Psychomimetic reactions after neurolept and propofol anaesthesia

Abstract

The purpose of this study was to compare the frequency of psychomimetic reactions after 24 h and 3 months following total intravenous anaesthesia with propofol and neurolept anaesthesia. Forty otherwise healthy female patients were randomly divided into two groups. All were undergoing elective gynaecological laparotomy for non-malignant disease. Nineteen patients were anaesthetized with droperidol, fentanyl, pancuronium, N2O/O2. Twenty patients received total intravenous anaesthesia with propofol, fentanyl and pancuronium. Twenty-four hours after the anaesthesia the patients were interviewed about their subjective experiences of anaesthesia and recovery. Three months after the operation the patients were sent a questionnaire concerning ability to work, sleep and memory disorders. After 24 h the anaesthesia was judged as good by 18 patients receiving propofol and 13 patients receiving NLA (n.s.). The recovery was judged as good by 16 patients in the propofol group and six patients in the NLA group (P < 0.05). Locked-in feelings were reported by one patient in the propofol group and ten patients in the NLA group (P < 0.01). Impairment of memory was reported by one patient in the propofol group and seven patients in the NLA group (P < 0.01). A questionnaire used after 3 months was answered by 18 patients in the propofol group and 17 patients in the NLA group. There were few complaints, and no differences were found between the two groups. In conclusion, total intravenous anaesthesia with propofol seems more acceptable than anaesthesia with neurolept as judged by the patients 24 h after anaesthesia. There were no differences between the two groups concerning psychomimetic reactions 3 months after anaesthesia.

Unresponsiveness ≠ Unconsciousness

“…Interestingly a positive IFT response has been observed in a non-paralyzed pediatric patient undergoing orthopedic surgery 36 ; although the patient did not make spontaneous movements or “wake up” they moved their hand to command. IFT positive responses may therefore share similarities with lucid dreaming where patients also do not move spontaneously, but clearly have higher order cognition and can perform goal-directed behavior The IFT data are supported by reports from neurolept anesthesia where patients report being “locked in” 37 rather than unconscious during anesthesia 24 . Furthermore case reports describe external auditory and visual experiences under anesthesia.…”

“…Based on studies using the isolated forearm technique (IFT) (Table 2), and case reports of anesthetic awareness without change in patient variables 24,25 (such as hemodynamic measures and respiratory rate) or spontaneous movement in non-paralyzed patients 26,27, we provide evidence of connected consciousness that is dissociated from spontaneous responsiveness during anesthesia. In the IFT, anesthesia is followed by inflation of a cuff on the arm before neuromuscular blockade is induced.…”

General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis

“…Butyrophenones have been used in combination with opioids—haloperidol with phenoperidine and droperidol with fentanyl—to create a state of neuroleptic anesthesia characterized by unresponsiveness with eyes open, analgesia, and decreased mobility (catalepsy) with maintenance of ventilation and cardiovascular stability (Corssen et al 1964). Neuroleptic anesthesia is no longer used because not infrequently patients complained of feeling locked in: being aware of what transpired during the surgery with substantial pinned-up emotion that they could not express (Klausen et al 1983, Linnemann et al 1993, Klafta et al 1995). …”

Regional anaesthesia and propofol sedation for carotid endarterectomy

“…Neuroleptanalgesia with short‐acting opiates has been used successfully during carotid surgery, but in addition to a high incidence of physical reactions, small adjustments to the depth of sedation are difficult 7 . In addition, the patient may remain heavily sedated at the end of the procedure 12,13 . Combinations of benzodiazepines and opoids have also been used with varying degrees of success.…”