FLUMAZENIL AND MIDAZOLAM IN ANESTHESIA

Flumazenil, the first benzodiazepine antagonist, is currently used wid ely as an emergency drug: and has also been utilized in planned proced ures, to time arousal intra- or post-operatively. It is known that flu mazenil, used at the end of a procedure, causes instant recovery by re versing the residual effects of, for example, midazolam. An agonist-an tagonist concept, midazolam-flumazenil, where benzodiazepine sedation or anaesthesia is terminated at will, is, therefore, finding increasin g application. In neuroanaesthesia, for example, it facilitates immedi ate recovery cardiovascular stabilization and the use of midazolam as an alternative to thiopentone and inhalational agents, and in ear, nos e and throat endoscopies, it permits more rapid turnover of patients a nd is a good choice for haemodynamic stability in patients with a high cardiovascular risk factor. There continues to be debate over the ter m used to describe the level of sedation remaining after the effects o f the antagonist have worn off 'Resedation' is often used incorrectly to describe what is in reality residual sedation. Given the correct us e of midazolam or the exploitation of synergism using opioids, flumaze nil will cause arousal, while maintaining the benefit of opioid analge sia. Such a technique may eliminate the need for formal recovery facil ities in many ambulatory patients, thereby reducing dependence on trol leys: beds and nurses. This has major implications for health economic s, particularly in relation to endoscopy clinics and when co-induction of anaesthesia is employed.