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BJA Advance Access published online on November 26, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei040
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted October 27, 2004

Clinical Investigation

Double-blind randomized controlled trial to determine extent of amnesia with midazolam given immediately before general anaesthesia

R. Bulach 1, P. S. Myles 2*, and M. Russnak 1

1 Department of Anaesthesia and Pain Management, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia
2 Department of Anaesthesia and Pain Management, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Anaesthesia, Monash University, Melbourne, Australia; Department of Epidemiology, Monash University, Melbourne, Australia; Department of Preventive Medicine, Monash University, Melbourne, Australia; Centre for Clinical Research Excellence, Canberra, Australia

* To whom correspondence should be addressed.
P. S. Myles, E-mail: p.myles{at}alfred.org.au


  Abstract

Background. Anterograde, but not retrograde, amnesia has been demonstrated following midazolam administration. However, there have been no studies investigating whether or not immediate retrograde amnesia can be produced with midazolam.

Methods. After ethics committee approval and consent, 40 adult patients undergoing surgery and general anaesthesia were randomly allocated to one of four groups: midazolam 2 mg, midazolam 5 mg, midazolam 10 mg or control (normal saline). Measurements were made from 12 min prior to induction of anaesthesia, and the study drug was administered 8 min prior to induction of anaesthesia. Midazolam effects were measured using visual recognition of posters, recall of specific events, bispectral index (BIS) and sedation visual analogue score.

Results. Recognition and recall rates were similar between groups up until the time of study drug administration, with no evidence of retrograde amnesia (all P>0.3). There was a dose-dependent deterioration in visual recall (P=0.002), event recollection (P<0.001), BIS (P<0.001) and sedation score (P<0.001) following i.v. midazolam when compared with control.

Conclusions. We found no evidence that i.v. midazolam 2-10 mg produces immediate retrograde amnesia. Midazolam causes anterograde amnesia in a dose-responsive manner.

Keywords: anaesthesia, awareness; complications, amnesia; monitoring, bispectral index; sedation.
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