Reversal agents in sedation and anesthesia: a review

Abstract

This paper reviews the use of prototypic drugs for reversal of the effects produced by anesthetic and sedative agents. Efficacy and toxicity information is presented for naloxone (as used to reverse opioids), physostigmine (as used for reversal of sedatives), and Flumazenil (a new specific benzodiazepine receptor antagonist). Naloxone is very useful and specific for reversing adverse and life-threatening respiratory depression caused by narcotic drugs and should be used in these situations. Physostigmime has been advocated in incremental doses for reversing sedative effects in patients who are obtunded or depressed after having received benzodiazepines, droperidol, scopolamine, opioids, and phenothiazines. Flumazenil has been shown to readily antagonize the sedative, respiratory depressant, anxiolytic, muscle relaxant, anticonvulsant, amnestic, and anesthetic effects of the benzodiazepines; it appears to have tremendous potential for use in anesthesia, conscious sedation, and emergency medicine when available.