Sedation for day-case urology: an assessment of patient recovery profiles after midazolam and flumazenil

Abstract

The specific antagonist flumazenil has been shown to reverse the central actions of benzodiazepines. Its use, in day-case procedures performed under benzodiazepine sedation, offers the potential for enhanced patient recovery. However, concern has been expressed over the possibility of resedation given the short elimination half-life of flumazenil. A randomised, double-blind, placebo controlled trial was therefore designed to assess patient recovery profiles after flumazenil. A total of 44 adults were entered into the trial. Recovery was assessed by means of a battery of psychomotor tests performed pre- and postoperatively. Psychomotor function in patients receiving flumazenil returned to, or near to, baseline levels within 15 min of administration--an improvement maintained throughout the 6 h test period. Patients receiving placebo did not recover fully until the 2 h test point--significant differences between the two groups existing at 15 min and 1 h. In this study, flumazenil effectively reversed midazolam-induced sedation without evidence of resedation. The implications for day-case surgery are discussed.