FLUMAZENİL BENZODİAZEPİNLER DIŞINDAKİ ANESTEZİK AJANLARI DA ETKİLER Mİ?: OLGU SUNUMU

Flumazenil benzodiazepinlerin sedatif ve hipnotik etkilerini geri çevirmek için kullanılan bir imidazobenzodiazepindir.Yakın tarihlerde yayınlanan çalışmalarda, mekanizması tam açıklanamasa da, Flumazenilin di¤er genel anestezik ajanlar üzerine de etkili olabilece¤ine dikkat çekilmektedir. Bu nedenle, bu olgu sunumunda uyanmaları beklemedi¤imiz şekilde geciken iki hastada Flumazenil ile olan deneyimimizin paylaşılması amaçlanmıştır. Preoperatif muayenelerinde ASA I olarak de¤erlendirilen, 18 ve 19 yaşlarında iki erkek hasta sırasıyla, tonsillektomi, adenoidektomi ve septorinoplasti yapılmak üzere operasyona alındı. Hastalardan birine ameliyathaneye gelmeden 30 dk. önce yapılan Midazolam (1mg iv) dışında, anestezi indüksiyon (Propof ol, Fentanil) ve idamesinde (Sevof luran, Remif entanil) aynı ajanlar kullanıldı. Operasyonların sonunda anestezik ajanlar kesilip, kas gevşetici etkisini geri çevirmek için Atropin ve Neostigmin yapıldı; ancak 30-45 dk beklenmesine karşın uyanıklık belirtisi ve solunum ef oru saptanmadı. Bu klinik tabloyu açıklayacak bir neden bulunamaması üzerine Flumazenil (0,5mg iv) uygulandı. Her iki hasta da birkaç dakika içinde gözlerini açtı ve solumaya başladı. Bu iki olgudaki deneyimimiz, gecikmiş derlenmelerde Flumazenil kullanımının göz ardı edilmemesi gerekti¤ini ve etki mekanizmasının anlaşılması adına, detaylı araştırma yapılmasının yararlı olaca¤ını göstermektedir.

DOES FLUMAZENIL EFFECT THE ANESTHETIC AGENTS OTHER THAN BENZODIAZEPINES?: CASE REPORT

Flumazenil is an imidazobenzodiazepine which is used to reverse sedative and hypnotic eff ects of benzodiazepines. Although reversing eff ect of Flumazenil on other anesthetic drugs has been published in the recent studies the mechanism is still unknown. In this case report we present our experience in two patients who unexpectedly recovered f rom anesthesia f ollowing Flumazenil administration. Two male patients respectively at the age of 18 and 19 evaluated as ASA I in preoperative examination, were operated f or tonsillectomy, adenoidectomy and septorhinoplasty. One of them was given Midazolam (1 mg iv) as premedication 30 minutes bef ore the operation. Both patients received the same anesthesia induction method (Propof ol, Fentanyl) and agents used f or maintanence of anesthesia (Sevof lurane, Remif entanil) were identically same. At the end of the operation Atropine and Neostigmine were aplied to the patients to reverse neuromuscular blockers. Signs of recovery f rom anesthesia were not observed even af ter more than half an hour period. Flumazenil (0,5 mg iv) were used since there were no any possible reasons to explain this clinical manif estation. In both patients spontaneous eye opening and recovery of respiration were recorded af ter about a f ew minutes f ollowing Flumazenil administration. Our experience related to these two patients puts f orward Flumazenil administration as an unignorable option in delayed recovery f rom anesthesia and the mechanism behind this phenomenon is worth to proceed f urther studies.

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