CONTINUOUS FLUMAZENIL INFUSION IN PREVENTING COMPLICATIONS ARISING FROM SEVERE BENZODIAZEPINE INTOXICATION

A prospective, randomly controlled study was conducted to test the eff ect of continuous flumazenil infusion in preventing complications aris ing from severe benzodiazepine (BZ) intoxication, Patients who were be lieved to be suffering benzodiazepine intoxication and whose Glasgow C oma Scale (GCS) score was below 10 were enrolled after showing a clear -cut response to flumazenil 0.5 or 1 mg (an improvement by 4 or more o n the GCS). The patients were consecutively enrolled and randomized in to two groups: a continuous infusion group (CI, n = 50) who were immed iately given flumazenil 0.5 mg/h for 5 hours, and a control group (CIN , n = 50), Age, sex, incidence of underlying disease, GCS score at sev eral time points, and complication rate were compared in the two group s. Although the CI group had a higher GCS score at most time points, t he complication rate did not significantly differ between the two grou ps (14 of 36 in the CI group v 12 of 38 in the CIN group, P = .684). A greater incidence of underlying disease and an older age seemed to co ntribute to the higher complication rates in both groups, Several pati ents (in both groups) resedated into deeper coma after showing an init ial response to flumazenil or after the cessation of flumazenil infusi on. For severe BZ intoxication, treatment with flumazenil infusion sho uld still be considered skeptically and should not be recommended as r outine manage ment BZ intoxicated patients with an underlying disease, an older age, and resedation into a deep comatose state after showing an initial response to flumazenil should be treated in an intensive c are unit. Copyright (C) 1998 by W.B. Saunders Company.