Midazolam and awareness with recall during total intravenous anaesthesia

Miller, Donald R.; Blew, Philip G.; Martineau, Raymond; Hull, Kathryn A.

doi:10.1007/bf03011809

Cited by 50 publications

(15 citation statements)

References 17 publications

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“…Despite relatively high BIS values, none of our patients complained of awareness, which is consistent with the results of other studies in which no patients complained of awareness during anesthesia with midazolam and fentanyl for a coronary artery bypass graft, even when the BIS was [60 [10]. Other studies have also shown that the incidence of intraoperative awareness is lower in patients receiving midazolam before the induction of general anesthesia than in those who do not receive it [22,23], suggesting that midazolam has a good amnesic effect and ability to prevent intraoperative awareness. However, we cannot completely eliminate the possibility that intraoperative awareness did occur.…”

Section: Discussionsupporting

confidence: 93%

Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation

et al. 2010

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Section: Discussionsupporting

confidence: 93%

Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation

et al. 2010

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“…[14] There is also evidence that TIVA may predispose patients to awareness compared to inhalational anesthetics with measurement of ETAC. [2491516] In addition, there has been speculation about the influence of genetics and ethnic differences on anesthetic requirements; this may have also contributed to the low incidence of awareness in our study as compared to western population. [517]…”

Section: Discussionmentioning

confidence: 96%

Awareness during general anesthesia: An Indian viewpoint

Ambulkar

Agarwal

Ranganathan

et al. 2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:The incidence of intra-operative awareness with explicit recall in the Western world has been reported to be between 0.1% and 0.2% in the general surgical population and up to 1–2% of patients at high risk for this complication. Awareness in the Indian population has never been studied; we therefore wanted to detect the incidence of awareness in patients who were at high risk of experiencing awareness during surgery in our population.Material and Methods:We conducted a prospective single-center observational study at a 600-bedded tertiary cancer care referral hospital. We recruited adult patients posted for major cancer surgery who were considered to be at high risk for awareness. These patients were interviewed at three time-points using the structured modified Brice interview questionnaire. The primary outcome studied was the incidence of definite intra-operative awareness.Results:A total of 934 patients were included in the final analysis of which none reported awareness. Using the rule of three (Hanley and Lippman-Hand) we conclude that the upper 95% confidence interval for the incidence of awareness in this population is <1 in 300 (0.33%).Conclusion:Awareness under anesthesia is a distressing complication with a potential for long-term psychological consequences, and every effort should be undertaken to prevent it. It is reassuring though that our data in Indian cancer patients at high risk for intra-operative awareness suggests that it is an uncommon occurrence.

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“…18,19 Furthermore, commonly used TIVA combinations such as propofolremifentanil or propofol-alfentanil show less haemodynamic stability compared with inhaled drugs. 20 For these reasons, we prefer to use combined anaesthesia with inhalational (sevoflurane) and intravenous (i.v.…”

Section: Anaesthetic Technique and Ponvmentioning

confidence: 99%

The Incidence of Postoperative Nausea and Vomiting after Thyroidectomy using Three Anaesthetic Techniques

et al. 2011

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The choice of anaesthetics can affect the incidence of postoperative nausea and vomiting (PONV). This study compared the incidence of PONV in 177 female patients who underwent thyroidectomy, with anaesthesia induced and maintained using one of three regimens: (i) sevoflurane (thiopental sodium 4 -5 mg/kg and sevoflurane 2.0 -2.5 vol% in 50% air); (ii) total intravenous anaesthesia (TIVA; propofol-remifentanil [target blood concentrations 2.5 -3.5 µg/ml and 3.5 -4.5 ng/ml, respectively]); or (iii) combined inhalation and intravenous anaesthesia (sevoflurane 1.0 vol% in 50% air plus propofol-remifentanil [target blood concentrations 1.5 -2.5 µg/ml and 2.5 -3.5 ng/ml, respectively]). The incidence and severity of PONV and the need for rescue antiemetics were assessed at 0 -24 h postoperatively. Overall, the incidence of PONV was significantly lower in the TIVA and combined groups compared with the sevoflurane group (33.9%, 39.0% and 64.4%, respectively). In conclusion, the maintenance of anaesthesia with propofol-remifentanil or sevofluranepropofol-remifentanil decreased the incidence of PONV compared with sevoflurane alone.

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Midazolam and awareness with recall during total intravenous anaesthesia

Cited by 50 publications

References 17 publications

Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation

Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation

Awareness during general anesthesia: An Indian viewpoint

The Incidence of Postoperative Nausea and Vomiting after Thyroidectomy using Three Anaesthetic Techniques

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