Jafarian Ali Akbar, Khatibi Ali, Mesbah Kiaei Mehrdad, Alebouyeh Mahmood-Reza, Alimian Mahzad, Habibi Azadeh, Amniati Saied
Department of Anesthesiology and Pain Medicine, Motahari Medical Center, Iran University of Medical Sciences, Tehran, Iran.
Firouzgar General Hospital, Iran University of Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2023 Feb 14;13(1):e134300. doi: 10.5812/aapm-134300. eCollection 2023 Feb.
The identification of different factors affecting anesthesia and physiological changes during anesthesia can be effective in improving the quality of anesthesia. Midazolam is a benzodiazepine that has been used for many years for sedation under anesthesia. Stress is also an important factor affecting memory and other physiological changes, such as blood pressure and heart rate.
his study aimed to investigate the effects of stress on retrograde and anterograde amnesia among patients undergoing general anesthesia.
This multi-center, parallel, stratified, randomized controlled trial was performed on patients undergoing non-emergency abdominal laparotomy. The patients were divided into high- and low-stress groups according to the Amsterdam Preoperative Anxiety and Information Scale. Then, both groups were randomly divided into three subgroups receiving 0, 0.02, or 0.04 mg/kg of midazolam. Recall cards were shown to patients at 4 minutes, 2 minutes, and immediately before injection to determine retrograde amnesia and at 2 minutes, 4 minutes, and 6 minutes after injection to determine anterograde amnesia. Hemodynamic changes were recorded during intubation. The chi-square and multiple regression tests were used to analyze the data.
Midazolam injection was associated with the development of anterograde amnesia in all groups (P < 0.05); however, it had no effect on the development of retrograde amnesia (P < 0.05). Midazolam could decrease the systolic and diastolic blood pressure and heart rate during intubation (P < 0.05). Stress also caused retrograde amnesia in patients (P < 0.05); nevertheless, it had no effect on anterograde amnesia (P > 0.05). Stress and midazolam injection could not affect the oxygen levels during intubation.
The results showed that midazolam injection could induce anterograde amnesia, hypotension, and heart rate; nonetheless, it had no effect on retrograde amnesia. Stress was associated with retrograde amnesia and increased heart rate; however, it was not associated with anterograde amnesia.
识别影响麻醉及麻醉期间生理变化的不同因素，有助于提高麻醉质量。咪达唑仑是一种苯二氮䓬类药物，多年来一直用于麻醉下的镇静。应激也是影响记忆及其他生理变化（如血压和心率）的重要因素。
本研究旨在调查应激对全身麻醉患者顺行性和逆行性遗忘的影响。
本多中心、平行、分层、随机对照试验在接受非急诊腹部剖腹手术的患者中进行。根据阿姆斯特丹术前焦虑和信息量表，将患者分为高应激组和低应激组。然后，将两组患者随机分为三个亚组，分别接受0、0.02或0.04mg/kg的咪达唑仑。在注射前4分钟、2分钟和即将注射时向患者展示回忆卡片，以确定逆行性遗忘，并在注射后2分钟、4分钟和6分钟展示，以确定顺行性遗忘。在插管期间记录血流动力学变化。采用卡方检验和多元回归检验分析数据。
所有组中，咪达唑仑注射均与顺行性遗忘的发生有关（P<0.05）；然而，它对逆行性遗忘的发生没有影响（P<0.05）。咪达唑仑可降低插管期间的收缩压、舒张压和心率（P<0.05）。应激也会导致患者出现逆行性遗忘（P<0.05）；然而，它对顺行性遗忘没有影响（P>0.05）。应激和咪达唑仑注射不影响插管期间的氧水平。
结果表明，咪达唑仑注射可诱导顺行性遗忘、低血压和心率降低；然而，它对逆行性遗忘没有影响。应激与逆行性遗忘和心率增加有关；然而，它与顺行性遗忘无关。
