Reversal of conscious sedation by flumazenil: current status and future prospects

Flumazenil is safe and highly effective at reversing both benzodiazepine-induced sedation and amnesia. Bolus intravenous injection is the most appropriate technique when the goal is to fully reverse conscious sedation. Currently, the proven effective dose of flumazenil is 0.5 mg. For practical purposes, in this clinical setting, true resedation does not occur, and if the appropriate type and dose of agonist have been used, residual sedation is not a clinical problem. Concerns over acute anxiety reactions and precipitation of acute withdrawal syndrome in chronic benzodiazepine users remain theoretical and unsubstantiated by human data. Further clinical studies are required to determine whether the clinical practice of using flumazenil could include this group of patients. Depression of ventilatory responsiveness induced by benzodiazepines can be reversed effectively and promptly by flumazenil. Flumazenil must be immediately available as an emergency drug in any area where benzodiazepines are used. The clinical and economic benefits of elective and routine use of flumazenil have been demonstrated, but yet to gain widespread acceptance.