Pharmacoeconomic evaluation of flumazenil for routine outpatient EGD

Background: Flumazenil is a benzodiazepine antagonist indicated for reversa l of the sedative effects of benzodiazepines. Previous studies suggest that flumazenil may shorten recovery time after endoscopy, but there are few da ta on actual recovery room times and charges. Methods: Fifty patients undergoing routine upper endoscopy were sedated wit h midazolam alone in the usual titrated manner. Patients were randomized in a double-blind fashion to receive either flumazenil or saline immediately after procedure. Assessments of responsiveness, speech, facial expression, and ptosis (Observer's Assessment of Alertness/Sedation [OAA/S] scale) were made before procedure, immediately after procedure and every 15 minutes th ereafter. The patient was discharged from the recovery room when vital sign s and OAA/S scale reached preprocedure levels. Recovery room times and char ges were recorded. Results: The flumazenil group demonstrated shorter recovery room times and recovery room charges than the placebo group (p < 0.001). The difference in recovery room charges was not statistically different when flumazenil char ges were included (p = 0.09). Conclusions: The routine use of flumazenil after midazolam sedation for upp er endoscopy significantly shortened recovery time and charges but did not statistically reduce overall charges.