Should a benzodiazepine antagonist be used in unconscious patients presenting to the emergency department?

Department of Emergency Medicine, Singapore General Hospital, Tumasik, 00, Singapore
Resuscitation (Impact Factor: 4.17). 08/2007; 74(1):27-37. DOI: 10.1016/j.resuscitation.2006.11.010
Source: PubMed


Patients in coma with suspected drug poisoning are commonly encountered in the emergency department. Benzodiazepines are one of the most commonly used drugs in self-poisoning. Flumazenil, a benzodiazepine antagonist has been suggested as a diagnostic and treatment tool in suspected poisoning of unclear cause, but caution is required due to potential side effects. No systemic review of this literature has been done on this topic.
The aim of this study is to examine if flumazenil should be used in patients with coma from suspected drug poisoning.
Randomised controlled trials were identified from the Cochrane Library, Pubmed and EMBASE. Bibliographies from included studies, known reviews and texts were searched. Content experts were contacted.
Randomised controlled trials were eligible for inclusion. Studies were included if patients who presented with altered mental state from suspected drug poisoning were treated with intravenous flumazenil as compared to placebo.
Data were extracted and methodological quality was assessed independently by two reviewers.
Seven randomised controlled trials were included. A total of 466 patients were involved. Flumazenil was found to reverse coma from suspected drug poisoning with a relative benefit of 4.45 (95% CI 2.65, 7.45). In terms of major side effects, there was no statistical difference between flumazenil and placebo (RR 2.86, 95% CI 0.12-69.32). However, in terms of minor side effects, flumazenil was associated with a higher incidence of anxiety (RR 2.84, 95% CI 1.28-6.30) and other side effects (RR 3.73, 95% CI 2.078-6.73). There was no difference in the incidence of vomiting (RR 4.28, 95% CI 0.95-19.35).
Current evidence shows that flumazenil may be effective in the reversal of coma in patients presenting to the emergency department with coma from suspected drug poisoning.

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    • "For most acute poisonings, treatment is symptomatic, as there is seldom time to wait for a laboratory diagnosis. The poisoned patients presenting in a coma often require urgent diagnosis and management [7], and knowledge of the most common causes is therefore important for clinicians. Local epidemics of special types of poisoning may also impose diagnostic challenges [8]. "
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    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 07/2012; 20(1):49. DOI:10.1186/1757-7241-20-49 · 2.03 Impact Factor
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    • "The severity and duration of withdrawal symptoms depend in part on the half-life of the medication being used. The benzodiazepine withdrawal syndrome can be precipitated by administration of flumazenil to patients taking benzodiazepines [89]. "
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