Correspondence  |   February 2017
A Rising Tide Lifts All Boats: Increased Ventilation May Be Involved in Accelerated Recovery from Isoflurane Anesthesia after Flumazenil Administration
Author Notes
  • Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan (A.B.P.). abpetr@med.niigata-u.ac.jp
  • (Accepted for publication October 11, 2016.)
    (Accepted for publication October 11, 2016.)×
Article Information
Correspondence
Correspondence   |   February 2017
A Rising Tide Lifts All Boats: Increased Ventilation May Be Involved in Accelerated Recovery from Isoflurane Anesthesia after Flumazenil Administration
Anesthesiology 2 2017, Vol.126, 351-352. doi:10.1097/ALN.0000000000001445
Anesthesiology 2 2017, Vol.126, 351-352. doi:10.1097/ALN.0000000000001445
Recently, Safavynia et al.1  demonstrated that flumazenil administration upon cessation of isoflurane anesthesia hastens the reappearance of the wake-like electroencephalographic activity in rats that is suggestive of accelerated emergence. They also demonstrated that flumazenil can inhibit enhancement of isoflurane-induced γ-aminobutyric acid (GABA) receptor—mediated activity in preparations of cultured human cells.1  Hence, the authors are inclined to think that the observed speedier recovery is a direct consequence of flumazenil antagonism of GABA receptors in the brain that results in faster restoration of cortical activity. They exclude the possibility of improved lung ventilation after flumazenil administration as a potential cause for accelerated emergence based solely on similar respiratory rates observed in their pilot studies in control and flumazenil-treated groups, which, in our view, is not sufficient. By examining only a respiratory rate, the authors leave out another critical determinant of minute ventilation, tidal volume, which can be modulated positively by flumazenil.
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