Skip to main content
SpringerLink
Log in

Wakeful response to command indicates memory potential during emergence from general anesthesia

  • Original Articles
  • Published:
Journal of Clinical Monitoring Aims and scope Submit manuscript

Abstract

Objective. An important aspect of assessing anesthetic depth is determining whether a patient will remember events during surgery. We looked for a clinical sign that would indicate a patient's potential for memory formation during emergence from anesthesia. A clinical sign indicating memory potential could be a useful endpoint for measuring the performance of anesthetic depth monitors and for titrating administration of anesthetic agents.Methods. We evaluated patients' responses to commands to open the eyes, squeeze the hand four times, and count 20 numbers. These responses were correlated with results on recall, cued recall, and multiple-choice memory tests.Main Results. Patients did not have evidence of memory formation until they sustained wakefulness sufficiently long to complete at least four hand squeezes or count four numbers. Of 28 patients, 13 (46%) with this sustained wakeful response had memory. Of 22 patients, 0 (0%) had evidence of memory formation when they demonstrated a brief wakeful response, defined as being responsive to command but unable to complete more than one hand squeeze or count, or an intermediate response, defined as two or three hand squeezes or counts.Conclusions. We conclude that a brief wakeful response to command indicates that a patient is unlikely to form memories, while a sustained wakeful response indicates that a patient may form memories. Thus, a patient's wakeful response to command could be a useful indicator of potential for memory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Eger EI II, Saidman LJ, Brandstater B. Minimum alveolar anesthetic concentration: A standard of anesthetic potency. Anesthesiology 1965;26:756–763

    PubMed  Google Scholar 

  2. Stoelting RK, Longnecker DE, Eger EI II. Minimum alveolar concentrations in man on awakening from methoxyflurane, halothane, ether, and fluroxene anesthesia: MAC Awake. Anesthesiology 1970;33:5–9

    Article  PubMed  CAS  Google Scholar 

  3. Dutton RC, Smith WD, Smith NT. The use of the EEG to predict movement during anaesthesia. In: Rosen M, Lunn JN, eds. Consciousness, awareness, and pain in general anesthesia. London: Butterworth, 1987:72–82

    Google Scholar 

  4. Sessler DI, Stoen R, Olofsson CI, Chow F. Lower esophageal contractility predicts movement during skin incision in patients anesthetized with halothane, but not with nitrous oxide and alfentanil. Anesthesiology 1989;70:42–46

    PubMed  CAS  Google Scholar 

  5. Watcha MF, White PF. Failure of lower esophageal contractility to predict patient movement in children anesthetized with halothane and nitrous oxide. Anesthesiology 1989;71:664–668

    Article  PubMed  CAS  Google Scholar 

  6. Thornton C, Barrowcliffe MP, Konieczko KM, et al. The auditory evoked response as an indicator of awareness. Br J Anaesth 1989;63:113–115

    Article  PubMed  CAS  Google Scholar 

  7. Richards MJ, Skues MA, Jarvis AP, Prys-Roberts C. Total IV anaesthesia with propofol and alfentanil: Dose requirements for propofol and the effect of premedication with clonidine. Br J Anaesth 1990;65:157–163

    Article  PubMed  CAS  Google Scholar 

  8. Couture LJ, Greenwald B, Edmonds HL Jr. Detection of responsiveness during anaesthesia. In: Bonke B, Fitch W, Millar K, eds. Memory and awareness of anesthesia. Amsterdam: Swets & Zeitlinger, 1990:320–329

    Google Scholar 

  9. Dutton RC, Smith WD, Smith NT. Does EEG predict anesthetic depth better than cardiovascular variables? Anesthesiology 1990;75:A532

    Google Scholar 

  10. Raftery S, Enever G, Pyrs-Roberts C. Oesophageal contractility during total IV anaesthesia with and without glycopyrronium. Br J Anaesth 1991;66:566–571

    Article  PubMed  CAS  Google Scholar 

  11. Sebel PS, Bowles S, Saini V, Chamoun N. Accuracy of EEG in predicting movement at incision during isoflurane anesthesia. Anesthesiology 1991;75:A446

    Google Scholar 

  12. Dwyer R, Rampil I, Eger EI II, Bennett HL. The EEG does not predict movement in response to surgical incision at 1.0 MAC isoflurane. Anesthesiology 1991;75:A1025

    Google Scholar 

  13. Plourde G, Boyan JF. The auditory steady state response during sufentanil anaesthesia. Br J Anaesth 1991;66:683–691

    Article  PubMed  CAS  Google Scholar 

  14. Vernon J, Bowles S, Sebel PS. EEG bispectrum predicts movement at incision during isoflurane or propofol anesthesia. Anesthesiology 1992;77:A502

    Google Scholar 

  15. Teasdale G, Bryan J. Assessment of coma and impaired consciousness. Lancet 1974;2:81–84

    Article  PubMed  CAS  Google Scholar 

  16. Dutton RC, Smith WD, Smith NT. The hand squeeze response test predicts learning during emergence from general anesthesia. J Clin Monit 1992;8:169

    Google Scholar 

  17. Dwyer R, Bennett HL, Eger EI II, Heilbron D. Effects of isoflurane and nitrous oxide in subanesthetic concentrations on memory and responsiveness in volunteers. Anesthesiology 1992;77:888–898

    Article  PubMed  CAS  Google Scholar 

  18. Newton DEF, Thornton C, Konieczko K, et al. Levels of consciousness in volunteers breathing sub-MAC concentrations of isoflurane. Br J Anaesth 1990;65:609–615

    Article  PubMed  CAS  Google Scholar 

  19. Artusio JF. Di-ethyl ether analgesia: A detailed description of the first stage of ether anesthesia in man. J Pharmacol Exp Ther 1954;111:343–348

    PubMed  CAS  Google Scholar 

  20. Ghoneim MM, Block, RI. Learning and consciousness during general anesthesia. Anesthesiology 1992;76:279–305

    Article  PubMed  CAS  Google Scholar 

  21. Squire LR. Mechanisms of memory. Science 1986;232:1612–1619

    Article  PubMed  CAS  Google Scholar 

  22. Schacter DL. Implicit memory: History and current status. J Exp Psychol (Learn Mem Cogn) 1987;13:501–518

    Article  Google Scholar 

  23. Kihlstrom JF. The cognitive unconscious. Science 1987;237:1445–1451

    Article  PubMed  CAS  Google Scholar 

  24. Kihlstrom JF, Schacter DL. Anaesthesia, amnesia, and the cognitive unconscious. In: Bonke B, Fitch W, Millar K, eds. Memory and awareness in anaesthesia. Amsterdam: Swets & Zeitlinger, 1990:21–44

    Google Scholar 

  25. Kihlstrom JF, Schacter DL, Cork RC, et al. Implicit and explicit memory following surgical anesthesia. Psycho Sci 1990;1:303–306

    Article  Google Scholar 

  26. Cork RC, Kihlstrom JF, Schacter D. Absence of explicit or implicit memory in patients anesthetized with sufentanil/nitrous oxide. Anesthesiology 1992;76:892–898

    Article  PubMed  CAS  Google Scholar 

  27. Block R, Ghoneim M, Pathak D, et al. Effects of a subanesthetic concentration of nitrous oxide on overt and covert assessments of memory and associative process. Psychopharmacology 1988;96:324–331

    Article  PubMed  CAS  Google Scholar 

  28. Roorda-Hrdlickova V, Wolters G, Bonke B, Phaf R. Unconscious perception during general anaesthesia demonstrated by an implicit memory task. In: Bonke B, Fitch W, Millar K, eds. Memory and awareness in anaesthesia. Amsterdam: Swets & Zeitlinger, 1990:150–155

    Google Scholar 

  29. Chortkoff BS, Bennett HL, Eger EI II. Subanesthetic concentrations of isoflurane suppress learning as defined by the category-example task. Anesthesiology 1993;79:16–22

    Article  PubMed  CAS  Google Scholar 

  30. Goldmann L. Information-processing under general anaesthesia: A review. J Royal Soc Med 1988;81:224–227

    CAS  Google Scholar 

  31. Dwyer R, Bennett HL, Eger EI II, Peterson N. Isoflurane anesthesia prevents unconscious learning. Anesth Analg 1992;75:107–112

    Article  PubMed  CAS  Google Scholar 

  32. Bennett HL, Davis HS, Giannini AJ. Nonverbal response to intraoperative conversation. Br J Anaesth 1985;57:174–179

    Article  PubMed  CAS  Google Scholar 

  33. Goldmann L, Shah MV, Helden MW. Memory of cardiac anesthesia: psychological sequelae in cardiac patients of intraoperative suggestion and operating room conversation. Anaesthesia 1987;42:596–603

    Article  PubMed  CAS  Google Scholar 

  34. Eich E, Reeves JL, Katz RL. Anesthesia, awareness and the memory/awareness distinction. Anesth Analg 1985;64:1143–1148

    Article  PubMed  CAS  Google Scholar 

  35. Jansen CK, Bonke B, Klein J, et al. Unconscious perception during balanced anesthesia? In: Bonke B, Fitch W, Millar K, eds. Memory and awareness in anesthesia. Amsterdam: Swets & Zeitlinger, 1990:115–119

    Google Scholar 

  36. Levinson BW. States of awareness during general anesthesia. Br J Anaesth 1965;37:544–546

    Article  PubMed  CAS  Google Scholar 

  37. Osborn AG, Bunker JP, Cooper LM, et al. Effects of thiopental sedation on learning and memory. Science 1967;157:574–576

    Article  PubMed  CAS  Google Scholar 

  38. Weinberger NM, Gold PE, Sternberg DB. Epinephrine enables pavlovian fear conditioning under anesthesia. Science 1984;223:605–607

    Article  PubMed  CAS  Google Scholar 

  39. Gold PE, Stone WS. Neuroendocrine effects on memory in aged rodents and humans. Neurobiol Aging 1988;9:709–717

    Article  PubMed  CAS  Google Scholar 

  40. Saucier N, Watts LF, Moreland JR. Patient awareness during nitrous oxide, oxygen, and halothane anesthesia. Anesth Analg 1983;62:239–240

    Article  PubMed  CAS  Google Scholar 

  41. Griffiths D, Jones JG. Awareness and memory in anaesthetized patients (Editorial). Br J Anaesth 1990;65:603–606

    Article  PubMed  CAS  Google Scholar 

  42. Jessop J, Jones JG. Conscious awareness during general anaesthesia—what are we attempting to monitor (Editorial). Br J Anaesth 1991;66:635–637

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Kaiser Permanente Medical Center, 27400 Hesperian Blvd, 94545, Hayward, CA

    Robert C. Dutton MD

  2. From the Biomedical Engineering Program, California State University, Sacramento, CA

    Warren D. Smith PhD

  3. From the Department of Anesthesia, University of California, San Diego, VA Medical Center, San Diego, CA

    N. Ty Smith MD

Authors
  1. Robert C. Dutton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Warren D. Smith PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Ty Smith MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This work was supported by the Kaiser Foundation Research Institute. Elements of this work were presented at the Society for Technology in Anesthesia, January 1992, San Diego, CA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dutton, R.C., Smith, W.D. & Smith, N.T. Wakeful response to command indicates memory potential during emergence from general anesthesia. J Clin Monitor Comput 11, 35–40 (1995). https://doi.org/10.1007/BF01627418

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01627418

Key words

Search

Navigation