Protective effect of flumazenil infusion in severe acute benzodiazepine toxicity: a pilot randomized trial
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CLINICAL TRIAL
Protective effect of flumazenil infusion in severe acute benzodiazepine toxicity: a pilot randomized trial Akram Sadat Razavizadeh 1 & Nasim Zamani 2,3 & Pardis Ziaeefar 4 & Sara Ebrahimi 4 & Hossein Hassanian-Moghaddam 2,3 Received: 18 August 2020 / Accepted: 23 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective We aimed to investigate the efficacy of flumazenil infusion in the maintenance of arousal and prevention of development of complications in severe benzodiazepine poisoning. Materials and method Sixty severely poisoned patients (intubated due to loss of consciousness) intoxicated by sole benzodiazepines referred to Loghman Hakim hospital between May 2018 and August 2019 were considered to be included in the current study. All were evaluated for possible contraindications of flumazenil administration. If there were no contraindications, we continued supportive care in one group and supportive care plus flumazenil infusion in the second group. Following response to the stat dose of flumazenil, complications, hospital stay, and outcome were compared between these two groups. Results A total of 60 benzodiazepine-poisoned patients aged between 16 and 84 years old (37 males and 23 females) were enrolled. There was no statistically significant difference between these two groups regarding the period of hospital stay. Need for intubation significantly decreased in the infusion group. None of the patients experienced seizure or dysrhythmia. One patient died in the control group which received only a stat dose of flumazenil. Conclusions Administration of flumazenil is safe in benzodiazepine-poisoned patients with appropriate indications. Flumazenil infusion can significantly decrease the need for intubation and subsequent ICU admission. Even though flumazenil is an expensive antidote, its administration may decrease the need for ICU beds in the setting of acute poisoning. Keywords Flumazenil . Benzodiazepine . Benzodiazepine antagonist . Benzodiazepine toxicity
Key points Benzodiazepine toxicity is a common poisoning all over the world, and it is not life-threatening with treatment in most cases. Still there are reports of 3.2% severe toxicity and 0.1% death in these groups that make considerable numbers of morbidity and mortality. Flumazenil is a competitive benzodiazepine receptor antagonist that is used as a diagnostic antidote to obviate the need for further diagnostic and therapeutic interventions in case of unknown loss of consciousness. After evaluation for possible contraindications of flumazenil administration, we run a pilot randomized trial and found that flumazenil infusion can significantly decrease the need for intubation and subsequent ICU admission in those poisoned by this popular CNS drug. * Hossein Hassanian-Moghaddam [email protected] 1
2
Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3
Department of Cl
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