Comparative effects of sevoflurane and propofol based general anaesthesia for elective surgery on memory

Lito Flouda, Ageliki Pandazi, Charalampos Papageorgiou, Despoina Perrea, Eleni Krepi, Georgia Kostopanagiotou, Lito Flouda, Ageliki Pandazi, Charalampos Papageorgiou, Despoina Perrea, Eleni Krepi, Georgia Kostopanagiotou

Abstract

Introduction: Unconscious processing of words during general anaesthesia has been suggested. We used the process dissociation procedure (PDP) to test memory performance during sevoflurane and propofol anaesthesia in relation to hypnotic depth.

Material and methods: One hundred participants anaesthetised for elective surgery (50 with propofol and 50 with sevoflurane) and 50 non-anaesthetized listened to a list of words. The bispectral index (BIS) of the anaesthetised patients was recorded. Within 36 h after word presentation, memory was assessed using a word stem completion task, based on Buchner's model applied on the PDP.

Results: There was evidence of memory for words presented during light (BIS 61-80) (p = 0.001) and adequate (BIS 41-60) (p = 0.008) but not deep anaesthesia (BIS 21-40) (p = 0.09). The PDP showed a significant implicit but not explicit memory contribution (mean total explicit memory scores: 0.04 ±0.07 in all BIS categories; mean implicit memory scores: 0.01 ±0.04, 0.1 ±0.08, and 0.05 ±0.09 at BIS = 21-40, 41-60, and 61-80, respectively). There was a statistically significant difference between the mean implicit memory score (I) of the propofol and sevoflurane group in the BIS category 41-60 in general (p = 0.016), and after incision (IA.I.) (p = 0.005) in particular, with propofol depressing I more than sevoflurane in both cases. Memory performance of nonanaesthetized participants was better, with a higher contribution of explicit and a comparable contribution of implicit memory.

Conclusions: During general anaesthesia, implicit memory persists even in adequate hypnotic states. Sevoflurane affects the implicit memory of adequately anaesthetised subjects less than propofol.

Keywords: bispectral index; implicit/explicit memory; process dissociation procedure.

References

    1. Veselis RA, Pryor KO. Propofol amnesia: what's going on in the brain? In: Hudits A, Pearce R, editors. Suppressing the mind: anesthetic modulation of memory and consciousness. 1st ed. New York: Human Press; 2010. pp. 215–43.
    1. Ghoneim MM. Drugs and human memory (part 2). Clinical, theoretical and methodologic issues. Anesthesiology. 2004;100:987–1002.
    1. Liu W, Thorp T, Graham S, Aitkenhead. A. Incidence of awareness with recall during general anaesthesia. Anaesthesia. 1991;46:435–7.
    1. Sandin R, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet. 2000;355:707–11.
    1. Sebel P, Bowdle T, Ghoneim M, et al. The incidence of awareness during anesthesia: a multicenter United States Study. Anesth Analg. 2004;99:833–9.
    1. Ghoneim MM. On memory, general anesthesia, and sleep. Anesthesiology. 2010;113:1480–1.
    1. Merikle PM, Daneman M. Memory for unconsciously perceived events: evidence from anesthetized patients. Conscious Cogn. 1996;5:525–41.
    1. Andrade J. Learning during anaesthesia: a review. Br J Psychol. 1995;86:479–506.
    1. Munte S, Schmidt M, Meyer M, et al. Implicit memory for words played during isoflurane- or propofol-based anesthesia: the lexical decision task. Anesthesiology. 2002;96:588–94.
    1. Lubke G, Kerssens C, Phaf H, Sebel P. Dependence of explicit and implicit memory on hypnotic state in trauma patients. Anesthesiology. 1999;90:670–80.
    1. Lubke G, Kerssens C, Gershon R, Sebel P. Memory formation during general anesthesia for emergency caesarean sections. Anesthesiology. 2000;92:1029–34.
    1. Kerssens C, Lubke G, Klein J, Van der Woerd A, Bonke B. Memory function during propofol and alfentanil anesthesia: predictive value of individual differences. Anesthesiology. 2002;97:382–9.
    1. Stapleton C, Andrade J. An investigation of learning during propofol sedation and anesthesia using the process dissociation procedure. Anesthesiology. 2000;93:1418–25.
    1. Hadzidiakos D, Horn D, Buchner A, Rehberg B. Analysis of memory formation during general anesthesia (propofol/remifentanyl) for elective surgery using the process-dissiciation-procedure. Anesthesiology. 2009;111:1010–5.
    1. Deeprose C, Andrade J, Varma S, Edwards N. Unconscious learning during surgery with propofol anaesthesia. Br J Anaesth. 2004;92:171–7.
    1. Deeprose C, Andrade J, Harrison N, Edwards N. Unconscious auditory priming during surgery with propofol and nitrous oxide anaesthesia: a replication. Br J Anaesth. 2005;94:57–62.
    1. Kerssens C, Klein J, Van Der Woerd A, Bonke B. Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index. Anesth Analg. 2001;92:1210–4.
    1. Kerssens C, Takashi O, Sebel P. No evidence of memory function during anesthesia with propofol or isoflurane with close control of hypnotic state. Anesthesiology. 2005;102:57–62.
    1. Dobrunz UE, Jaeger K, Vetter G. Memory priming during light anaesthesia with desflurane and remifentanil anaesthesia. Br J Anaesth. 2007;98:491–6.
    1. Renna M, Lang E, Lockwood G. The effect of sevoflurane on implicit memory: a double-blind, randomised study. Anaesthesia. 2000;55:634–40.
    1. Kerssens C, Galther JR, Sebel P. Preserved memory function during bispectral index-guided anesthesia with sevoflurane for major orthopaedic surgery. Anesthesiology. 2009;111:518–24.
    1. Stonell CA, Leslie K, He C, Lee L. No sex differences in memory formation during general anesthesia. Anesthesiology. 2006;105:920–6.
    1. Kristoffer CA, Albrecht E, Tartaglia EM, Farron A, Soom P, Herzog MH. Anesthesia prevents auditory perceptual learning. Anesthesiology. 2009;111:1010–5.
    1. Flouda L, Lotis C, Matsota P, et al. Method for the evaluation of the function of implicit memory of Greek patients under general anaesthesia. Acta Anaesthesiologica Hellenica. 2008;41:141–51.
    1. Jacoby L. A process dissociation framework: separating automatic from intentional uses of memory. J Mem Lang. 1991;30:513–41.
    1. Buchner A, Erdfelder E, Vaterrodt-Plunnecke B. Toward unbiased measurement of conscious and unconscious memory processes within the process dissociation framework. J Exp Psychol Gen. 1995;124:137–60.
    1. Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth. 1970;42:535–42.
    1. Luethi M, Meier B, Sandi C. Stress effects on working memory, explicit memory, and implicit memory for neutral and emotional stimuli in healthy men. Front Behav Neurosci. 2009;2:1–9.
    1. Iselin-Chaves IA, Willems SJ, Jermann FC, Forster A, Adam SR, Van der Linden M. Investigation of implicit memory during Isoflurane anesthesia for elective surgery using the process dissociation procedure. Anesthesiology. 2005;103:925–33.
    1. Glass P, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997;86:836–47.
    1. Münte S, Münte T, Grotkamp J, et al. Implicit memory varies as a function of hypnotic electroencephalogram stage in surgical patients. Anesth Analg. 2003;97:132–8.
    1. Struys M, Versichelen L, Byttebier G, Mortier E, Moerman A, Rolly G. Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration. Anaesthesia. 1998;53:4–12.
    1. Aceto P, Valente A, Gorgoglione E, Adducci E, De Cosmo G. Relationship between awareness and middle latency auditory evoked responses during surgical anaesthesia. Br J Anaesth. 2003;90:630–5.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere