Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Audit of flumazenil use in special care and oral surgery sedation services


Background The National Patient Safety Agency (2008) has advised against routine reliance on flumazenil for reversal of sedation and encourages regular audit to help identify issues with excessive dosing of midazolam. This multi-centre audit of flumazenil use across both community-based special care and dental hospital oral surgery specialist services was conducted to compare practice against that reported from other UK sedation services.

Methods A six-year retrospective audit was conducted using controlled drug records and patient case notes.

Results Both services used flumazenil at very infrequent levels and far below the agreed standard. The dose of flumazenil and justification for its use was recorded in all records. There was variability in the nature of the justifications between the two services, which likely relates to the differing patient groups seen by the specialties. The majority of cases related to supporting the patient's escort for their journey home; however, this was not always pre-planned.

Conclusions There was a low level of flumazenil use over an extended period of time, supporting the concept of a culture of safe sedation provision in both services. The audit highlighted variation in record-keeping and need for improved communication with patients about escort requirements.

Key points

  • Highlights the importance of record-keeping of flumazenil use in dental sedation services.

  • Demonstrates the low levels of flumazenil prescribing in both a community and hospital setting.

  • Highlights the varying indications for flumazenil reversal of benzodiazepine-based dental sedation.

This is a preview of subscription content

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2


  1. 1.

    Amrein R, Hetzel W. Pharmacology of Dormicum (midazolam) and Anexate (flumazenil). Acta Anaesthesiol Scand Suppl 1990; 92: 6-15; discussion 47.

  2. 2.

    National Patient Safety Agency. Rapid response report: Reducing risk of overdose with midazolam injection in adults. 2008. Available at (accessed April 2021).

  3. 3.

    Intercollegiate Advisory Committee on Sedation in Dentistry. Standards for Conscious Sedation in the provision of Dental Care. 2015. Available online at (accessed March 2020).

  4. 4.

    Scottish Dental Clinical Effectiveness Programme. Conscious Sedation in Dentistry. 2017. Available online at (accessed March 2020).

  5. 5.

    UK Medicines Information. Q&A 178.4: How should dentists prescribe, store, order and dispose of controlled drugs? 2016. Available at (accessed May 2020).

  6. 6.

    Girdler N M, Wilson K E, Booth E J. A prospective study of complications and outcomes associated with conscious sedation for the anxious dental patient. J Disabil Oral Health 2005; 6: 24-30.

  7. 7.

    Henthorn K M, Dickinson C. The use of flumazenil after midazolam-induced conscious sedation. Br Dent J 2010; 209: E18.

  8. 8.

    Ransford N J, Manley M C, Lewis D A et al. Intranasal/intravenous sedation for the dental care of adults with severe disabilities: a multicentre prospective audit. Br Dent J 2010; 208: 565-569.

  9. 9.

    Lewis D, Wray L, Sherborne M et al. The use of flumazenil for adults with learning disabilities undergoing conscious sedation with midazolam for dental treatment: a multicentre prospective audit. J Disabil Oral Health 2015; 16: 33-37.

  10. 10.

    Harrhy C R, Robb N D. The use of flumazenil in a community dental service - a service evaluation. SAAD Dig 2019; 35: 28-32.

  11. 11.

    General Dental Council. Standards for the Dental Team. 2013. Available online at (accessed March 2020).

  12. 12.

    Folland L, Brown E, Boyle C. A review of the use of flumazenil for the reversal of midazolam conscious sedation in dentistry. SAAD Dig 2017; 33: 13-17.

  13. 13.

    Yonel Z, Asuni A, Taneja P. Defining over-sedation: literature review and national survey of dental hospitals within the United Kingdom. SAAD Dig 2016; 32: 28-33.

  14. 14.

    Greaves A. The use of midazolam as an intranasal sedative in dentistry. SAAD Dig 2016; 32: 46-49.

  15. 15.

    Moon Y E. Paradoxical reaction to midazolam in children. Korean J Anesthesiol 2013; 65: 2-3.

  16. 16.

    McKenzie W S, Rosenberg M. Paradoxical Reaction Following Administration of a Benzodiazepine. J Oral Maxillofac Surg 2010; 68: 3034-3036.

  17. 17.

    Cizmeci Senel F, Buchanan J M, Senel A C, Obeid G. Evaluation of Sedation Failure in the Outpatient Oral and Maxillofacial Surgery Clinic. J Oral Maxillofac Surg 2007; 65: 645-650.

Download references

Author information



Corresponding author

Correspondence to Claire L. Wilson.

Ethics declarations

The authors declared no potential conflicts of interest with respect to the research, funding, authorship and/or publication of this article.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wilson, C., Bird, J., Harrison, S. et al. Audit of flumazenil use in special care and oral surgery sedation services. Br Dent J (2021).

Download citation


Quick links