The routine use of a flumazenil infusion following percutaneous endoscopic gastrostomy placement to reduce early post-procedure mortality.

Autor:	Bosanko NC; Department of Gastroenterology, Mid Staffordshire NHS Foundation Trust, Weston Road, Stafford ST163SA, UK. nickbosanko@doctors.net.uk, Barrett D, Emm C, Lycett W, O'Toole S, Evans K, Hearing SD
Jazyk:	angličtina
Zdroj:	The journal of the Royal College of Physicians of Edinburgh [J R Coll Physicians Edinb] 2010 Jun; Vol. 40 (2), pp. 111-4.
DOI:	10.4997/JRCPE.2010.204
Abstrakt:	Objectives: Percutaneous endoscopic gastrostomy (PEG) insertion offers secure enteral nutrition, but there is a significant mortality associated with the procedure. We reviewed our sedation practice and the effect of yearly protocol changes to establish if the routine reversal of midazolam with a flumazenil infusion improved mortality. Methods: Since 2003 yearly protocol changes have been introduced, including pre-assessment and sedation reversal. We retrospectively audited one-week and one-month mortality and aspiration rates. Results: The average one-week mortality rate was 9.2%. The pooled death rates within the first week for patients prior to routine sedation reversal (n=522) was 10.7% and for patients who received routine reversal (n=144) was 5.4% (p=0.087). Within the first month, death rates were 26.3% prior to reversal and 21.4% in the sedation reversal group (p=0.30). Conclusions: The routine use of flumazenil infusion in appropriate patients is safe. Flumazenil infusion may have a role to play in selected patients at highest risk of aspiration. A prospective, randomised study is warranted.
Databáze:	MEDLINE
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