Advanced Education In General Dentistry

Module 01: Advanced Pain Control and Sedation


Reversal Agents and Other Sedative Agents

The advantages to using narcotics and the benzodiazapines is that there are specific reversal agents for both those classes of drugs. For the narcotics, the reversal agent is naloxone or narcan, and for the benzodiazapines the reversal agent is flumazinal or rumazicon.

Naloxone and Narcan

Naloxone is an opiate antagonist that competitively binds to the opiod receptors. If the patient is apneic, it is recommended that 0.4 mg or 1 ampule of naloxone be administered IV or IM with careful monitoring. If the patient is not apneic but has a falling O2 stat, it is recommended that the narcan or the naloxone be titrated into effect.

Complications of naloxone administration include the development of pulmonary edema and hypertension. In the apneic patient, it is important to remember to support the airway, and the first drug of choice to administer is oxygen. It is also important to realize that the patient may re-narcotize since the half life of naloxone is only about 20 minutes and the half life of most narcotics is longer than that.


The agent used for benzodiazapines is flumazinil. Flumazinil binds to the benzodiazapine receptor; however, it does not affect other GABAgeric agents such as alcohol or the barbiturates. It is administered by giving 0.2 milligrams intravenously over 15 seconds, and then waiting another 45 seconds, and then repeating the dose. Up to 1 mg may be given. Again, it is important to remember to support the airway and administer oxygen. The only precaution with flumazinil is to be careful of its use in patients with a history of seizures.

Other Sedative Agents

Though not discussed here, barbiturates, especially the ultra-short acting barbiturates such as pentothal and brevatol propofal, and ketamine may also be used as sedative agents. Brevatol propafore is a sedative hypnotic, unrelated to the benzodiazapines; ketamine is used frequently in children, and it provides for dissociative anesthesia.