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Effects of the benzodiazepine antagonist flumazenil on postoperative performance following total intravenous anaesthesia with midazolam and alfentanil
Central
outcome of a common complication of the subclavian vein catheterization [Letter]. Crit Care Med 1990;18:7967. 47. Keats AS: The Rovenstine lecture, 1983: cardiovascular anesthesia: perceptions and perspectives. Anesthesiology 1984;60: 467-74. 48. Tinker JH, Dull DL, CaplanRA, Ward RJ, CheneyFW: Role of monitoringdevicesin preventionof anestheticmishaps:a closedclaimsanalysis. Anesthesiology 1989;7 1:541-6. 49. JensenN, Tinker JH: Quality in medicalcare: lessons from
Effects of the Benzodiazepine Performance Following Total
Department
Venous monitoring
in head and neck surgery: Jensen et al.
industry and a proposalfor valid measurement and improvement.Qua1Perform Qua1 Health Care1993;1:138-53. 50. Institute of Medicine:Assessing Medical Technologies. Washington, DC: NationalAcademyPress,1985. 51. WennbergJE: The paradoxof appropriatecare.JAMA 1987; 258:2568-g. 52
Antagonist Intravenous and Alfentanil
Bunker JP: Is efficacy the gold standardfor quality assessment?Inquiry 1988;25:51-8.
Flumazenil on Postoperative Anaesthesia with Midazolam
A. Nilson, M.P. Person, and P. Hartvig of Anaesthesiology, Uppsala University Uppsala, Sweden
Hospital,
Abstract Postoperative performance following total intravenous anesthesia(TIVA) using midazolam and alfentanil was studied with and without the administration of a single dose of a benzodiazepine antagonist, flumazenil (Ro 15-1788). Performance was compared with a reference group anaesthetized with thiopentone, alfentanil and nitrous oxide. All patients were assessedby use of a rating scale which took into account the degree of sedation, amnesia, comprehension and cooperation as well as temporal and spatial orientation. There was a slow recovery following TIVA with somnolence and amnesia lasting several hours. Administration of flumazenil 1.O mg i.v. at extubation caused a significant reduction of sedation (P < 0.001) during the first postoperative hour, with patients fully awake or only lightly sedated, but was later followed by resedation. The patients of the reference group were moderately sedated during the observational period. Five and six hours postoperatively there was no difference between the groups. Amnesia was more profound in the groups that received midazolam; the effect of the antagonist could only be seen for 15 min after its administration. Comprehension and cooperation, as well as orientation, were equally good in the antagonist and in the reference group during the immediate postoperative period, whereas in the TWA group a gradual improvement over the first hours was seen. In the antagonist group there wasno increase in the number of analgesic requirements, no anxiety attacks or other adverse effects. It is concluded that flumazenil offers an improvement in postoperative performance following TIVA induced by midazolam and alfentanil, but the effects are of short duration. Reprinted with permission from Acta Anaesthesiologica
Scandinavica
1988;32:441-6.
J. Clin. Anesth.,vol. 7, March 1995
125
outcome of a common complication of the subclavian vein catheterization [Letter]. Crit Care Med 1990;18:7967. 47. Keats AS: The Rovenstine lecture, 1983: cardiovascular anesthesia: perceptions and perspectives. Anesthesiology 1984;60: 467-74. 48. Tinker JH, Dull DL, CaplanRA, Ward RJ, CheneyFW: Role of monitoringdevicesin preventionof anestheticmishaps:a closedclaimsanalysis. Anesthesiology 1989;7 1:541-6. 49. JensenN, Tinker JH: Quality in medicalcare: lessons from
Effects of the Benzodiazepine Performance Following Total
Department
Venous monitoring
in head and neck surgery: Jensen et al.
industry and a proposalfor valid measurement and improvement.Qua1Perform Qua1 Health Care1993;1:138-53. 50. Institute of Medicine:Assessing Medical Technologies. Washington, DC: NationalAcademyPress,1985. 51. WennbergJE: The paradoxof appropriatecare.JAMA 1987; 258:2568-g. 52
Antagonist Intravenous and Alfentanil
Bunker JP: Is efficacy the gold standardfor quality assessment?Inquiry 1988;25:51-8.
Flumazenil on Postoperative Anaesthesia with Midazolam
A. Nilson, M.P. Person, and P. Hartvig of Anaesthesiology, Uppsala University Uppsala, Sweden
Hospital,
Abstract Postoperative performance following total intravenous anesthesia(TIVA) using midazolam and alfentanil was studied with and without the administration of a single dose of a benzodiazepine antagonist, flumazenil (Ro 15-1788). Performance was compared with a reference group anaesthetized with thiopentone, alfentanil and nitrous oxide. All patients were assessedby use of a rating scale which took into account the degree of sedation, amnesia, comprehension and cooperation as well as temporal and spatial orientation. There was a slow recovery following TIVA with somnolence and amnesia lasting several hours. Administration of flumazenil 1.O mg i.v. at extubation caused a significant reduction of sedation (P < 0.001) during the first postoperative hour, with patients fully awake or only lightly sedated, but was later followed by resedation. The patients of the reference group were moderately sedated during the observational period. Five and six hours postoperatively there was no difference between the groups. Amnesia was more profound in the groups that received midazolam; the effect of the antagonist could only be seen for 15 min after its administration. Comprehension and cooperation, as well as orientation, were equally good in the antagonist and in the reference group during the immediate postoperative period, whereas in the TWA group a gradual improvement over the first hours was seen. In the antagonist group there wasno increase in the number of analgesic requirements, no anxiety attacks or other adverse effects. It is concluded that flumazenil offers an improvement in postoperative performance following TIVA induced by midazolam and alfentanil, but the effects are of short duration. Reprinted with permission from Acta Anaesthesiologica
Scandinavica
1988;32:441-6.
J. Clin. Anesth.,vol. 7, March 1995
125