Flumazenil Use in the Emergency Department: Benefit or Risk

ABSTRACT

PURPOSE: Flumazenil is frequently administered to poisoned and benzodiazepine-induced sedated patients. However, seizure, resedation, dysrhythmia, and death may occur in patients who awaken following flumazenil administration. Thus, this study investigated the benefit and the risk of the clinical use of flumazenil in emergency situations because the taking of an accurate history was often impossible METHODS: We included 177 patients given flumazenil in the emergency department. They were divided into four groups Group I (n=51) was poisoned patients who were treated with flumazenil as an antidote, Group II (n=14) was patients in comas of unknown origin who were treated with flumazenil as a universal antidote, Group III (n=69) was patients who were treated with flumazenil for reversal from conscious, procedural sedation, and Group IV (n=43) was patients who were treated with flumazenil for recovery from unexpected oversedation. The benefits of flumazenil were analyzed based on a decreased need for procedures such as endotracheal intubation and mechanical ventilation. Then, the risks were evaluated based on the incidence of serious complications during flumazenil administration. RESULTS: In group I, removals of ventilators and endotracheal intubation were possible in 7/12 and 6/13 cases. However, more serious complications occurred in group I than in the other groups. In group II, a no-awakening response to flumazenil occurred in 71.4% of the patients. Group III had the lowest risk ratio among the groups. In group IV, removals of ventilator and endotracheal intubation were possible in 18/26 and 10/27 cases. However, in 16/43 (37.2%) cases, risk factors for seizures existed; thus, the use of flumazenil was considered inappropriate. CONCLUSION: Flumazenil may be safer and more effective for reversal action; but its clinical utility as an antidote in the emergency department is questionable.