Digestive Diseases and Sciences

, Volume 59, Issue 8, pp 1717–1725 | Cite as

Significant and Safe Shortening of the Recovery Time After Flumazenil-Reversed Midazolam Sedation

  • Elisabeth M. H. Mathus-Vliegen
  • Linda de Jong
  • Hedwig A. Kos-Foekema
Original Article



Endoscopy under midazolam sedation requires a 2-h recovery facility.


To study the potential of shortening patients’ stay without jeopardizing patients’ safety by the use of the benzodiazepine-antagonist flumazenil in the everyday practice and to investigate the feasibility of a study comparing midazolam with recovery with midazolam–flumazenil and immediate discharge.


Consecutive ambulatory patients referred for endoscopy under midazolam sedation with ASA I or II, escorted by a person, were eligible. Flumazenil was given on arrival in the recovery room. Patients were discharged when adequate Aldrete scores and physical mobility were present. The next day, they were contacted by telephone.


A total of 1,506 patients participated. They received 5 mg midazolam, while 887 patients also received 50 mcg fentanyl. The median dose of flumazenil was 0.2 mg. Oxygen desaturation (sO2 <92 %) occurred in 15 % during the procedure without an effect on recovery and discharge times. Patients left the department 65 min after the last midazolam administration. The majority (82.7 %) were fully alert during their journey home. At home, 2.7 % went to bed, 45.2 % took a nap, and 40 % undertook activities. Almost every patient (98.8 %) liked the shortened recovery time. Three patients had an incident (fainting, fall, and near-fall) without consequences. Based on this low incidence, a non-inferiority comparison of midazolam–flumazenil with midazolam-recovery would require a total of 32,650 patients.


Administration of flumazenil resulted in a safe shortening of the recovery period and offers the possibility for substantial savings in time, space, and nurse resources. A non-inferiority comparison will not be practicable.


Midazolam Flumazenil Midazolam antagonist Endoscopy Intravenous sedation Fentanyl 



The authors are deeply indebted to the department of Anesthesiology for their help and advice.

Conflict of interest


Supplementary material

10620_2014_3061_MOESM1_ESM.tif (488 kb)
Supplemental figure. Time in minutes from the administration of midazolam to arrival in the recovery room, administration of flumazenil, discharge, arrival at home, and end of sleep for 649 patients (289 in upper and 360 in lower endoscopy) who took a nap. ***p < 0.001 for the comparison of times between upper and lower endoscopy (TIFF 488 kb)


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Elisabeth M. H. Mathus-Vliegen
    • 1
  • Linda de Jong
    • 1
  • Hedwig A. Kos-Foekema
    • 1
  1. 1.Department of Gastroenterology and Hepatology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

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