Midazolam-flumazenil topical anaesthesia for microlaryngoscopy with jet ventilation

A comparison between midazolam and midazolam-flumazenil for total intravenous anaesthesia in combination with topical anaesthesia and muscle relaxants was performed in a double-blind, parallel study in 40 patients scheduled for microlaryngoscopy with or without bronchoscopic procedures using jet ventilation with oxygen. A single intravenous injection of midazolam 0.3 mg/kg, lignocaine spray and muscle relaxants provided adequate anaesthesia and good operative conditions throughout the procedures, which took 20 to 30 minutes. Patients who had placebo at the end of the procedures had a longer recovery and a high incidence of airway obstruction (20%). Administration of flumazenil provided prompt awakening in 19 of 20 patients (95%) within five minutes, resulting in rapid and favourable recovery without resedation or other side-effects, while only three of 20 (15%) patients in the placebo-treated group had improved consciousness within five minutes. The simplicity and reliability of the midazolam-flumazenil technique is attractive. We consider it worthy of further investigation for wider application in clinical practice.