Flumazenil as an Antagonist for Midazolam Anesthesia in Outpatient Surgery

於門診手術病患以Flumazenil拮抗Midazolam麻醉之效果

游學信(Hsueh-Hsin Yu) ； 許淑霞(Shu-Shya Hseu) ； 陳國瀚(Kwok-Hon Chan) ； 陳昶甫(Chang-Fu Chen) ； 李德譽(Tak-Yu Lee)

《Acta Anaesthesiologica Sinica》 28卷4期 (1990/12) Pp. 401-409

https://doi.org/10.6955/AAS.199012.0401

摘要

Rapid recovery is an essential component in the anesthesia of OPD surgery. In this study midazolam, the short-duration benzodiazepine, was used as an intravenous anesthetic in OPD surgery. At the end of the operation flumazenil, the specific antagonist of benzodiazepines, was given to reverse the effect of midazolam. Recovery of these patients was compared with those in the control group who received saline instead of flumazenil. In a randomized, placebo-controlled clinical study the antagonistic effect of flumazenil on midazolam was investigated in fifty ASA class I-II gynecologic outpatients subjected to D & C procedure under anesthesia induced with midazolam (0.3 mg/kg). They were divided A (flumazenil group) and group B (placebo group) with 25 patients in each. At the end of operation patients in group were given 0.2 mg flumazenil intravenously to antagonize the residual effect of midazolam while patients in group B were given 2 ml normal saline intravenously as control. Our results showed that patients in group A exhibited a rapid and steady return of consciousness scaled by alertness, orientation of time and place and activity collaboration at 5, 30 and 60 min intervals following administration of flumazenil (p ＜ 0.005). There were no significant changes found in the hemodynamic or respiratory aspect between groups (p ＞ 0.05). All the patients tolerated midazolam and flumazenil well. It is concluded that the use of flumazenil to antagonize the residual effect of midazolam is safe and effective as far as outpatient procedure is concerned.

關鍵字

Flumazenil ； Midazolam ； Benzodiazepine ； Antagonism

並列摘要

門診手術之麻醉，快速的恢復是一項重要考慮因素。本篇研究在門診手術病患，靜脈給予短效的benzodiazepine衍生物－midazolam於手術結束後，再以benzodiazepine的特定拮抗劑flumazenil來拮抗midazolam之效果觀察病患恢復之情況與對照組作比較。在隨機，對照組比較的臨床研究中，50位ASA I-II的婦産科門診病患分為兩組每組25人，以midazolam 0.3 mg/kg作麻醉誘導，進行D＆C手術。手術後，分別給予flumazenil（A組）或是placebo（B組）來拮抗midazolam的中樞抑制作用，於5、30、60及120分鐘時，評估其清醒度，認知力與活動合作性，並同時測量血壓，心跳，呼吸之變化。與對照組比較，使用flumazenil的病人，於5、30、60分鐘能極明顯且快速的恢復其意識，認知以及活動力（P ＜ 0.005）兩組病人的呼吸循環變化，並無明顯的差異（P ＞ 0.05）。兩組病人對於flumazenil或midazolam的耐受力（tolerance）都很好。我們的結論是，於門診病患使用midazolam麻醉，之後再使用flumazenil以拮抗之是安全且有效的方式。