A Seven-Year Experience of Benzodiazepine Intoxication: Evaluation of the Role of Flumazenil

Abstract

A retrospective study covering a seven year period was carried out to estimate the mortality and complication rates of benzodiazepine intoxication. Although it is well documented that flumazenil may reverse the central benzodiazepine effect, no published reports indicate whether it reduces the complication rate among these cases. This study was also an attempt to evaluate the role of fiumazenil in preventing complications associated with benzodiazepine overdoses. The records of two hundred and sisteen patients admitted with benzodiazepine intoxication were reviewed. Forty two patients (19%) suffered complications including aspiration pneumonia (34), respiratory depression (7) and cardiac arrest (1). Seven patients (3.2%) died. Based on the presence of complications, patients were divided into 2 Groups-Group 1, those who developed potentially fatal complications and Group 2, those who did not. Group 1 had a lower initial level of consciousness compared to Group 2. This finding was statistically significant. The 216 cases were further divided with Group 3, those patients who received flumazenil initially in the emergency department, and Group 4, those who did not. Mortality and complication rates were compared between these two groups and no statistically significant differences were noted. We conclude that benzodiazepine overdose carry clear risks of morbidity and mortality. Patients who were less responsive on arrival had an increased risk of poor clinical outcome. The use of flumazenil in the emergency department to antagonize benzodiazepine action did not appear to improve outcome in patients with benzodiazepine overdose who were admitted to the hospital.