Pharmacoeconomic evaluation of flumazenil for routine outpatient EGD

• Published in: Gastrointestinal endoscopy Vol. 51; no. 3; pp. 282 - 287
• Main Authors: Wille, Richard T., Chaffee, Bruce W., Ryan, Michael L., Elta, Grace H., Walter, Virginia, Barnett, Jeffrey L.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.2000; Elsevier
• Subjects: Adult; Ambulatory Care; Analgesics; Anesthesia Recovery Period; Attitude of Health Personnel; Biological and medical sciences; Cost-Benefit Analysis; Double-Blind Method; Endoscopy, Gastrointestinal; Female; Flumazenil - administration & dosage; Flumazenil - economics; Hospital Charges; Humans; Hypnotics and Sedatives; Male; Medical sciences; Midazolam; Middle Aged; Neuropharmacology; Patient Satisfaction; Pharmacology. Drug treatments; Recovery Room - economics; Time Factors; Human; Chemotherapy; Flumazenil; Anesthesia; Benzodiazepine derivatives; Endoscopy; Antagonist; Gastroscopy; Sedation; Recovery time; Biological activity; Esophagoscopy
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(00)70356-7

Background:  Flumazenil is a benzodiazepine antagonist indicated for reversal of the sedative effects of benzodiazepines. Previous studies suggest that flumazenil may shorten recovery time after endoscopy, but there are few data on actual recovery room times and charges. Methods:  Fifty patients undergoing routine upper endoscopy were sedated with midazolam alone in the usual titrated manner. Patients were randomized in a double-blind fashion to receive either flumazenil or saline immediately after procedure. Assessments of responsiveness, speech, facial expression, and ptosis (Observer's Assessment of Alertness/Sedation [OAA/S] scale) were made before procedure, immediately after procedure and every 15 minutes thereafter. The patient was discharged from the recovery room when vital signs and OAA/S scale reached preprocedure levels. Recovery room times and charges were recorded. Results:  The flumazenil group demonstrated shorter recovery room times and recovery room charges than the placebo group ( p < 0.001). The difference in recovery room charges was not statistically different when flumazenil charges were included ( p = 0.09). Conclusions:  The routine use of flumazenil after midazolam sedation for upper endoscopy significantly shortened recovery time and charges but did not statistically reduce overall charges. (Gastrointest Endosc 2000;51:282-7.)