FLUMAZENIL REVERSAL OF PSYCHOMOTOR IMPAIRMENT DUE TO MIDAZOLAM OR DIAZEPAM FOR CONSCIOUS SEDATION FOR UPPER ENDOSCOPY

Background: Flumazenil is a competitive benzodiazepine antagonist that acts to reverse their sedative and hypnotic effects. It is indicated In the management of benzodiazepine overdose, but its role in the rout ine reversal of endoscopic conscious sedation has not been defined. Me thods: Patients undergoing diagnostic upper endoscopy who received sed ation with either diazepam or midazolam atone were given flumazenil 0. 2 mg incrementally immediately following the procedure until awake. Th ey were then asked to repeat th ree psychomotor tests measuring cognit ive and motor skills, with their baseline scores compared with postpro cedure scores over a 3-hour period. Results: Full psychomotor function was restored to baseline values within 30 minutes after flumazenil in 79% of patients, with no differences in the reversal of psychomotor s kill impairment observed between diazepam and midazolam sedation, Ther e was no evidence of rebound sedation seen for up to 3 hours. No signi ficant anterograde amnesia was evident in 78% of individuals. Conclusi ons: These results demonstrate that flumazenil's effects on reversing psychomotor impairment are similar when midazolam or diazepam are used for conscious sedation. However, the potential usefulness of routine flumazenil reversal of conscious sedation will require further evaluat ion of specific psychomotor performance skills (such as driving a car) before we lift the admonition against leaving the endoscopic suite un attended, driving a vehicle, or operating complicated machinery for se veral hours.