Flumazenil, an imidazobenzodiazepine, is the first benzodiazepine antagonist and is being used to reverse the adverse pharmacological effects of benzodiazepine. There have been a few reports on the central nevous system side effects with its use. We report a patient with generalized ballism following administration of flumazenil. The mechanism through which flumazenil induced this symptom is unknown. It is conceivable that flumazenil may antagonize the GABA-benzodiazepine receptor complex and induce dopamine hypersensitivity, thus induce dyskinesic symptoms.
Diagnosis, Differential ; Dyskinesias/etiology* ; Female ; Flumazenil/adverse effects* ; GABA Modulators/adverse effects* ; Human ; Middle Aged

BACKGROUND/AIMS: Flumazenil was administered after the completion of endoscopy under sedation to reduce recovery time and increase patient safety. We evaluated patient satisfaction after endoscopy under sedation according to the timing of a postprocedural flumazenil injection. METHODS: In total, 200 subjects undergoing concurrent colonoscopy and upper endoscopy while sedated with midazolam and meperidine were enrolled in our investigation. We randomly administered 0.3 mg of flumazenil either immediately or 15 minutes after the endoscopic procedure. A postprocedural questionnaire and next day telephone interview were conducted to assess patient satisfaction. RESULTS: Flumazenil injection timing did not affect the time spent in the recovery room when comparing the two groups of patients. However, the subjects in the 15 minutes injection group were more satisfied with undergoing endoscopy under sedation than the patients in the immediate injection group according to the postprocedural survey (p=0.019). However, no difference in overall satisfaction, memory, or willingness to undergo a future endoscopy was observed between the two groups when the telephone survey was conducted on the following day. CONCLUSIONS: This study demonstrated that a delayed flumazenil injection after endoscopic sedation increased patient satisfaction without prolonging recovery time, even though the benefit of the delayed flumazenil injection did not persist into the following day.
Adult ; Anesthesia Recovery Period ; Endoscopy/adverse effects ; Female ; Flumazenil/*administration & dosage ; GABA Modulators/*administration & dosage ; Humans ; Male ; Memory/drug effects ; Middle Aged ; Pain/epidemiology ; *Patient Satisfaction ; Prospective Studies ; Time Factors ; Treatment Outcome

OBJECTIVETo investigate the value of applying acupuncture in patients with respiratory failure Sixty (RF) during mechanical ventilation (MV) when there happened man-machine counteraction.

METHODSRF patients with nonsynchronous spontaneous breath (SB) during mechanical ventilation were divided into two groups randomly, 30 in each group. The control group treated with intravenous midazolam injection, and the treated group with acupuncture in Siguan points combined intravenous midazolam injection to maintain synchronized SB and MV, and to calm patients. The dose of midazolam used, the sedative effect as well as the complications occurred at different time points in the two groups were observed and compared.

RESULTSCompared with the control group, advantages such as smaller dose of midazolam used, lighter in deepness of sedation, and less complications were observed in the treated group (all P < 0.05).

CONCLUSIONAcupuncture auxiliary Western medicine treatment has better effects than that of Western treatment alone in treating RF patients with man-machine counteraction during mechanical ventilation.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Combined Modality Therapy ; Female ; GABA Modulators ; administration & dosage ; therapeutic use ; Humans ; Injections, Intravenous ; Male ; Midazolam ; administration & dosage ; therapeutic use ; Middle Aged ; Respiration, Artificial ; Respiratory Insufficiency ; physiopathology ; therapy ; Treatment Outcome

PURPOSE: Ca2+ homeostasis plays an important role in myocardial cell injury induced by hypoxia-reoxygenation, and prevention of intracellular Ca2+ overload is key to cardioprotection. Even though thiopental is a frequently used anesthetic agent, little is known about its cardioprotective effects, particulary in association with Ca2+ homeostasis. We investigated whether thiopental protects cardiomyocytes against hypoxia-reoxygenation injury by regulating Ca2+ homeostasis. MATERIALS AND METHODS: Neonatal rat cardiomyocytes were isolated. Cardiomyocytes were exposed to different concentrations of thiopental and immediately replaced in the hypoxic chamber to maintain hypoxia. After 1 hour of exposure, a culture dish was transferred to the CO2 incubator and cells were incubated at 37degrees C for 5 hours. At the end of the experiments, the authors assessed cell protection using immunoblot analysis and caspase activity. The mRNA of genes involved in Ca2+ homeostasis, mitochondrial membrane potential, and cellular Ca2+ levels were examined. RESULTS: In thiopental-treated cardiomyocytes, there was a decrease in expression of the proapoptotic protein Bax, caspase-3 activation, and intracellular Ca2+ content. In addition, both enhancement of anti-apoptotic protein Bcl-2 and activation of Erk concerned with survival were shown. Furthermore, thiopental attenuated alterations of genes involving Ca2+ regulation and significantly modulated abnormal changes of NCX and SERCA2a genes in hypoxia-reoxygenated neonatal cardiomyocytes. Thiopental suppressed disruption of mitochondrial membrane potential (Delta Psi m) induced by hypoxia-reoxygenation. CONCLUSION: Thiopental is likely to modulate expression of genes that regulate Ca2+ homeostasis, which reduces apoptotic cell death and results in cardioprotection.
Animals ; Apoptosis ; Calcium/*metabolism ; Cell Hypoxia/*physiology ; Cell Survival/drug effects ; Cells, Cultured ; GABA Modulators/*pharmacology ; Homeostasis/drug effects ; Immunoblotting ; In Situ Nick-End Labeling ; Membrane Potential, Mitochondrial/drug effects ; Microscopy, Confocal ; Myocytes, Cardiac/*drug effects/*metabolism ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction ; Thiopental/*pharmacology