Flumazenil in the treatment of hepatic encephalopathy in children with fulminant liver failure.
OBJECTIVE: To evaluate the effect of flumazenil on hepatic encephalopathy complicating fulminant liver failure in children. DESIGN: Uncontrolled prospective study. SETTING: Pediatric Intensive Care Unit, tertiary care center. PATIENTS: 9 children with fulminant liver failure and hepatic encephalopathy awaiting emergency liver transplantation. INTERVENTIONS: Changes in hepatic encephalopathy grade and in electroencephalogram were recorded during the injection of a bolus of flumazenil (0.01 mg/kg/i.v. bolus) followed by a continuous infusion of flumazenil (0.01 mg/kg/h). MEASUREMENTS AND MAIN RESULTS: Before flumazenil, 7 children had grade 2 and 2 had grade 3 hepatic encephalopathy. Flumazenile injection mediated an arousal effect in 1 child in whom encephalopathy improved from grade 3 to grade 2. This effect lasted 30 min. No clinical response was observed in other children. An improvement of EEG anomalies was observed lasting 3 min in one child. Despite continuous infusion of flumazenil, encephalopathy worsened in all children. CONCLUSION: The effect of intravenous administration of flumazenil on hepatic encephalopathy in children with fulminant liver failure is inconsistent. Its efficacy is transient. The therapeutic value of flumazenil in children with fulminant liver failure awaiting a liver graft is minimal at this dosage.