DICP : the annals of pharmacotherapy
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Postoperative analgesic requirements following flumazenil administration.
The effect of flumazenil (RO 15-1788) on postoperative analgesic requirements was evaluated in 30 postoperative patients. This prospective investigation was a double-blind, placebo-controlled trial in patients undergoing general anesthesia supplemented by midazolam and fentanyl or sufentanil. Patients received either flumazenil (n = 20) or placebo (n = 10) by random assignment. ⋯ MEs (flumazenil 4.1 +/- 3.8 mg vs. placebo 3.7 +/- 3.2 mg) were not significantly different (p = 0.57) when similar levels of consciousness were compared. The onset of pain was more rapid with flumazenil patients as evidenced by the first analgesic dose at 15.7 +/- 25.1 minutes for the flumazenil group versus 34.7 +/- 43.7 for the placebo group; however, these data were not statistically different (p = 0.144). These results suggest that flumazenil does not increase postoperative analgesic requirements during the immediate postanesthesia period; however, patients receiving flumazenil may experience an earlier onset of postoperative pain.
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Fluconazole, a new triazole antifungal agent, interacts with a number of drugs. Only one study to date has examined the potentiation of warfarin's anticoagulant effect by fluconazole. To our knowledge, this is the first published case report of this interaction in the clinical setting. ⋯ Fresh-frozen plasma was administered and warfarin was discontinued while the patient completed a planned 21-day course of fluconazole. The patient eventually resumed the original warfarin dosage with stable coagulation parameters. Until the influence of fluconazole on the anticoagulant effect of warfarin is studied in further detail, careful monitoring of coagulation parameters is recommended for all patients receiving the combination.