Engelhardt W, Friess K, Hartung E, Sold M, Dierks T
Institute of Anaesthesiology, University of Würzburg, Federal Republic of Germany.
Br J Anaesth. 1992 Jul;69(1):75-80. doi: 10.1093/bja/69.1.75.
We have compared the EEG and auditory evoked wave P300 with psychometric tests in assessing vigilance after flumazenil antagonism of midazolam sedation in 12 healthy volunteers. Measurements were made before and after midazolam 0.1 and 0.2 mg kg-1 i.v., and immediately and 30, 60, 120 and 240 min after administration of flumazenil 1 mg. The sedative effects of midazolam and antagonism by flumazenil resulted in alterations in EEG, P300 and psychometric tests (syndrome short test, letter cancellation, choice reaction and recognition). However, 60 and 120 min after flumazenil a decrease in test performance indicating rebound sedation was seen only in P300 mapping. Thus P300 mapping was a sensitive method of detecting subtle differences in vigilance. Rebound sedation occurred even when midazolam 0.2 mg kg-1 was antagonized with an adequate dose of flumazenil. We suggest that it is advisable to supervise patients for at least 240 min after flumazenil antagonism of midazolam 0.2 mg kg-1.
我们比较了12名健康志愿者在咪达唑仑镇静后用氟马西尼拮抗时，脑电图（EEG）和听觉诱发电位P300与心理测量测试在评估警觉性方面的情况。在静脉注射0.1和0.2 mg/kg咪达唑仑之前和之后进行测量，并在注射1 mg氟马西尼后即刻、30、60、120和240分钟进行测量。咪达唑仑的镇静作用和氟马西尼的拮抗作用导致EEG、P300和心理测量测试（综合征简短测试、字母取消、选择反应和识别）发生改变。然而，在氟马西尼注射后60和120分钟，仅在P300图谱中观察到测试表现下降，表明出现了反跳性镇静。因此，P300图谱是检测警觉性细微差异的一种敏感方法。即使0.2 mg/kg咪达唑仑用足够剂量的氟马西尼拮抗，仍会发生反跳性镇静。我们建议，在0.2 mg/kg咪达唑仑用氟马西尼拮抗后，对患者进行至少240分钟的监测是明智的。
