Memory Is Malleable Under Anesthesia
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Memory Is Malleable Under Anesthesia

ORLANDO, FL -- November 14, 1997 -- A Columbia-Presbyterian Medical Center study has demonstrated patients under general anesthesia are capable of processing certain types of auditory information such as word-pair associations.

The findings, presented at the annual meeting of the American Heart Association in Orlando, FL., raise the possibility that words or music played during surgery can be used to condition patients to respond better during recovery.

In the study, open-heart surgery patients were randomized to hear an audiotape of one of two different lists of 15 highly-associated word pairs, such as boy-girl, table-chair and always-never. The lists were delivered over headphones and repeated continuously throughout surgery.

An average of four days after the operation, the patients were given the first half of each word pair from both lists and asked to free associate, that is, to respond with the first word that came to mind. The patients were also asked a series of questions to determine whether they had any explicit, or conscious, memories of the operation or of the word pairs.

"We found strong evidence of implicit memory," says David Adams, MD, assistant professor of anesthesiology at Columbia-Presbyterian and the principal investigator of the study. According to the researcher, during the free-association test, patients made significantly more correct matches with the word pairs that they had heard during surgery than they made with ones they had not heard. In addition, there was no evidence of explicit memory, suggesting the unconscious memories of the word pairs were not affected by conscious learning during the operation.

The study is part of a multi-phase investigation into unconscious memory processing. In the first
phase, the researchers demonstrated that auditory processing occurs in patients under general
anesthesia. In this experiment, patients undergoing open-heart surgery were subjected to auditory
stimuli (clicks) while their brainwaves were measured. In all cases, the patients' EEGs responded to
the clicks, demonstrating at least some level of cerebral processing during the operation. The
response was highest immediately after the patients were put under anesthesia and lowest when they
were cooled and placed on cardiopulmonary bypass. The responses grew as the patients were taken
off bypass and rewarmed.

In phase two -- the current study -- the researchers demonstrated this level of processing is sufficient for implicit memory processing.

"In the next phase we will try to determine whether we can affect the patient's recovery by what we do in the OR. For instance, can we lessen post-operative pain or depression," said Mehmet Oz, MD, assistant professor of surgery at Columbia-Presbyterian and a member of the research team.

The team hopes eventually to test whether involuntary responses, such as heart rhythm or rate of bleeding, can be influenced by intraoperative conditioning.

"There are some reasonable studies in which blood loss was reduced, compared to control groups, by playing audiotapes directing the patient to reduce blood flow. It opens an entire array of research," Dr. Oz said.

However, before the researchers get to these phases, they intend to examine whether there might be certain times during anesthesia when patients are more susceptible to conditioning. They will also determine which kinds of audiotapes are most effective: words, music, music with background words, or words with background music.

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