Acta Anaesthesiol Scand 1990: 34, Supplementum 92: 78

Discussion after Session I I I

Geller (Israel): If a patient wakes up during an oper- ation, would you administer midazolam to produce anterograde amnesia?

Desiderio ( U S A ) : This would be an appropriate strategy.

Reves ( U S A ) : I also use midazolam in a dose of 2-5 mg for this purpose in cardiac surgery.

Neumark (Australia): Is there any evidence for retro- grade in addition to anterograde amnesia?

Desiderio ( U S A ) : I do not believe that any of the benzodiazepines produce retrograde amnesia.

Geller (Israel): I would further comment that, to the best of my knowledge, no drugs produce retrograde amnesia. This is a feature of organic brain damage.

Thomson (Switzerland) : Does Dr Bell consider that pulse oximetry is mandatory?

Bell (UK): Our studies using pulse oximetry had led us to the routine use of oxygen therapy during gas- troscopy. However, at this stage, I would not like to express the opinion that pulse oximetry should be mandatory.

Thomson (Switzerland) : Do you think that monitoring of the end-tidal C 0 2 would increase the safety in this situation?

Geller (Israel): The capnograph gives an earlier indi- cation of airway obstruction, but there may be difi- culty in its application.

S’inelli (Italy): Does Dr Bell use midazolam in other operative endoscopic procedures such as sphincteroto- my or colonoscopy?

Bell (UK) : Yes, I use midazolam for all my endoscopic procedures and prefer it to diazepam. Our studies suggest that midazolam is as safe as diazepam and has superior amnesic effects. When using a combination of midazolam and a narcotic, one has to be doubly care- ful and use supplemental oxygen and possible pulse oximetry.

Desiderio ( U S A ) : Does anyone have experience with midazolam sedation combined with epidural narcotics for post-operative pain?

Camu (Belgium): I would strongly advise against giving midazolam together with epidural narcotics. When combined they may cause unpredictable sedation and severe respiratory depression.

Maneksha (UK): In view of what has been said about the effect of midazolam and opioids combined, should we use naloxone in addition to flumazenil?

Geller (Israel): In my experience it has not been necess- ary in the doses that we have used.

Nilsson (Sweden) : In patients recovering from total intravenous anaesthesia, after reversal of muscle relax- ation, the first thing to do is to reverse the hypnosis with flumazenil if required. Then, in my experience, the use of naloxone is rarely necessary.