Effects of flumazenil on hemodynamics and the strees reaction in patients under the sedation with midazolam.
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We administered the benzodiazepine antagonist flumazenil to patients sedated with midazolam in order to assess their neurological and respiratory status, and evaluated changes in hemodynamics and the acute stress reaction before and after a bolus injection of flumazenil. We monitored consciousness level, heart rate (HR), arterial blood pressure (BP), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) in 5 patients with status asthmaticus, empyema or pneumonia aged 38 to 74 years (mean±SD: 61±15years) who had been placed on mechanical ventilation. The patients were intravenously infused with midazolam continuously for 4±2 days (1.1 to 3.1mg/kg/min; total dose: 940±510mg), and their serum benzodiazepine-receptor binding activity measured by benzodiazepine receptor assay ranged from 250 to 2, 700ng/ml (990±980ng/ml) as the diazepam equivalent concentration before administration of flumazenil. Pressure-rate product (PRP), cardiac index (CI) and systemic vascular resistance index (SVRI) were calculated, and plasma concentration of epinephrine, norepinephrine and 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) and serum concentrations of cortisol were measured before and after intravenous bolus injection of 0.5mg flumazenil. Flumazenil improved consciousness levels from 8.0±1.4 to 10±0, as the sum of the scores for eye opening and best motor response of the Glasgow coma scale, and elevated HR, BP, PAP and PCWP transiently, causing a increase in PRP from 12, 000±2, 200 to 17, 200±6, 800mmHg/min 5 minutes after administration. Plasma concentrations of epinephrine and norepinephrine had increased from 120±50 and 290±160, respectively, to 270±120pg/ml and 390±140pg/ml, respectively, 5 minutes after administration. Flumazenil resulted in no significant changes in plasma MHPG or serum cortisol levels. The results of the present study suggest that the flumazenil enhanced sympathetic nerve activity, resulting in increased myocardial oxygen consumption, and that bolus injection of 0.5mg of flumazenil contributed less to induction of an acute stress reaction in patients sedated with midazolam.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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