Korean Journal of Gastrointestinal Endoscopy 2006;32(6): 361-367.
Midazolam 수면 내시경에서 고정량 Flumazenil이 의식 회복에 미치는 영향
권계형·박영숙·김태헌·조윤주·송문희·김충현·김성환
을지의과대학교 노원을지병원 소화기내과
The Effect of Fixed Dose of Flumazenil on Recovery after Sedative Endoscopy by Midazolam
Kye Hyoung Kwon, M.D., Young Sook Park, M.D., Tae Hun Kim, M.D., Yun Ju Jo, M.D., Moon Hee Song, M.D., Chung Hyeon Kim, M.D. and Seong Hwan Kim, M.D.
Department of Gastroenterology, Eulji University School of Medicine, Nowon Eulji Medical Center, Seoul, Korea
Abstract
Background/Aims: Midazolam is widely used as a form of conscious sedation during endoscopy because of its rapid onset and safety. However, its relatively long half-life and paradoxical reactions are still a concern for doctors and patients. Flumazenil is a competitive benzodiazepine antagonist that acts to reverse the sedative and hypnotic effects of midazolam but its role and adequate dose have not been fully documented. This study evaluated the effect of a fixed dose of flumazenil on the recovery from sedative endoscopy by midazolam. Methods: First study: 100 patients who received 0.05 mg/kg midazolam for conscious sedation were randomized into two groups: intravenous 0.25 mg flumazenil and a placebo. All patients were assessed using OAA/S (Observers Assessment of Alertness/Sedation Scale) scale (responsiveness, speech, facial expression and ptosis of eyelid) before the endoscopy, immediately after the procedure and every 5 minutes thereafter. The recovery time was defined as the time at which the OAA/S scale reached the pre-endoscopy level. Second study: In 40 patients, the OAA/S scale was assessed only after full recovery without any exogenous stimuli. The total dose of midazolam and the procedure time were assessed. Results: The flumazenil group demonstrated a significantly shorter recovery time than the placebo group (p＜0.0001). These results were not affected by age, gender, total midazolam dose and procedure time. There was a larger difference in the recovery time between the two groups in the second study than in the first. Conclusions: A fixed low dose flumazenil significantly reduced the recovery time after sedative endoscopy by midazolam. Flumazenil will be helpful for the early return to daily activities and for preventing post sedative complication. (Korean J Gastrointest Endosc 2006;32:361367)
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