The Comparative Amnestic Effects of Midazolam, Propofol, Thiopental, and Fentanyl at Equisedative Concentrations

@article{Veselis1997TheCA,
  title={The Comparative Amnestic Effects of Midazolam, Propofol, Thiopental, and Fentanyl at Equisedative Concentrations},
  author={Robert A. Veselis and Ruth A. Reinsel and Vladimir A. Feshchenko and Marek Wr{\'o}nski},
  journal={Anesthesiology},
  year={1997},
  volume={87},
  pages={749–764}
}
Background: The authors evaluated the effects of midazolam, propofol, thiopental, and fentanyl on volunteer participants' memory for words and pictures at equisedative concentrations. Methods: Sixty‐seven healthy volunteers were randomized to receive intravenous infusions of midazolam (n = 11), propofol (n = 11), thiopental (n = 10), fentanyl with ondansetron pretreatment (n = 11), ondansetron alone (n = 8), or placebo (n = 16) in a double‐blind design. Three increasing and then two decreasing… 
Thiopental and propofol affect different regions of the brain at similar pharmacologic effects.
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Differences in regional cerebral blood flow (rCBF) were identified by using SPM99 analysis of images obtained with positron emission tomography with (15)O water to identify the loci of action for the nonsedative effects of propofol, such as amnesia.
A comparison of the effects of propofol and midazolam on memory during two levels of sedation by using target-controlled infusion.
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Clinically distinct levels of sedation were accompanied by small differences in venous propofol or midazolam concentrations, which indicates steep concentration-effect relationships and Neutral information is still memorized during low-level sedation with both drugs.
A Comparison of the Effects of Propofol and Midazolam on Memory During Two Levels of Sedation by Using Target-Controlled Infusion
TLDR
Clinically distinct levels of sedation were accompanied by small differences in venous propofol or midazolam concentrations, which indicates steep concentration-effect relationships and indicates Neutral information is still memorized during low-level sedation with both drugs.
Drug-induced Amnesia Is a Separate Phenomenon from Sedation: Electrophysiologic Evidence
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Midazolam and propofol affect memory differentially from their sedative effects, and these are indexed by specific components of the auditory ERP.
Propofol and Thiopental Do Not Interfere with Regional Cerebral Blood Flow Response at Sedative Concentrations
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The presence of propofol or thiopental does not affect the r CBF response to increasing stimulus rate during consciousness, and changes in rCBF activation patterns with sedative concentrations of these drugs represent effects on brain activity itself.
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TLDR
The authors found no evidence that i.v. midazolam 2-10 mg produces immediate retrograde amnesia, and found that anterograde amnesia is caused in a dose-responsive manner in patients undergoing surgery and general anaesthesia.
A triazolam/amphetamine dose–effect interaction study: dissociation of effects on memory versus arousal
TLDR
Benzodiazepines have specific effects on memory that are not merely a by-product of the drugs’ sedative effects, and the degree to which sedatives contribute to the amnestic effects varies as a function of the particular memory process being assessed.
The Effect of the Interaction of Propofol and Alfentanil on Recall, Loss of Consciousness, and the Bispectral Index
TLDR
BIS correlated well with the hypnotic component of anesthesia independent of the presence of an opioid, and in moderately sedated patients who received a painful stimulus, the Bispectral Index increased, but this response was blocked by the analgesic or increasing propofol concentrations.
Facilitation of Serotonergic Activity and Amnesia in Rats Caused by Intravenous Anesthetics
TLDR
Because amnesia was completely diminished by a 5-hydroxytryptamine antagonist, facilitation of the serotonergic system may be involved in retrograde amnesia caused by these agents.
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