==================================CMR10================================== 10. Sedation Sedatives and memory Hypnotics Barbiturates Exclude: benzodiazepines, diazepam, flurazepam. 1 UI - 87084348 AU - Ochs MW ; Tucker MR ; White RP Jr TI - A comparison of amnesia in outpatients sedated with midazolam or diazepam alone or in combination with fentanyl during oral surgery. AB - Midazolam is a new, water-soluble benzodiazepine that has been reported to produce a greater degree of amnesia than does diazepam. This study compares the amnesia produced in patients sedated with midazolam or diazepam or in combination with fentanyl during oral surgery. Twenty-four hours after surgery, each patient answered a questionnaire designed to assess his or her recall of events during and after surgery. Patients who received midazolam alone recalled significantly less than did patients in either diazepam group. The addition of fentanyl to midazolam did not produce any significant difference in recall. MH - *Anesthesia, Dental ; Anesthesia, Local ; Comparative Study ; Diazepam/ADMINISTRATION & DOSAGE/*PHARMACODYNAMICS ; Double-Blind Method ; *Fentanyl/PHARMACODYNAMICS ; Human ; Memory/*DRUG EFFECTS ; Midazolam/ADMINISTRATION & DOSAGE/*PHARMACODYNAMICS ; *Preanesthetic Medication ; Random Allocation ; Support, Non-U.S. Gov't ; Time Factors ; Tooth Extraction SO - J Am Dent Assoc 1986 Dec;113(6):894-7 3 UI - 87000344 AU - Ricou B ; Forster A ; Br:uckner A ; Chastonay P ; Gemperle M TI - Clinical evaluation of a specific benzodiazepine antagonist (RO 15-1788). Studies in elderly patients after regional anaesthesia under benzodiazepine sedation. AB - The efficacy, usefulness and side effects of RO 15-1788 (RO), a specific benzodiazepine (BZD) antagonist, have been evaluated. Sixty-two patients (ASA I-III, mean age 72 +/- 9 yr) scheduled for urological surgery under regional anaesthesia and BZD sedation received placebo or RO in a randomized, double-blind fashion at the end of the procedure, following sedation with midazolam. When compared with placebo, RO improved alertness and collaboration for 15 min, and suppressed anterograde amnesia for 60 min. No major side effect was noted, although five patients became anxious after administration of RO. Two cases of a paradoxical reaction to midazolam were treated successfully by RO. MH - Aged ; Amnesia/CHEMICALLY INDUCED ; Anesthesia Recovery Period ; *Anesthesia, Conduction ; Benzodiazepines/*ANTAGONISTS & INHIBITORS ; Drug Evaluation ; Female ; Flumazepil/ADVERSE EFFECTS/*PHARMACODYNAMICS ; Human ; Hypnotics and Sedatives/ ANTAGONISTS & INHIBITORS ; Male ; Midazolam/*ANTAGONISTS & INHIBITORS ; Middle Age ; Vital Capacity/DRUG EFFECTS SO - Br J Anaesth 1986 Sep;58(9):1005-11 1 UI - 87067664 AU - Karas CA ; Picker M ; Poling A TI - Effects of phenobarbital in combination with phenytoin or valproic acid on the delayed-matching-to-sample performance of pigeons. AB - The present study examined the effects of phenobarbital (5, 10, 20, and 40 mg/kg), phenytoin (2.5, 5, 7.5, and 15 mg/kg), and valproic acid (40, 60, 80, and 120 mg/kg), and those of phenobarbital (10 and 20 mg/kg) in combination with phenytoin (2.5, 5, and 7.5 mg/kg) or valproic acid (40, 60, and 80 mg/kg), on the delayed-matching-to-sample performance of pigeons. In general, high doses of each individual drug reduced accuracy. Drug combinations also reduced accuracy relative to control values. Reductions in accuracy produced by drug combinations were very similar in magnitude to those predicted by a response-addition model of drug interaction. MH - Animal ; Drug Interactions ; Memory, Short-Term/*DRUG EFFECTS ; Phenobarbital/*PHARMACODYNAMICS ; Phenytoin/*PHARMACODYNAMICS ; Pigeons ; Support, U.S. Gov't, P.H.S. ; Valproate/ *PHARMACODYNAMICS SO - Pharmacol Biochem Behav 1986 Oct;25(4):929-32 2 UI - 86319407 AU - Scott DB TI - Chlormethiazole as a sleep cover for regional anaesthesia. AB - Intravenous chlormethiazole has been used in conjunction with regional anaesthesia to induce sedation in several hundred patients. Advantages of using chlormethiazole include rapid induction and recovery. Disadvantages include nasal irritation. MH - *Anesthesia, Conduction ; Arousal/DRUG EFFECTS ; Chlormethiazole/ ADVERSE EFFECTS/*THERAPEUTIC USE ; Human ; Infusions, Parenteral ; *Preanesthetic Medication ; Recall/DRUG EFFECTS ; Sleep Stages/ *DRUG EFFECTS SO - Acta Psychiatr Scand [Suppl] 1986;329:182-4 3 UI - 86293728 AU - Reitan JA ; Porter W ; Braunstein M TI - Comparison of psychomotor skills and amnesia after induction of anesthesia with midazolam or thiopental. AB - In two groups of 31 healthy patients undergoing minor elective surgery, anesthesia was induced intravenously with either midazolam maleate, 0.2 mg/kg, or thiopental, 3.5 mg/kg. All subjects received 2 micrograms/kg fentanyl 5 min before the induction agents. Induction time with midazolam was significantly longer than with thiopental (97.1 +/- 10.9 sec vs 59.4 +/- 5.0 sec) and time to orientation postoperatively was significantly longer after midazolam (31.7 +/- 4.2 min vs 11.0 +/- 1.1 min). Continued recovery after orientation, measured by a series of psychomotor tests, was also significantly longer with midazolam than with thiopental. Anterograde amnesia was evident in 84.8% of the midazolam treated patients and in only 31.4% of the thiopental group. This degree of absence of recall was acknowledged positively by the affected patients. The protracted recovery period may limit the use of midazolam in short surgical procedures. MH - Adult ; *Anesthesia Recovery Period ; Anesthesia, Intravenous ; Anesthetics/*PHARMACODYNAMICS ; Benzodiazepines/*PHARMACODYNAMICS ; Clinical Trials ; Comparative Study ; Double-Blind Method ; Female ; Human ; Male ; Memory, Short-Term/*DRUG EFFECTS ; *Postoperative Period ; Psychomotor Performance/*DRUG EFFECTS ; Random Allocation ; Support, Non-U.S. Gov't ; Thiopental/ *PHARMACODYNAMICS SO - Anesth Analg 1986 Sep;65(9):933-7 4 UI - 86231460 AU - Lesser RP ; Dinner DS ; L:uders H ; Morris HH TI - Memory for objects presented soon after intracarotid amobarbital sodium injections in patients with medically intractable complex partial seizures. AB - We evaluated the abilities of 36 patients with intractable temporal lobe epilepsy and left hemisphere dominance for language to later recognize objects presented in the confusional phase after left intracarotid amobarbital injection. Eighteen of 24 patients with left, but only 4/12 with right, temporal lobe epilepsy recognized at least two-thirds of objects during a post-test. These results demonstrate that the initial muteness and apparent confusion after amobarbital injection do not prohibit the formation of new memories; this gives further support to the idea that consciousness can be retained despite transient disruption of function of the language-dominant hemisphere. MH - Adolescence ; Adult ; Amobarbital/ADMINISTRATION & DOSAGE/ *PHARMACODYNAMICS ; Attention/DRUG EFFECTS ; Brain/DRUG EFFECTS/ PHYSIOPATHOLOGY ; Carotid Artery, Internal ; Child ; Confusion/ ETIOLOGY ; Electroencephalography ; Epilepsy, Temporal Lobe/ *PHYSIOPATHOLOGY ; Human ; Injections ; Memory, Short-Term/*DRUG EFFECTS SO - Neurology 1986 Jul;36(7):895-9 5 UI - 86165818 AU - Markowitz J ; Viederman M TI - A case report of dissociative pseudodementia. AB - The authors report the case of a patient admitted to a medical hospital for seizures and considered for more than 1 month to be demented. Psychiatric examination revealed a fluctuating cognitive capacity, suggesting a psychogenic etiology. Following a sodium amytal interview, the patient's symptoms dramatically resolved. Diagnosis, treatment, and the importance of considering dissociative pseudodementia are discussed. MH - Amnesia/*DIAGNOSIS ; Amobarbital/DIAGNOSTIC USE ; Case Report ; Dementia/*DIAGNOSIS ; Diagnosis, Differential ; Dissociative Disorders/*DIAGNOSIS ; Human ; Male ; Middle Age SO - Gen Hosp Psychiatry 1986 Mar;8(2):87-90 6 UI - 86128258 AU - Nussmeier NA ; Arlund C ; Slogoff S TI - Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. AB - The authors prospectively investigated the ability of thiopental to decrease neuropsychiatric complications as a consequence of open-ventricle operations requiring cardiopulmonary bypass. Eighty-nine randomly assigned patients received sufficient thiopental to maintain electroencephalographic silence throughout the period from before atrial cannulation to termination of bypass. These patients received an average of 39.5 mg/kg of thiopental, while 93 control patients received only fentanyl. On the first postoperative day, five thiopental (5.6%) and eight control (8.6%) patients exhibited clinical neuropsychiatric abnormalities. By the tenth postoperative day, all neuropsychiatric dysfunction had resolved in the thiopental group but persisted in seven (7.5%) control patients (P less than 0.025). The incidence of complications was significantly related to calcification of replaced valves, aortic valve replacement, advanced age, and prolonged bypass, but not to low blood pressure during perfusion. The authors believe their data are consistent with embolism as the most important cause of sensory-motor neurologic dysfunction following cardiopulmonary bypass. The data also provide evidence that thiopental in sufficient dosage can reduce the clinical consequences of these events. This is the first demonstration of cerebral protection by a barbiturate in humans. MH - Age Factors ; Aged ; Barbiturates/*THERAPEUTIC USE ; Blood Pressure ; Calcinosis/COMPLICATIONS ; Cardiopulmonary Bypass/ *ADVERSE EFFECTS ; Delusions/ETIOLOGY ; Electroencephalography ; Female ; Hallucinations/ETIOLOGY ; Heart Valve Prosthesis ; Human ; Male ; Memory Disorders/ETIOLOGY ; Middle Age ; Myocardial Contraction/DRUG EFFECTS ; Neuropsychological Tests ; Postoperative Complications/PREVENTION & CONTROL/*PSYCHOLOGY ; Sleep Stages ; Thiopental ; Time Factors SO - Anesthesiology 1986 Feb;64(2):165-70