Agree with the below -
And isn't flumazenil quite expensive too?
> 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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