Stem-completion tasks (indirect, direct inclusion and exclusion) are differently affected by equipotent doses of lorazepam and flunitrazepam

The assessment of memory under total intravenous anesthesia

BACKGROUND AND OBJECTIVES

In this study, we aimed to assess implicit and explicit memory in patients who had abdominal surgery under total intravenous anesthesia (TIVA) with propofol and remifentanil, in which anesthesia level was controlled by bispectral index (BIS) monitoring.

METHOD

Total intravenous anesthesia was administered to 60 adult patients, to obtain BIS levels of 40-60. Patients were randomly allocated to three groups according to tapes they listened to. Patients in the category group (CT) listened to a tape containing five animal names. Patients in the word recognition group (WM) listened to a tape containing five intermediate-frequency words, adapted into Turkish. Patients in the control group (CG) listened to sea sounds until the end of surgery. Two hours after surgery, tests were administered to each patient in the recovery room to assess memory.

RESULTS

There was a difference between the CT and CG groups in their Mini-Mental State Examination scores, all values were > 20. The results of the category and word recognition tests that were applied to assess implicit memory were not statistically different among the groups. There was no evidence of implicit memory in any of the patients. One patient remembered hearing 'the sound of water' as a proof of explicit memory. Eleven patients said they had dreamt.

CONCLUSIONS

Although no evidence of implicit memory under adequate anesthesia with TIVA was found, one patient showed explicit memory. Although adequate depth of anesthesia provided by BIS monitoring supports our implicit memory results, it does not explain the explicit memory results.

Effect of intranasally administered cholecystokinin on encoding of controlled and automatic memory processes

RATIONALE

The neuropeptide cholecystokinin (CCK) is present in abundance in the central nervous system, where it is involved in the regulation of a wide range of functions. It also takes part in the modulation of memory processes, but its effect on human memory systems and processes is not yet well understood.

OBJECTIVE

The present experiment was conducted to examine the influence of CCK when present during encoding on later controlled and automatic recognition memory processes in humans.

MATERIALS AND METHODS

A version of the process dissociation procedure was used to separate the contributions of controlled and automatic memory processes to participants' recognition memory performance. Data were analyzed within a multinomial modeling framework. Participants (N = 64) received either 40 microg CCK-8S or placebo intranasally. The learning and test phases began 30 min after substance application. Behavioral, physiological, and self-report control variables were measured at three points of time during the experiment.

RESULTS

Compared to placebo, CCK increased the automatic, familiarity-based recognition memory component, while the parameter representing controlled, retrieval-based processes did not differ between groups. Also, in the exclusion condition of the test phase, the guessing parameter was reduced by CCK. None of the control variables were affected by the peptide.

CONCLUSIONS

This result-the enhancement of the automatic recognition memory component when CCK is applied before encoding (and thus present during encoding and retrieval)-complements earlier results indicating that CCK decreases controlled, recollection-based recognition memory when applied during consolidation. The possible neuronal systems and processes mediating these effects are discussed.

Effects of lorazepam on visual perceptual abilities

OBJECTIVE

To evaluate the effects of an acute dose of the benzodiazepine (BZ) lorazepam in young healthy volunteers on five distinguishable visual perception abilities determined by previous factor-analytic studies.

METHODS

This was a double-blind, cross-over design study of acute oral doses of lorazepam (2 mg) and placebo in young healthy volunteers. We focused on a set of paper-and-pencil tests of visual perceptual abilities that load on five correlated but distinguishable factors (Spatial Visualization, Spatial Relations, Perceptual Speed, Closure Speed, and Closure Flexibility). Some other tests (DSST, immediate and delayed recall of prose; measures of subjective mood alterations) were used to control for the classic BZ-induced effects.

RESULTS

Lorazepam impaired performance in the DSST and delayed recall of prose, increased subjective sedation and impaired tasks of all abilities except Spatial Visualization and Closure Speed. Only impairment in Perceptual Speed (Identical Pictures task) and delayed recall of prose were not explained by sedation.

CONCLUSION

Acute administration of lorazepam, in a dose that impaired episodic memory, selectively affected different visual perceptual abilities before and after controlling for sedation. Central executive demands and sedation did not account for results, so impairment in the Identical Pictures task may be attributed to lorazepam's visual processing alterations.

Impairment of contrast sensitivity in long-term lorazepam users

RATIONALE

Oculomotor balance and contrast sensitivity are known to be impaired after an intake of a single dose of lorazepam. To the best of our knowledge, these effects have not been explored in long-term users of lorazepam, despite the potential importance of such deficits in everyday life.

OBJECTIVE

We tested the ophthalmological effects and contrast sensitivity for static stimuli in long-term lorazepam users.

MATERIALS AND METHODS

There were 15 lorazepam users and 15 sex-, age- and education level-matched control subjects tested, using a simple blind procedure.

RESULTS

The ophthalmological effects were scarce, with a discrete exophoria. Visual acuity was preserved. Contrast sensitivity, however, was more markedly impaired, consistent with the effects of an acute dose of lorazepam. The effects were not correlated with anxiety or sedation.

CONCLUSIONS

The results are discussed in terms of their possible impact on everyday life. As visual acuity does not allow the detection of the impairments that are observed in the present study, it is suggested that a more systematic exploration of contrast sensitivity be carried out in long-term users of benzodiazepines.

Effects of a benzodiazepine on free recall of semantically related words

Although it is widely known that benzodiazepines impair episodic memory, few studies have investigated their effects upon specific processes involved in free recall. This study evaluated the acute effects of flunitrazepam (1.0 mg; 1.3 mg) and placebo in healthy volunteers on immediate and delayed free recall of word lists considering serial positions as well as semantic relations between words inserted in the middle of the lists (e.g. milk-cheese-butter). Flunitrazepam promoted a global amnestic effect, impairing recall in all serial positions except the last words (recency effect). Primacy and recency effects were preserved as indexed, respectively, by larger recall of the first and last words in relation to adjacent items. Facilitation in recall of semantically related words was not impaired by the drug when compared to recall in adjacent positions, in spite of a dose-dependent diminution of the number of words recalled also in mid-list positions. Flunitrazepam-induced deficits were interpreted as impairment in the formation of new associations between items, or groups of items in the case of related words, and context.

Is priming during anesthesia unconscious?

General anesthesia provides an alternative to typical laboratory paradigms for investigating implicit learning. We assess the evidence that a simple type of learning--priming--can occur without consciousness. Although priming has been shown to be a small but persistent phenomenon in surgical patients (Merikle & Daneman, 1996) there is reason to question whether it occurs implicitly due to problems in detecting awareness using typical clinical signs. This paper reviews the published studies on priming during anesthesia that have included a measure of awareness or of anesthetic depth. We conclude that perceptual priming, but not conceptual priming, takes place in the absence of conscious awareness.