I believe that it is the same reason why we don't use a single dose of
naloxone to deal with opiate OD - i.e. the half-life of flumazenil is 1
hour, midazolam 2 hours. Theoretically your patient may suddenly fall asleep
again on their way home/sitting in x-ray.
I think that the argument for flumazenil causing fits is only applicable in
intentional overdose patients. Frequently these guys have taken mixed ODs,
potentially including both tricyclics and benzodiazepines. The tricyclics
are pro-epileptic, the benzodiazepines are anti-epileptic. If you then
reverse the action of the benzos with flumazenil, this results in unopposed
tricyclics - the patient fits.
Chris Kirke
----- 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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