A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period

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Title: A randomised crossover trial of post-operative cognitive and psychomotor recovery from benzodiazepine sedation: effects of reversal with flumazenil over a prolonged recovery period
Author(s): Girdler, Nicholas Martin; Fairbrother, K. J.; Lyne, J. P.; Neave, Nick J.; Scholey, A.; Hargaden, N.; Wesnes, Keith A.; Engler, J.; Rotherham, N. A.
Abstract: Objective: To study the post-operative cognitive and psychomotor recovery from midazolam conscious sedation, after reversal with the benzodiazepine antagonist flumazenil over a prolonged recovery period. Design: A prospective, double-blind, randomised, crossover trial. Setting: Out-patient Sedation Department, Newcastle Dental Hospital and School Method: Eighteen patients, ASA I or II, received midazolam on two separate occasions to undergo equivalent dental treatment Following treatment patients were reversed with intravenous flumazenil or saline [placebo] at alternate appointments. Assessment of mood and cognitive function was undertaken using a highly sensitive and specific computerised battery of cognitive tests administered by telephone. Cognitive and psychomotor tests were administered prior to sedation and every hour for 6 hours post reversal. Results: Results indicated no significant effect of flumazenil on simple reaction time and choice reaction time but did show a trend of reversing the effects of midazolam on numeric working memory and word recognition. Conclusion: The cognitive and psychomotor effects of the sedation were not fully reversed by flumazenil. Cognitive impairments were still present up to 6 hours post-reversal, despite patients appearing clinically more alert. This has important implications for treatment protocols and discharge instructions.
Publication type: Journal article
Source: British Dental Journal, Vol. 192, no. 6 (Mar 2002), pp. 335-339
Publication year: 2002
Keyword(s): Anesthesia recovery period; Anesthetic recovery; Antidotes; Attention; Choice behavior; Cognition; Decision making; Drug antagonism; Drug effect; Flumazenil; Hypnotic sedative agent; Hypnotics; Midazolam; Memory; Psychomotor performance; Reaction time; Sedatives
Publisher: Nature Publishing Group
ISSN: 0007-0610
Publisher URL: http://www.nature.com/bdj/journal/v192/n6/index.html
Peer reviewed