The role of midazolam and flumazenil in urology

Abstract

The effects of midazolam (3–10 mg im.) and their reversal by flumazenil were studied in transurethral endoscopic procedures performed using topical analgesia. In one randomised study, patients (n = 84) received either no medication or flumazenil (0.5 mg i.v.) on completion of endoscopy. Recovery was assessed subjectively. Within 15 min, 83% of those receiving flumazenil were considered ready for discharge compared with only 24% of the control group (P<0.001). In a second randomised, double‐blind, placebo‐controlled trial of 44 patients, post‐operative recovery was assessed using five objective psychomotor tests. Whereas the placebo group took up to 2 h to recover, those receiving flumazenil recovered fully or returned to near control values within 15 min. Sedoanalgesia ‐ a technique combining adequate local anaesthesia with sedation (using midazolam) ‐ has wide application in urology, and the introduction of flumazenil has major implications for the practice of day‐case surgery.