Avaliação da memória sob anestesia venosa total

Gulistan Aktas; Elvan Sahin; Meltem Turkay Aydogmus; Yuksel Erkin

doi:10.1590/S0034-70942013000300013

Review Article

Avaliação da memória sob anestesia venosa total

The assessment of memory under total intravenous anesthesia

Gulistan Aktas; Elvan Sahin; Meltem Turkay Aydogmus; Yuksel Erkin

http://dx.doi.org/10.1590/S0034-70942013000300013 Braz J Anesthesiol, vol.63, n3, p.301-306, 2013

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: Neste estudo, objetivamos avaliar a memória implícita e explícita em pacientes submetidos à cirurgia abdominal sob anestesia venosa total (AVT) com propofol e remifentanil, na qual o nível de anestesia foi controlado pelo monitoramento do índice bispectral (BIS). MÉTODO: Anestesia venosa total foi administrada a 60 pacientes adultos para obter níveis de BIS de 40-60. Os pacientes foram randomicamente divididos em três grupos, de acordo com as gravações que ouviram. Os pacientes do grupo categoria (CT) ouviram uma fita gravada contendo cinco nomes de animais. Os pacientes do grupo recordar palavras (RP) ouviram uma fita gravada contendo cinco palavras de frequência média na língua turca, depois de adaptadas. Os pacientes do grupo controle (GC) ouviram os sons do mar até o fim da cirurgia. Duas horas após a cirurgia, os testes foram administrados a cada paciente na sala de recuperação para avaliar a memória. RESULTADOS: Houve uma diferença entre os escores dos grupos CT e GC no Miniexame do Estado Mental (MMSE); todos os escores foram > 20. Os resultados dos testes de categoria e recordar palavras, aplicados para avaliar a memória implícita, não foram estatisticamente diferentes entre os grupos. Não houve evidência de memória implícita em nenhum dos pacientes. Um paciente lembrou-se de ouvir "o som de água" como uma prova de memória explícita. Onze pacientes declararam não ter sonhado. CONCLUSÕES: Apesar de não termos encontrado nenhuma evidência de memória implícita sob anestesia adequada com AVT, um paciente apresentou memória explícita. Embora a profundidade adequada da anestesia fornecida pelo monitoramento do BIS corrobore nossos resultados para a memória implícita, ela não explica os resultados para a memória explícita.

Palavras-chave

Memória de Curto Prazo, MONITORAÇÃO, Índice Bispectral, TÉCNICAS ANESTÉSICAS, Geral, venosa, total, ANESTÉSICOS, Venoso, propofol, ANALGÉSICOS, Opióides, remifentanil

Abstract

BACKGROUND AND OBJECTIVES: In this study, we aimed to assess implicit and explicit memory in patients who had abdominal surgery under total intravenous anesthesia (TIVA) with propofol and remifentanil, in which anesthesia level was controlled by bispectral index (BIS) monitoring. METHOD: Total intravenous anesthesia was administered to 60 adult patients, to obtain BIS levels of 40-60. Patients were randomly allocated to three groups according to tapes they listened to. Patients in the category group (CT) listened to a tape containing five animal names. Patients in the word recognition group (WM) listened to a tape containing five intermediate-frequency words, adapted into Turkish. Patients in the control group (CG) listened to sea sounds until the end of surgery. Two hours after surgery, tests were administered to each patient in the recovery room to assess memory. RESULTS: There was a difference between the CT and CG groups in their Mini-Mental State Examination scores, all values were > 20. The results of the category and word recognition tests that were applied to assess implicit memory were not statistically different among the groups. There was no evidence of implicit memory in any of the patients. One patient remembered hearing 'the sound of water' as a proof of explicit memory. Eleven patients said they had dreamt. CONCLUSIONS: Although no evidence of implicit memory under adequate anesthesia with TIVA was found, one patient showed explicit memory. Although adequate depth of anesthesia provided by BIS monitoring supports our implicit memory results, it does not explain the explicit memory results.

Keywords

Memory, Short-Term, Consciousness Monitors, Anesthesia, Intravenous, Propofol, Piperidines

Referencias

Ghoneim MM. Block RI: Learning and consciousness during general anesthesia. Anesthesiology. 1992;76(2):279-305.

Liu WHD, Thorp TAS, Graham SG, Aitkenhead AR. Incidence of awareness with recall during general anaesthesia. Anaesthesia. 1991;46(6):435-437.

Ghoneim MM. Awareness during anesthesia. Anesthesiology. 2000;92(2):597-602.

Sebel PS, Bowdle TA, Ghoneim MM. The incidence of awareness during anesthesia: a Multicenter United States Study. Anesth Analg. 2004;99(3):833-839.

Lee L, Leslie K. Target words for the word stem completion test in Australian patients. Anaesthesia Intensive Care. 2003;31(2):184-186.

Andrade J, Englert L, Harper C, Edwards ND. Comparing the effects of stimulation and propofol infusion rate on implicit and explicit memory formation. Br J Anaesthesia. 2001;86(2):189-195.

Lequeux PY, Velghe-Lenelle CE, Cantraine F, Sosnowski M, Barvais L. Absence of implicit and explicit memory during propofol/remifentanil anaesthesia. Eur J Anaesthesiology. 2005;22(5):333-336.

Lubke GH, Kerssens C, Phaf H, Sebel PS. Dependence of explicit and implicit memory on hypnotic state in trauma patients. Anesthesiology. 1999;90(3):670-680.

Jelicic M, Asbury AJ, Millar K, Bonke B. Implicit learning during enflurane anaesthesia in spontaneously breathing patients?. Anaesthesia. 1993;48(9):766-768.

Ghoneim MM, Block RI, Fowles DC. No evidence of classical conditioning of electrodermal responses during anesthesia. Anesthesiology. 1992;76(5):682-688.

Struys M, Versichelen L, Bytteiber G, Mortier E, Moerman A, Rolly G. Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration. Anaesthesia. 1998;53(1):4-12.

Drummond JC. Monitoring depth of anesthesia. Anesthesiology. 2000;93(3):876-882.

Akçalı DT, Özköse Z, Yardım S. Do we need bispectral index monitoring during total intravenous anesthesia for lumbar discectomies?. Turk Neurosurg. 2008;18(2):125-133.

Haas RE, Patterson D, Powell S, Eslick R, Cassingham R, Nesley T. Is there postoperative evidence of implicit learning following aural stimuli at moderate hypnotic BIS levels during general anesthesia?. AANA Journal. 2002;70(3):205-211.

Mychaskiw G, Horowitz M, Sachdev V, Heath BJ. Explicit intraoperative recall at bispectral index of 47. Anesth Analg. 2001;92(4):808-809.

Moerman N, Bonke B, Oosting J. Awareness and recall during general anesthesia. Anesthesiology. 1993;79(3):454-464.

Hagihira S. Unusually low bispectral index values during emergence from anaesthesia. Anesth Analg. 2004;98(4):1036-1038.

Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awereness during anaesthesia: a prospective case study. Lancet. 2000;355(9205):707-711.

Jelicic M, De Roode A, Bovill JG, Bonke B. Unconscious learning during anaesthesia. Anaesthesia. 1992;47(10):835-837.

Russell IF, Wang M. Absence of memory for intraoperative information during surgery under adequate general anaesthesia. Br J Anaesthesia. 1997;78(1):3-9.

Munte S, Kobbe I, Demertzis A. Increased reading speed for stories presented during general anaesthesia. Anesthesiology. 1999;90(3):662-669.

Pompeia S, Bueno OFA, Galduroz JCF, Tufik S. Stem-completion tasks (indirect, direct inclusion and exclusion) are differently affected by equipotent doses of lorazepam and flunitrazepam. Hum Psychopharmacol Clin Exp. 2003;18(7):541-549.

Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during anesthesia: a closed claims analysis. Anesthesiology. 1999;90(4):1053-1061.

Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. Anesthesiology. 1997;86(1):24-33.

Vanluchene ALG, Struys MMRF, Heyse BEK, Mortier EP. Spectral entropy measurement of patient responsiveness during propofol and remifentanil: A comparison with the bispectral index. Br J Anaesthesia. 2004;93(5):645-654.

Chaves IA, Flaishon R, Sebel PS. The effect of the interaction of propofol and alfentanil on recall, loss of consciousness, and the bispectral index. Anesth Analg. 1998;87(4):949-955.

Russell IF, Wang M. Absence of memory for intra-operative information during surgery with total intravenous anaesthesia. Br J Anaesthesia. 2001;86(2):196-202.

Parker CJR, Oates JDL, Boyd AH, Thomas SD. Memory for auditory material presented during anaesthesia. British Journal of Anaesthesia. 1994;72(2):181-184.

Bonebakker E, Bonke B, Klein J, Wolters G, Hop WCJ. Implicit memory during balanced anaesthesia. Anaesthesia. 1993;48(8):657-660.

Leslie K, Myles PS, Forbes A, Chan MTV, Swallow SK, Short TG. Dreaming during anaesthesia in patients at high risk of awareness. Anaesthesia. 2005;60(3):239-244.

Avaliação da memória sob anestesia venosa total

The assessment of memory under total intravenous anesthesia

Gulistan Aktas; Elvan Sahin; Meltem Turkay Aydogmus; Yuksel Erkin

Resumo

Palavras-chave

Abstract

Keywords

Referencias

Links

compartir

Braz J Anesthesiol