If you need to "reverse" sedation then you have done it wrong. Conscious Sedation
means the patient is able to respond to verbal commands. Anything else borders
on general anaesthesia. I agree with the comment that flumazenil should be reserved
for those patients you cannot ventilate adequately.
Flumazenil lowers the seizure threshold, hence to propensity for overdose patients
to fit when given it - Tricyclics also lower the seizure threshold.
The Royal College of Anaesthetists are shortly to publish their document which
reviews sedation for dental anaesthesia, and provides recommendations....my
feeling is that responsible Emergency Physicians will already have adopted a
safe practice for sedation, but worth a look. Also worth a look - various medical
defense organisations' archives on "sedation mishaps".......
Marten C. Howes MRCP(UK)
Specialist Registrar
Accident and Emergency Medicine
Royal Preston Hospital
Lancashire
PR2 9HT
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