AAPP 2024 Annual Meeting Poster Abstracts
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background: Flumazenil is a benzodiazepine reversal agent that is suggested to have a periprocedural role in electroconvulsive therapy (ECT) for patients on concomitant benzodiazepines.However, there is limited information available regarding its efficacy and appropriate use in this patient population.The primary objective of this study was to evaluate the efficacy of flumazenil administered postbenzodiazepine prior to a patient receiving ECT.The secondary objective was to analyze general practice of flumazenil administration in this patient population.Methods: This retrospective chart review included patients who received at least 1 dose of a benzodiazepine within 18 hours prior to undergoing ECT while admitted to a behavioral health unit from July 1, 2018, to June 30, 2023.Patients were excluded if they received ECT outpatient or received a benzodiazepine outside the time frame or if key outcomes were not documented.The primary outcome examined seizure duration.Secondary outcomes included flumazenil dose, change in lead placement, change in induction agent, change in ECT machine, addition of caffeine, and use of midazolam intravenous post-ECT.Results: A total of 852 patient encounters were included in the final analysis with 407 encounters with flumazenil and 445 without flumazenil prior to ECT.The average seizure duration was 39.1 seconds for those who received flumazenil compared with 41 seconds for those that did not receive flumazenil.The average dose of flumazenil administered was 0.37 mg.Patients who received flumazenil were more likely than not to experience a change in the lead placement (n ¼ 17, 4.18% versus n ¼ 5, 1.12%), an initiation of caffeine (n ¼ 6, 1.47% versus n ¼ 2, 0.45%), and a change in ECT machine (n ¼ 9, 2.21% versus n ¼ 0, 0%).Conclusions: Among inpatient encounters in which an ECT session was preceded within 18 hours by a benzodiazepine, approximately half received periprocedural flumazenil.There is a numerical trend indicating that flumazenil-associated encounters required more interventions to improve ECT effects compared with nonflumazenil encounters, including lead placement change and caffeine provision.These results could suggest inadequate seizures despite flumazenil administration or patient-specific variables not attributable to benzodiazepine use prior to ECT.
Source: Mental Health Clinician
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $250
OpenAlex ID: W4393375749