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J Korean Soc Emerg Med > Volume 27(5); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(5): 422-428.
일개 응급실에 의식저하로 내원한 벤조디아제핀 음독 의심 환자에게 있어서 플루마제닐 투여에 대한 임상 분석
김현준1, 김용환1, 이준호1, 황성연1, 조광원1, 강문주1, 이동우1, 이경렬2, 이나경3
1성균관대학교 의과대학 삼성창원병원 응급의학과
2경남대학교 체육교육학과
3경희대학교 간호학과
Clinical Analysis of Flumazenil Administration in the Single Emergency Department for Unconscious Patients, Suspected Benzodiazepine Overdose
Hyun Joon Kim1, Yong Hwan Kim1, Jun Ho Lee1, Seong Youn Hwang1, Kwang Won Cho1, Mun Ju Kang1, Dong Woo Lee1, Kyoung Yul Lee2, Na Kyoung Lee3
1Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine,Changwon, Korea
2Department of Physical Education, Kyungnam University, Changwon, Korea
3Department of Nursing, Graduate School, Kyung Hee University, Seoul, Korea
Correspondence  Yong Hwan Kim ,Tel: 055-290-6657, Fax: 055-290-6117, Email: suka1212@naver.com,
Received: April 12, 2016; Revised: April 19, 2016   Accepted: July 23, 2016.  Published online: October 30, 2016.
ABSTRACT
Purpose:
Flumazenil is an effective benzodiazepine antagonist. However, serious adverse effects, including seizures, cardiac arrhythmias, and even death, have been reported in patients treated with flumazenil. These adverse effects are commonly associated with co-ingested tricyclic antidepressants and benzodiazepine withdrawal. Herein, we examined the safety, effectiveness, and risk of using flumazenil to treat suspected benzodiazepine overdose in the emergency department (ED).
Method:
This is a retrospective observational study of adult patients administered with flumazenil for a known or suspected benzodiazepine overdose in the ED between July 2010 and January 2016. The outcomes included mental status improvement, incidence of seizures, and intubation rate after flumazenil administration.
Results:
Seventy-six patients were included in the analysis. Thirty-eight (50%) patients experienced clinically significant mental status improvement. One patient had a seizure (1.3%), despite 17 reported proconvulsant coingestants. No patient required endotracheal intubation, and no patient had arrhythmias after flumazenil administration. Flumazenil was given intravenously bolus in all cases, and the average dose was 0.44mg. There were no significant changes in the vital signs after flumazenil administration.
Conclusion:
Flumazenil was effective and associated with a low frequency of seizure. However, patients with contraindications may develop seizures. The benefits with respect to risk of adverse effects should be considered carefully in all patients.
Key words: Benzodiazepines, Flumazenil, Drug overdose
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