Is there implicit memory after propofol sedation?

Abstract

Recent evidence indicates that implicit memory may be preserved during general anaesthesia. We tested for the presence of explicit and implicit memory in patients undergoing surgical procedures with local or regional anaesthesia and sedation with propofol. Initial i.v. boluses of propofol 0.5 mg kg-1 and fentanyl 1 microgram kg-1 were administered, followed by an infusion of propofol 50 micrograms kg-1 min-1. Administration of one or more doses of propofol 30 mg i.v. during operation was controlled either by the patient or the anaesthetist. At the start of the last skin stitch, patients were presented with a list of 15 stimulus words and the most frequently associated response. The infusion was then discontinued. After 1 h in the recovery area, all patients were tested for free recall, free association, cued recall and recognition on the list presented during surgery (critical list) and a matched list not presented (neutral list). Data of all patients without free recall (explicit memory) were analysed with repeated-measures analysis of variance. Of 36 patients, five demonstrated free recall. For the remaining 31 patients, cued recall and recognition showed no evidence of explicit memory. However, the free association tests demonstrated significant priming. The mean number of critical free associations was 6.6 (SEM 0.4) compared with 5.5 (0.4) neutral free association (P < 0.05). In the absence of explicit memory, implicit memory persists after intraoperative sedation with propofol.