Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy
Resource
J. Formos. Med. Assoc., 114(6), 489-497
Journal
Journal of the Formosan Medical Association
Pages
489-497
Date Issued
2015
Date
2015
Author(s)
Abstract
Background/Purpose: Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations.
Methods: We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of a health check-up were recruited. Neuropsychological testing on the full cognitive spectrum was evaluated at 15 minutes and 120 minutes after low-dose midazolam administration. The modified reliable change index (RCI) was used for intrapersonal comparisons and controlling for practice effects.
Results: Midazolam affected psychomotor speed (48%), memory (40%), learning (32%), working memory (17%), and sustained attention (11%), while sparing orientation and the fluency aspect of executive function at the acute stage. Residual memory (10%) and learning (10%) impairments at 2 hours after administration were evidenced in some patients. The three object recall and digit symbol coding tests can serve as useful screening tools.
Conclusion: Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state. Copyright (C) 2013, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
Subjects
cognitive function
endoscopy
midazolam
reliable change index
SDGs
Other Subjects
midazolam; hypnotic sedative agent; intravenous anesthetic agent; midazolam; adult; age distribution; annoyance; anxiety; Article; assessment of humans; attention; clinical article; cognition; cognitive defect; colonoscopy; controlled study; drug dose titration; drug safety; executive function; fatigue; female; human; learning; light sedation; low drug dose; male; middle aged; motivation; neuropsychological test; orientation; prospective study; psychomotor performance; reliable change index; sedation; university hospital; working memory; case control study; chemically induced; cognition; Cognition Disorders; psychological rating scale; regression analysis; short term memory; Taiwan; Anesthetics, Intravenous; Attention; Case-Control Studies; Cognition; Cognition Disorders; Colonoscopy; Female; Humans; Hypnotics and Sedatives; Learning; Male; Memory, Short-Term; Midazolam; Middle Aged; Neuropsychological Tests; Prospective Studies; Psychiatric Status Rating Scales; Regression Analysis; Taiwan