Dear Andy,
Was the patient given an opiate as well? How much midazolam had been given?
Also, what was the time between using the midazolam and getting to the Ward.
Lastly, why had the patient fallen, had an ECG been done?
Ray McGlone
A&E Lancaster
----- Original Message -----
From: "A S Lockey" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 15, 2001 7:22 PM
Subject: Re: Flumazenil, Sedation and Fits
> WARNING - ANECDOTAL EVIDENCE ALERT!
>
> Several years ago, whilst doing anaesthetics in a DGH south of Yorkshire
> (missionary work), an A&E SHO zonked a patient with midazolam for a
> dislocated shoulder then reversed him after relocation with flumazanil as
> she had been told that this was routine practice. As he was elderly and it
> was late evening, he was admitted for observation. He was placed on a
> nightingale orthopaedic ward in the 'bed of doom' at the end (usually
> reserved for ultra-fit or imminently croaking) and when his next lot of
obs
> were due, was found deceased from a respiratory arrest. It was decided
that
> he had re-sedated after the flumazanil had worn off with midazolam still
on
> board.
>
> The main problem is when people use midazolam who are not familiar with
it.
> The patient does not have to be 'asleep' for it to be effective. I never
use
> flumazanil because the time that the patient snoozes after release of
their
> painful stimulus is usually quite short so long as they have not been
> completely flattened beforehand. You can achieve adequate relaxation (with
> protection of airway reflexes) and more than adequate amnesia whilst you
> relocate their joint at the same time that they profess their undying love
> to you and promise you a crate of ale for your troubles (damn that
> amnesia!).
>
> Having said that, I rarely use midazolam for shoulders, as that is usually
> evidence of failure at correctly trying to relocate them (in those with no
> associated fracture). But don't get me started on that one......!
>
> Andy
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of rmcglone
> Sent: 15 October 2001 18:38
> To: [log in to unmask]
> Subject: Re: Flumazenil, Sedation and Fits
>
> The "reference" for not using it routinely is cost. However, I do use it
if
> clinically indicated or if we are short of nursing staff to recover the
> patient. I've never had a problem with patients re-sedating after a bolus
of
> midazolam reversed by flumazenil.
>
> Ray McGlone
> A&E Lancaster
>
> ----- Original Message -----
> From: <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, October 15, 2001 2:43 PM
> Subject: Flumazenil, Sedation and Fits
>
>
> > Recently while reducing bilateral shoulder 'erecta' dislocations (don't
> ask)
> > under a bit of Midazolam and opiate I was challenged by a colleague as
why
> I
> > was not wanting to use Flumazenil to simply reverse the Midaz as soon as
> the
> > procedure was over.
> > I gave the standard 'Fit Risk' answer but was then asked to prove it....
> > So trying to be the good evidence based practitioner i went to Medline
and
> searched
> > around the subject. To my surprise their are papers that not only
document
> Flumazenil
> > causing fits, usually in relation to mixed ODs, but several advocating
its
> USE
> > as an ANTI-epileptic ( Oral flumazenil in the treatment of epilepsy.
> Annals
> > of Pharmacotherapy.29(5):530-1,1995May Reisner-Keller LA et al)
> > So does anyone have a reference/evidence for why we don't use it for
> simply
> > waking uncomplicated sedated patients up?
> > Cheers
> > Peter A Cutting
> >
> >
>
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