Diagnostic and therapeutic use of flumazenil in emergency medicine

Flumazenil, a specific benzodiazepine (BZ) antagonist, has been used in our department for treatment of some emergency cases. We treated different groups of comatose patients according to a standard protocol: patients with iatrogenic BZ overdosage, patients with intentional BZ intoxication, and alcoholic patients with head trauma. On the basis of our experience we can say that: (1) administration of a single 1 mg i.v. flumazenil bolus immediately brought about complete recovery of consciousness in pure BZ intoxications; (2) no adverse events (cardiocirculatory, respiratory, neurological, psychiatric) were observed in epileptics or in delirium tremens patients; (3) continuous infusion (0.5 mg h-1) was necessary for maintenance of the therapeutic effect. In conclusion flumazenil is an effective therapeutic agent in the primary management of BZ poisoning and a useful therapeutic and/or diagnostic tool in unclear comatose states; furthermore it could be used in particular situations such as alcoholic intoxication and hepatic coma, in which abnormal GABA-ergic transmission plays a role. Good tolerance of flumazenil makes it a safe agent, even in patients in coma not resulting from BZ overdosage.