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  • Title: Fentanyl-midazolam-flumazenil anaesthesia during induced abortion.
    Author: Hamar O, Garamvölgyi G.
    Journal: Acta Chir Hung; 1990; 31(1):63-8. PubMed ID: 2239023.
    Abstract:
    A new anaesthetic method (fentanyl-midazolam-flumazenil) was compared with recently administered (pethidine-diazepam-ketamine) anaesthesia in two groups of 25 women, each undergoing termination of pregnancy. No significant difference was found between the two groups in the quality of anaesthesia. Recovery was assessed by means of the Aldrete score and a visual analogue scale. The recovery time was significantly shorter in patients who received midazolam-flumazenil. In the ketamine group, 36% of the patients complained of unpleasant dreams. The recovery in the midazolam group was comfortable. The ideal anesthesia for abortion should provide rapid induction, maintenance of an adequate level of anesthesia without producing cardiorespiratory instability or increased blood loss, and the absence of complications such as anaphylactoid reactions or the side effects of nausea and vomiting. At Hungary's Semmelweis University Medical Center, pethidine-diazepam-ketamine has been the general anesthesia of choice in recent years for 1st trimester abortion. It was decided to compare this anesthesia to a new method--fentanyl-midazolam-flumazenil. Midazolam is being used increasingly in outpatient surgical procedures due to its minimal effect on the cardiovascular system. 25 consecutive 1st-abortion patients were allocated to the ketamine group and 25 were assigned to receive mindazolam. Recovery from both anesthetic preparations was evaluated by means of the Aldrete score and a visual analogue score. The most important finding was the significantly shorter recovery time after anesthesia administration in the mindazolam group (4.5 + or - 0.5 minutes) compared to the ketamine group (31.2 + or - 6.8 minutes). 92% of women in the former group but only 64% of those in the latter group voiced satisfaction with their anestheticization. Blood gas, blood pressure, heart rate, and respiration rate were within normal limits in both groups and there were no serious complications. 2 women in each group experienced slight vomiting. Also of interest was the finding that 36% of women who received the ketamine preparation complained of unpleasant dreams while under anesthesia. Given the shorter recovery time, more widespread use of fentanyl-midazolam-flumazenil is recommended in abortion.
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