RESUMEN
BACKGROUND: There have been reports of memory formation during general anesthesia. The process-dissociation procedure has been used to determine if these are controlled (explicit/conscious) or automatic (implicit/unconscious) memories. This study used the process-dissociation procedure with the original measurement model and one which corrected for guessing to determine if more accurate results were obtained in this setting. METHODS: A total of 160 patients scheduled for elective surgery were enrolled. Memory for words presented during propofol and remifentanil general anesthesia was tested postoperatively by using a word-stem completion task in a process-dissociation procedure. To assign possible memory effects to different levels of anesthetic depth, the authors measured depth of anesthesia using the BIS XP monitor (Aspect Medical Systems, Norwood, MA). RESULTS: Word-stem completion performance showed no evidence of memory for intraoperatively presented words. Nevertheless, an evaluation of these data using the original measurement model for process-dissociation data suggested an evidence of controlled (C = 0.05; 95% confidence interval [CI] 0.02-0.08) and automatic (A = 0.11; 95% CI 0.09-0.12) memory processes (P < 0.01). However, when the data were evaluated with an extended measurement model taking base rates into account adequately, no evidence for controlled (C = 0.00; 95% CI -0.04 to 0.04) or automatic (A = 0.00; 95% CI -0.02 to 0.02) memory processes was obtained. The authors report and discuss parallel findings for published data sets that were generated by using the process-dissociation procedure. CONCLUSION: Patients had no memories for auditory information presented during propofol/remifentanil anesthesia after midazolam premedication. The use of the process-dissociation procedure with the original measurement model erroneously detected memories, whereas the extended model, corrected for guessing, correctly revealed no memory.
Asunto(s)
Anestesia General , Anestésicos Intravenosos , Trastornos Disociativos/psicología , Memoria/efectos de los fármacos , Piperidinas , Propofol , Adulto , Anciano , Algoritmos , Procedimientos Quirúrgicos Electivos , Electroencefalografía , Femenino , Humanos , Hipnóticos y Sedantes , Masculino , Recuerdo Mental , Midazolam , Persona de Mediana Edad , Monitoreo Intraoperatorio , Periodo Posoperatorio , Medicación Preanestésica , Desempeño Psicomotor/efectos de los fármacos , RemifentaniloRESUMEN
PROBLEM: The acceptance of the semi-allogeneic fetus within the maternal environment requires tolerance mechanisms not fully characterized yet. Normal pregnancy is known to be associated with a Th2 profile. Furthermore, regulatory T cells (Tregs) were proposed to regulate the Th2/Th1 balance at early stages of pregnancy. Treg may avoid the shift to a Th1 profile, thus preventing miscarriage. Accordingly, spontaneous abortion is characterized by a Th1 dominance and diminished levels of Treg. The major aim of the present work was to investigate if pre-eclampsia, a late immunological complication of pregnancy, is characterized by similar hallmarks. METHOD OF STUDY: We measured the surface antigens CD4, CD25, CD8 and CTLA4 in peripheral blood from patients suffering from pre-eclampsia (n = 8) and age-matched patients undergoing normal pregnancies (n = 9) by four-color flow cytometry. RESULTS: We were not able to find any significant differences in the levels of CD4(+), CD25(+), CD8(+), CTLA4, CD4(+)/CD25(+), CD4(+)/CD25(bright), CD4(+)/CTLA4, CD25(+)/CTLA4, CD4(+)/CD25(+)/CTLA4, CD8(+)/CD25(+), CD8(+)/CTLA4 or CD8(+)/CD25(+)/CTLA4 cell subsets. CONCLUSIONS: Our data confirm comparable number of Tregs during pre-eclampsia and normal pregnancy in peripheral blood. Other regulatory mechanisms might be involved during late pregnancy.