Abstract
The effects of a pure benzodiazepine antagonist (Flumazenil) on the responses R1 and R2 of the blink reflex, psychomotor tests, and Event Related Potentials (ERP), in six healthy volunteers sedated with Midazolam have been compared. Measurements were made during each of four successive phases. Phase 0 corresponded to control recordings. Midazolam was administered rapidly during phase 1 and slowly during phase 2. Phase 3 corresponded to spontaneous waking once the administration of Midazolam had been stopped. Flumazenil was administered during phase 2. As the subjects fell asleep, R1 and R2 were the last parameters to disappear. Under the influence of Flumazenil, R1 was the first to reappear, while R2 did not recur until complete waking, and the other tests were unpracticable. During phase 3, R1 reappeared before R2 once more, the psychomotor test responses and ERP returning only later. The modifications of both R1 and R2 of the blink reflex are a good criterion of the presence of BZD in a toxic coma and a good test to indicate the depth of a coma or a sedation with BZD, whilst ERP, since they require the cooperation of the patient, are a test of vigilance and not of awakening.
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