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[Flumazenil as an emergency management of patients with acute mental disorder]
From July 1, 1990 to June 30, 1991, 55 adult patients with acute alteration of mental status of unknown etiology were enrolled into this study in order to evaluate the diagnostic and therapeutic role of flumazenil in the management of this disorder. Patients who were pregnant or had severe head injury, hemodynamic instability or a provisional diagnosis of hypoglycemia, meningitis or acute cerebrovascular event were excluded. Flumazenil was injected intravenously first in a regimen of 0.3 mg followed by alternative 0.2 mg and 0.3 mg doses every minute until a total dose of 1 mg was given or until the patients responded. These patients were divided into 2 groups based on their response to flumazenil: Group 1, responders (N = 26) and Group 2, nonresponders (N = 29). Good response in Group 1 allowed the cancellation or discontinuation of brain CT scan in 18 patients; intubation and artificial ventilation in 2 and vasopressor infusion in one. The hospital stay was shortened significantly as compared with historical information in uncomplicated benzodiazepine intoxication patients who were admitted before flumazenil was introduced. The Group 2 patients who were with a great span of levels of severity in clinical courses, had higher admission and mortality rate than Group 1 (p < 0.01). We concluded that flumazenil may serve as a useful tool in the diagnosis and management of carefully selected patients. The use of flumazenil with our selective criteria will be cost effective, achieve rapid diagnosis and reduce laborious care in certain cases.
From July 1, 1990 to June 30, 1991, 55 adult patients with acute alteration of mental status of unknown etiology were enrolled into this study in order to evaluate the diagnostic and therapeutic role of flumazenil in the management of this disorder. Patients who were pregnant or had severe head injury, hemodynamic instability or a provisional diagnosis of hypoglycemia, meningitis or acute cerebrovascular event were excluded. Flumazenil was injected intravenously first in a regimen of 0.3 mg followed by alternative 0.2 mg and 0.3 mg doses every minute until a total dose of 1 mg was given or until the patients responded. These patients were divided into 2 groups based on their response to flumazenil: Group 1, responders (N = 26) and Group 2, nonresponders (N = 29). Good response in Group 1 allowed the cancellation or discontinuation of brain CT scan in 18 patients; intubation and artificial ventilation in 2 and vasopressor infusion in one. The hospital stay was shortened significantly as compared with historical information in uncomplicated benzodiazepine intoxication patients who were admitted before flumazenil was introduced. The Group 2 patients who were with a great span of levels of severity in clinical courses, had higher admission and mortality rate than Group 1 (p < 0.01). We concluded that flumazenil may serve as a useful tool in the diagnosis and management of carefully selected patients. The use of flumazenil with our selective criteria will be cost effective, achieve rapid diagnosis and reduce laborious care in certain cases.