Effect of flumazenil on sevoflurane requirements for minimum alveolar anesthetic concentration-awake and recovery status.

OBJECTIVE: It is controversial that whether the GABA receptors contribute to the hypnotic action of volatile anesthetics. This study was to detect the effect of GABA receptors on the hypnotic action of volatile anesthetics by evaluation of the effect of intravenous flumazenil on sevoflurane minimum alveolar anesthetic concentration-awake (MAC-Awake) and emergence mental status.

METHODS: This study included two steps. Firstly, 49 healthy patients, aged 20-40 years scheduled for elective surgeries, were randomly assigned to two groups, a flumazenil group (n=24) and a saline group (n=25). The flumazenil group received 0.006 mg/Kg IV, and the control group received the same volume of saline 20 min before induction. The flumazenil group and the control group were compared with regard to MAC-Awake (anesthetic concentration achieving 50% probability of eye opening in response to a verbal command). We used the mask inhalation to measure the MAC-Awake by up-and-down method. The second steps, 60 patients undergoing lower abdomen surgeries were randomly divided into two groups, a experimental group (n=30) and a saline group (n=30). All patients were anesthetized with sevoflurane/sulfentanil. The experimental group received flumazenil at 0.006 mg/Kg IV, and the control group received the same volume of saline at the end of surgery. We recorded the time to awake and extubation. After extubation, the patients' recovery status was scored with the Mini-Mental state examination (MMSE) system in post anesthesia care unit (PACU).

RESULTS: The MAC-Awake was 0.65% in the control group and 0.82% in the flumazenil group (p=0.34). After extubation, the recovery time and time to extubation showed no difference between the flumazenil group and the saline group (p>0.05). But the 10 min and 15 min MMSE scores after extubation were better in the flumazenil group than those in the saline group (p<0.05). There was no difference for MMSE scores after 30 min between two groups.

CONCLUSION: We found that an IV flumazenil (0.006 mg/Kg) has no effect on sevoflurane MAC-Awake in humans. A single intravenous injection of flumazenil (0.006 mg/Kg) can partially reverse the hypnotic effect of sevoflurane/sulfentanil but do not contribute to reduction in the time to recovery and extubation.