The effect of flumazenil on patient recovery and discharge following ambulatory surgery.

Midazolam is a short-acting agent used for preoperative and conscious sedation. Despite a relatively short half-life, midazolam sedation contributes to postoperative sedation, delays in discharge, and increased costs. Administration of flumazenil, a benzodiazepine antagonist, can reverse the centrally mediated effects of midazolam and facilitate patient recovery and discharge, thereby reducing costs. The purpose of this multicenter study was to determine whether flumazenil antagonism of midazolam decreased the length of postoperative stay following intravenous sedation during local and selected regional procedures. A prospective, double-blinded, and randomized convenience sample of 110 adult patients who underwent procedures lasting 90 minutes or less was used. After receiving institutional review board approval and informed consent, patients received up to 150 micrograms of fentanyl and unlimited midazolam titrated intravenously to effect. Flumazenil or a placebo was administered at the conclusion of the surgical procedure. Cognitive scores were assessed by using the Digital Symbol Substitution Test and picture recall, while sedation scores were assessed by using the Observer's Assessment of Alertness/Sedation Scale. The time between the end of the surgical procedure until the patient met discharge criteria in phases I and II was recorded. Statistical analyses revealed no significant difference in age, height, weight, sex, ASA physical status, amount of midazolam and fentanyl received, time for each group to achieve phase I and phase II discharge criteria, or postoperative congnitive scores. The flumazenil group exhibited less amnesia and sedation than the placebo group on initial arrival in the postanesthesia care unit. Discharge times between the groups were not significantly different. Factors such as staffing and institutional discharge policies were identified as determinants of discharge times.