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NEUROPSYCHOLOGICAL RECOVERY AFTER MIDAZOLAM COINDUCED ANESTHESIA

Departments of Anesthesia and Clinical Epidemiology, Dalhousie University, IWK Health Centre, 5850-5980 University Ave., Halifax, Nova Scotia, B3J 3G9 and Memorial University of Newfoundland, St. John's, Newfoundland, A1B 3V6

INTRODUCTION

Following ambulatory surgery, rapid return of cognitive function is imperative. Data on the recovery of cognitive function after low dose midazolam coinduced general anesthesia is limited. This study uses neuropsychological testing to measure cognitive recovery after midazolam-propofol coinduced anesthesia compared to propofol induced controls in ambulatory gynecology patients undergoing short laparoscopic procedures.

METHODS

With approval of the hospital research ethics board, 88 eligible patients were randomized in a double blind manner into one of two groups; propofol 2 mg/kg control (n=44) or midazolam 0.02 mg/kg / propofol 1 mg/kg coinduced group (n=44). All patients received a standardized general anesthetic including intubation. Neuropsychological objective testing consisted of a Digit Symbol Substitution Test (DSST), a Treiger Dot Test (TDT) and five Visual Analogue Scales (VAS) for subjective assessment of anxiety, sedation, coordination, confusion and drowsiness. Tests were completed preoperatively and postoperatively every 30 minutes until discharged. Intraoperative variables (including adverse events, hemodynamics), time to discharge, Post Anesthesia Care Unit (PACU) narcotic and anti-emetic use were recorded.

RESULTS

At 60 minutes, 84 of the 88 subjects had complete data sets. There were no statistically significant differences on any of the neuropsychological testing between the propofol control group and the midazolam coinduced group (=0.05). There were similar scores on the VAS testing, DSST (51.8±12.7 vs 55.7±10.5 p=0.12) and TDT (7.9±7.3 vs 7.1±5.8 p=0.56). The DSST, TDT and VAS data was analyzed using repeated measures ANOVA for between subject factors (adjusting for baseline preoperative test scores) and no significant difference was found based upon group randomization. There was no significant difference in the incidence of adverse events (3 (7.1%) vs 2 (4.8%)); failed induction (5 (11.9%) vs 5 (11.9%)); length of PACU stay (1:31±37 vs 1:23±32 min); PACU morphine (0.13±0.10 vs 0.13±0.11mg/kg); ondansetron rescue (13 (31%) vs 12 (28.6%)). There was no intraoperative awareness/recall.

DISCUSSION

Midazolam in a low dose (0.02 mg/kg) during coinduced general anesthesia for short ambulatory procedures does not appear to alter cognitive recovery as measured by neuropsychological testing compared to standard propofol (2 mg/kg) induction. Intraoperative and PACU variables also appear to be equivalent between techniques.

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