The incidence of awareness, and amnesia for perioperative events, after cardiac surgery with lorazepam and fentanyl anesthesia.
One hundred patients (mean age 59 +/- 10 years) were premedicated with morphine, 0.15 mg/kg, and scopolamine, 0.008 mg/kg. Anesthesia was induced with lorazepam, 50 microg/kg, followed by fentanyl, 50 microg/kg, oxygen and pancuronium, 0.15 mg/kg. Isoflurane was given for short periods before and after cardiopulmonary bypass to 57 patients when hypertension was uncontrolled by addition of fentanyl and/or nitroglycerin. Morphine was used as the sole sedative postoperatively. Patients were interviewed following discharge from the surgical intensive care unit to assess the incidence of operative awareness, and to assess amnesia for events occurring during four preoperative and two postoperative periods of the patients' hospital stay. During three preoperative periods (day of admission, evening before, and morning before operation), 1%, 3%, and 2% of patients had complete amnesia, and 19%, 41%, and 31% had partial amnesia of events. Fifty-five percent of patients exhibited complete, and 34% of patients exhibited partial amnesia to events occurring in the preinduction period. Two patients reported intraoperative awareness (noises, conversation) occurring at the end of the anesthetic. In the two postoperative periods (morning of the day after surgery and intensive care stay), 9% and 15% of patients had complete, and 35% and 47% of patients exhibited partial amnesia. Amnesia was statistically significantly greater in patients over 60 years of age in the preinduction period. Duration of cardiopulmonary bypass did not affect the incidence of amnesia.
Robinson
R J
RJ
Department of Anaesthesia, The Montreal General Hospital and McGill University, Montreal, Quebec, Canada.
Boright
W A
WA
Ligier
B
B
McIlvena
K
K
Metcalf
L R
LR
Truong
D T
DT
D000368:Aged; D000701:Analgesics, Opioid; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D001364:Awareness; D006348:Cardiac Surgical Procedures; D005260:Female; D005283:Fentanyl; D006801:Humans; D006993:Hypnotics and Sedatives; D007530:Isoflurane; D008140:Lorazepam; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D019990:Perioperative Care; D011446:Prospective Studies
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D007530:Isoflurane; D008140:Lorazepam; D005283:Fentanyl