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Midazolam enhances anterograde but not retrograde amnesia in pediatric patients
R S Twersky1, J Hartung, B J Berger
1Long Island College Hospital, Ambulatory Surgical Unit, Brooklyn, New York.
Insights
Midazolam sedation impairs children's memory of events occurring after administration (anterograde amnesia) but does not affect memory of events before sedation (retrograde amnesia). This study investigated midazolam's effects on pediatric surgical patients.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Cognitive Neuroscience
Background:
- Midazolam sedation is known to reduce recall of pre-anesthesia events in children.
- Previous findings on midazolam's amnesic effects were limited.
- Further investigation into midazolam's impact on retrograde and anterograde memory was warranted.
Purpose of the Study:
- To evaluate the effect of midazolam sedation on retrograde and anterograde recall and recognition.
- To assess memory function in pediatric patients undergoing elective surgery.
Main Methods:
- A double-blind study randomized 40 pediatric patients (4-10 years) to receive intranasal midazolam or placebo.
- Recall and recognition tasks using picture cards assessed memory of events before and after sedation.
- Retrograde amnesia measured memory of pre-sedation events; anterograde amnesia measured memory of post-sedation events.
Main Results:
- Midazolam significantly reduced postoperative recall and recognition of events occurring after administration (anterograde amnesia).
- No significant difference was observed between midazolam and placebo groups for memory of pre-sedation events (retrograde amnesia).
Conclusions:
- Midazolam sedation impairs anterograde recall and recognition in pediatric patients.
- Midazolam provides partial anterograde amnesia without affecting retrograde memory.
- Findings support and extend previous research on midazolam's amnesic effects in children.
Background:
Midazolam sedation has been shown to diminish recall of one to four cards shown prior to induction of general anesthesia in pediatric patients. This promising but limited finding prompted us to investigate the effect of midazolam sedation on retrograde and anterograde recall and recognition in children scheduled for elective surgery.
Methods:
Forty patients aged 4-10 yr were randomized using a double-blind study design to receive either 0.2 mg/kg intranasal midazolam or 0.2 ml/5 kg placebo (distilled water) using a Devilbiss #286 atomizer. To assess postoperative memory of preoperative events, recall and recognition tasks were performed using a series of picture cards designed for this purpose. Retrograde amnesia was measured by postoperative recall and recognition of cards shown prior to midazolam/placebo administration, and anterograde amnesia was measured by postoperative recall and recognition of cards shown during the interval between midazolam/placebo administration and induction of general anesthesia.
Results:
Compared to placebo, the midazolam group experienced a significant postoperative reduction in ability to both recall (P < .003) and recognize (P < .001) cards shown subsequent to midazolam/placebo administration (anterograde amnesia). In distinction, there was no difference between groups in postoperative ability to recall or recognize cards shown prior to midazolam/placebo administration (retrograde amnesia).
Conclusions:
These results support and extend the inference that midazolam diminishes anterograde recall. In addition, our findings indicate that midazolam diminishes anterograde recognition, thereby providing partial anterograde amnesia without affecting retrograde memory in pediatric patients.