe the anesthetic and analgesic management and the surgical procedures of gonadectomy in six (four females and two males) healthy adult Egyptian fruit bats (Rousettus aegyptiacus). Bats were anesthetized with a combination of alfaxalone, midazolam, and morphine administered subcutaneously. Incisional line infiltration using bupivacaine was administered in all bats, and additional bilateral intratesticular injection was administered in the males. Ovariectomy was performed via a dorsal approach, by bilateral midline skin incisions at the paralumbar fossa level. Orchiectomy was performed via a ventral approach, by bilateral midline incisions of scrotal skin above the testes. Following surgery, all bats were administered flumazenil for midazolam reversal, and meloxicam for postoperative analgesia, subcutaneously. All bats recovered from anesthesia uneventfully. Bats were monitored for complications up to 10 days following surgery, when skin sutures were removed. No morbidities or mortalities occurred during this period in any of the bats. In conclusion, ventral approach orchiectomy and dorsal approach ovariectomy using the injectable combination alfaxalone-midazolam-morphine in conjunction with local anesthesia and meloxicam are feasible procedures in Egyptian fruit bats and can be performed with relative ease. However, further studies using these techniques in a larger group of bats should be performed to establish their safety.

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The use of flumazenil after midazolam-induced conscious sedation

Cited by 7 publications

References 9 publications

Midazolam use for dental conscious sedation: how safe are we?

Midazolam use for dental conscious sedation: how safe are we?

Safety and Efficacy of Flumazenil for Reversal of Iatrogenic Benzodiazepine-Associated Delirium Toxicity During Treatment of Alcohol Withdrawal, a Retrospective Review at One Center

Anesthesia, pain management and surgical approach of ovariectomy or orchiectomy in six Egyptian fruit bats (Rousettus aegyptiacus): A case report

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