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Effects of midazolam on explicit vs implicit memory in a pediatric surgery setting
Sherry H Stewart1, Susan E Buffett-Jerrott, G Allen Finley
1Department of Psychiatry, Dalhousie University, Life Sciences Center, Halifax, Nova Scotia B3H 4J1, Canada. sstewart@dal.ca
Insights
Midazolam impairs explicit memory but not implicit memory in young children undergoing surgery. This suggests a dissociation between memory types in pediatric patients receiving midazolam.
Area of Science:
- Pediatric Anesthesiology
- Cognitive Neuroscience
- Child Psychology
Background:
- Previous studies indicate midazolam impairs explicit memory in children undergoing surgery.
- A within-subjects study found midazolam impaired explicit but not implicit memory in older children.
Purpose of the Study:
- To replicate and extend findings on midazolam's effects on memory in younger children.
- To investigate memory performance in children aged 3-6 years undergoing surgery.
Main Methods:
- Randomized, placebo-controlled trial with children aged 3-6 years undergoing myringotomy surgery.
- Participants received either midazolam or placebo.
- Explicit (recognition) and implicit (priming) memory were assessed post-surgery for pre-surgery encoded pictures.
Main Results:
- Midazolam-treated children demonstrated poorer recognition memory compared to the placebo group.
- Priming on the implicit memory task was equivalent between midazolam and placebo groups.
Conclusions:
- Midazolam appears to induce a dissociation between explicit and implicit memory in young children undergoing surgery.
- Findings have theoretical and clinical implications for pediatric anesthesia and memory research.
Rationale:
Placebo-controlled studies show that midazolam impairs explicit memory in children undergoing surgery (Buffett-Jerrott et al., Psychopharmacology 168:377-386, 2003; Kain et al., Anesthesiology 93:676-684, 2000). A recent within-subjects study showed that midazolam impaired explicit memory while leaving implicit memory intact in a sample of older children undergoing painful medical procedures (Pringle et al., Health Psychol 22:263-269, 2003).
Objectives:
We attempted to replicate and extend these findings in a randomized, placebo-controlled design with younger children undergoing surgery.
Materials And Methods:
Children aged 3-6 years who were undergoing ear tube (myringotomy) surgery were randomly assigned to receive midazolam (n = 12) or placebo (n = 11). After surgery, they were tested on explicit (recognition) and implicit (priming) memory for pictures encoded before surgery.
Results:
Relative to placebo, the midazolam-treated children showed poorer recognition memory on the explicit task but equivalent priming on the implicit task.
Conclusions:
Overall, it appears that midazolam induces a dissociation between explicit and implicit memory in young children in the pediatric surgery setting. Theoretical and clinical implications of the findings are discussed along with directions for future research.
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