The Effect of Enflurane on the Tracheal Smooth Muscle Contracted with Electrical Field Stimulation in the Guinea Pig / 대한마취과학회지

BACKGORUND: inhalation anesthetics have been known as bronchodilators, and there are reports that enflurane has some relaxing effects on tracheal smooth muscles. However, there are not so many reports on the ACh release in the postganglion nerve endings. We tried to evaluate the effect of enflurane on the contraction of the tracheal smooth muscle in the postganglion nerve ending in guinea pigs. METHODS:isolated tracheal preparations of guinea pigs were used and contractions were induced by electrical field stimulation (3 Hz & 30 Hz). in the pilocarpine- enflurane group, pilocarpine (10(-5) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the gallamine-enflurane group, gallamine (10(-6) M) was administrated and enflurane (1 MAC and 2 MAC) was administered. in the enflurane 1 MAC group and 2 MAC group, contractions were induced by electrical field stimulation before and after administration of enflurane. The percentile contraction to the contraction induced by acetylcholine (10(-4) M) were evaluated. RESULTS: The potentiation of the contraction which was induced by electrical field stimulation was observed by enflurane administration and with prior administration of pilocarpine (10(-6) M), with prior administration of gallamine (10(-5) M). There was no potentiation of contractions, but potentiation of the contraction was observed with enflurazne (2 MAC, 30 Hz). CONCLUSiONS:Enflurane potentiates the contraction induced by electrical field stimulation in guinea pig tracheal smooth muscle. These findings seem to be related with prejunctional M2 receptor in the postganglionic nerve endings.

effects of cold block of the spinal cord in respiratory movement during hypocapnic apnoea

This paper investigates at segmental level, the behaviour of respiratory motorneurones during cold blocking of the spinal cord in hypocapnic apnoea. In expiratory biased preparations, lowering CO[2] level renders the inspiratory motoneurones silent, whereas the expiratory motorneurones discharge tonically. As for the effects of cold stimuli in eupnoea, application of the cold thermode to the dorsolateral surface of the spinal cord in hypocapnic apnoea evoked transient reciprocal reflex burst activity of both inspiratory and expiratory motoneurone populations. The expiratory burst activity attained double that of the control level. These activities could be explained by same reasoning as for dorsolateral cold block of the spinal cord in eupnea. Alternatively this additional activity may be attributed to the tonic non-respiratory source. Following recovery from blocking, the expiratory motoneurones showed an exaggerated tonic activity mounting double that before blocking and at the same level of the excitatory response produced by the cold thermode. The simplest explanation of this additional activity would be that, the effects of cold thermode could have aroused the preparation and over the time scale involved nearly 30min; led to a lighter level of general anaesthesia which would favour the expiratory bias state of the preparation. Alternatively, a release process was involved. An interesting possibility could be that, this exaggerated expiratory activity could have resulted from postsynaptic potentiation induced by accumulation of synaptic transmitter following cold block of the expiratory bulbospinal drive. Another possibility could be due to another system whose activity was released by blocking. One candidate for this would be the reticulospinal fibres arising from the nucleus reticularis gigantocellularis. Because sustained stimulation within the medial reticular formation causes a sustained activation of expiratory motoneurons and reciprocal inhibition of inspiratory motoneurons. Hence, it is proposed that such added tonicity of discharge arises from released traffic in the reticulospinal and expiratory bulbospinal axons

effects of cold block of the spinal cord on chest wall reflexes

It was previously established that passive movements of the chest wall induced by artificial respiration elicits reflex activity in both alpha and gamma motomeurons which persists in the spinal preparation. In this work re-examination of these results at segmental level was performed, with the intention to show the behaviour of the chest wall inflation and deflation reflexes at levels of CO[2] just at threshold for rhythm generation, on the one hand, and their response to cold blocking of the spinal cord on the other. In the first instance, the reflexes fluctuate in activity with the central respiratory drive [CROP] indicating a measure of coexistence as proposed by Sears. Hence, these results support the view that the normal functional operation of the inhibitory phase of the CROP is to prevent reflex excitation of the antagonistic muscle contraction. In the second instance, with application of the cold thermode to the dorsolateral surface of the spinal cord, the alpha spikes gradually decreased in number before completely abolished. Eventually the cold block had interrupted the descending supraspinal drives and subsequently brought the mean level of the membrane potential of the expiratory alpha motoneurones to its resting level. Thus the loss of these inputs at segmental level specifically reduces the efficacy of synaptic transmission from expiratory muscle spindle afferents. Although not pump modulated, the tonic discharging gammas reduced in number with the progress of cooling, This seems to be one of the sources facilitating the inflation reflex as their reduced firing reduced the amplitude of the reflex. Results were further discussed

Effects of Gallamine, Vecuronium and Rocuronium on Oculocardiac Reflex, Blood Pressure and Heart Rate in Pediatric Strabismus Surgery / 대한마취과학회지

BACKGROUND: Intraoperative oculocardiac reflex (OCR) is a common problem of pediatric strabismus surgery and potentially fatal as it can cause cardiac arrest. The goal of this study was to assess the effects of gallamine, vecuronium and rocuronium on the oculocardiac reflex, blood pressure and heart rate in pediatric strabismus surgery. METHODS: Ninety healthy children undergoing strabismus surgery were randomly assigned to three groups; gallamine, vecuronium or rocuronium group. All children were under general anesthesia induced with thiopental sodium and received gallamine 3 mg/kg, vecuronium 0.1 mg/kg, or rocuronium 0.8 mg/kg as a muscle relaxant, and were maintained with sevoflurane in 50% nitrous oxide. Systolic blood pressure, diastolic blood pressure, and heart rate were measured before anesthesia, before the operation, before traction and after traction of the ocular muscle. The OCR was defined as a 20% or greater decrease in heart rate from before traction of the ocular muscle. RESULTS: Compared with three groups, there were decreased incidences of OCR and increased heart rate at before the operation, before traction and after traction in the gallamine group (P<0.05). Systolic blood pressure and diastolic blood pressure were no differences occurred among three groups. CONCLUSIONS: We found that the gallamine group results in decreased incidences of OCR and increased heart rate were comparable with three groups.

Inhibitory Effects of Structurally Different Neuromuscular Blockers on the Serotonin Type 3 Receptor Expressed in Xenopus Oocytes / 대한마취과학회지

BACKGROUND: The serotonin type 3 receptors are diffusely distributed in both the central and the peripheral nervous system. Physiological and pathophysiological processes thought to be mediated by this receptor include nausea and vomiting, peripheral nociception and central antinociception, conditioned aversion response to drugs, anxiety, and cognition. Because of the structural similarity between the nicotinic acetylcholine receptor and the 5HT3 receptor, we investigated the effects of clinically used neuromuscular blockers on the 5HT3 receptor function related with PONV. METHODS: A cDNA clone encoding the full length murine 5HT3a receptor was subcloned into an oocyte expression vector and 50 ng of cRNA transcribed in vitro injected per oocyte. After 24 72 h incubation, oocytes were placed into a recording chamber continuously perfused with frog Ringer's solution and electrophysiological recordings were obtained by the two electrode voltage clamp technique. Serotonin with or without the various drugs were bath applied by a computer controlled solenoid valve. Peak currents induced by the drug applications were measured and dose responses were obtained. RESULTS: The 5HT3 receptor expression in Xenopus oocyte was identified by the pharmacologic tools. Serotonin induced rapid inward currents, and thus was showed dose-dependent: KD = 2.5 micrometer, Hill coefficiency = 2.09. Inhibition by the neuromuscular blockers showed dose-dependence and their inhibitory potency on 5HT3 receptor (IC50) was in order of d-tubocurarine (0.046 micrometer) > vecuronium (16.32 micrometer) > gallamine (1,169 micrometer). CONCLUSIONS: There was a different inhibitory effect of nicotinic cholinergic antagonists, clinically used neuromuscular blockers, on the 5HT3 receptor and a judicious selection of them might contribute to reducing the incidence of PONV clinically.

Inhibitory Effects of Structurally Different Neuromuscular Blockers on the Serotonin Type 3 Receptor Expressed in Xenopus Oocytes / 대한마취과학회지

BACKGROUND: The serotonin type 3 receptors are diffusely distributed in both the central and the peripheral nervous system. Physiological and pathophysiological processes thought to be mediated by this receptor include nausea and vomiting, peripheral nociception and central antinociception, conditioned aversion response to drugs, anxiety, and cognition. Because of the structural similarity between the nicotinic acetylcholine receptor and the 5HT3 receptor, we investigated the effects of clinically used neuromuscular blockers on the 5HT3 receptor function related with PONV. METHODS: A cDNA clone encoding the full length murine 5HT3a receptor was subcloned into an oocyte expression vector and 50 ng of cRNA transcribed in vitro injected per oocyte. After 24 72 h incubation, oocytes were placed into a recording chamber continuously perfused with frog Ringer's solution and electrophysiological recordings were obtained by the two electrode voltage clamp technique. Serotonin with or without the various drugs were bath applied by a computer controlled solenoid valve. Peak currents induced by the drug applications were measured and dose responses were obtained. RESULTS: The 5HT3 receptor expression in Xenopus oocyte was identified by the pharmacologic tools. Serotonin induced rapid inward currents, and thus was showed dose-dependent: KD = 2.5 micrometer, Hill coefficiency = 2.09. Inhibition by the neuromuscular blockers showed dose-dependence and their inhibitory potency on 5HT3 receptor (IC50) was in order of d-tubocurarine (0.046 micrometer) > vecuronium (16.32 micrometer) > gallamine (1,169 micrometer). CONCLUSIONS: There was a different inhibitory effect of nicotinic cholinergic antagonists, clinically used neuromuscular blockers, on the 5HT3 receptor and a judicious selection of them might contribute to reducing the incidence of PONV clinically.

Tetanic fade induced by d-Tubocurarine, Hexamethonium and Neostigmine in phrenic nerve diaphragm rats

A acetilcolina liberada do terminal nervoso motor (TNM) pode modular sua pr6pria liberagdo (automodulação do TNM), interagindo com receptores nicotinicos (autoestimulação do TNM) ou muscarinicos (autoinibição do TNM) pré-juncionais. Por outro lado, tem-se demonstrado que a neuropatia induzida pelo estado diabético determine vários danos estruturais no interior do TNM, sem, contudo, interferir na velocidade e na integridade da transmissão neuromuscular. Estudos farmacológicos demonstram que animais diabéticos, quando comparados aos normais, são menos sensíveis a alguns bloqueadores neuromusculares (d-tubocurarina, galamina, pancurônio e decametônio). Esses resultados sugerem que alguma modificação no sistema de automodulação do TNM pode contrabalançar as deficiências neuronais induzidas pelo estado diabético. Dessa forma, o presente estudo foi conduzido com preparações nervo frênico-diafragma isolado de ratos (obtidas de animais normais e diabéticos) na tentativa de verificar se existiriam diferenças na fadiga neuromuscular induzida por drogas (d-tubocurarina, neostigmina, hexametônio). Nossos resultados mostraram que, embora não existissem diferenças na indução da fadiga neuromuscular induzida por d-tubocurarina, neostigmina ou hexametônio, o recobro da fadiga neuromuscular induzida por d-tubocurarina foi mais rápido em preparações neuromusculares obtidas de animais diabéticos. Essa diferença pode estar relacionada a alguma modificação induzida pelo estado diabético que determinou redugio da afinidade da d-tubocurarina para os receptores nicotínicos pré-juncionais

Potential effect of omiprazole on skeletal muscle contraction in experimental animals

Omeprazole is widely used as an antiulcer and anesthetic premeditation. Recently, it was reported that, omeprazole potentiates the effect of neuromuscular blockers. So, the present study was designed to investigate the effect of omeprazole on skeletal muscle contraction and a potential interaction between omeprazole and some neuromuscular blockers namely gallamine [non depolarizing] and succinylcholine [depolarizing]. This study revealed that omeprazole I.V. [4-32 mg/kg] produced a significant [> 0.05] decrease in amplitude of contraction of indirect electrically stimulated rat's gastrocnemius muscle. Omeprazole 10 mg/kg I.V. intensified the relaxant effect in tone of indirect electrically stimulated rat's gastrocnemius muscle, produced by gallamine 0.4 mg/kg I.V. and succinycholine 0.1 mg/kg. The present study also, revealed that omeprazole produced a significant [> 0.05] decrease in amplitude of contraction of toad's rectus muscle induced by acetylcholine. Meanwhile, omeprazole failed to affect potassium chloride [KCI] induced toad's rectus muscle contraction. Omeprazole 0.02 mg/ml augmented the inhibitory effect produced by gallamine 4 micro g/ml and succinylcholine 1 micro g/ml on toad's rectus muscle contraction inducted by acetylcholine. In conclusion, omeprazole has a skeletal muscle relaxant effect at human therapeutic doses, also potentiates the effects produced by gallamine and succinylcholine on rat's gastrocnemius

Interaction of muscle relaxant effect of gallamine with ethanol: in vivo mammalian model.

Ethanol produces alterations in muscular contraction and neuromuscular function both in vitro and in vivo in mammalian and amphibian tissues in dose dependent manner. It is not very well known whether gallamine, a commonly used muscle relaxant produces any interaction with ethanol. Hence in the present study, interactions of ethanol with gallamine are undertaken using rabbit head drop method. The latency time to produce head drop by gallamine in the absence and presence of ethanol (dose which produce ataxia) was insignificantly different (P > 0.05). It may be due to fact that ataxic dose may not be affecting neuromuscular transmission a significant manner. It, therefore, does not warrant to adjust the dose of gallamine in alcoholic persons.

Estudo sobre o controle parácrino na hipófise: efeito do hormônio adrenocorticotrófico sobre a secreçäo do peptídeo intestinal vasoativo e da galanina / An study on the paracrine control in the hypophysy: effect of adrenocorticotropic hormone on secretion vasoactive intestinal peptide and of the galamin

Atualmente esté claro que os peptídeos gastrointestinais se localizam, também nas células da hipófise que produzem os hormônios "classicos". A funçäo fisiológica destes peptídeos gastrointestinais na hipófise porém, ainda näo foi bem elucidada e eles podem ter um importante papel no controle parácrino. Com o objetivo de estudar a possível interrelaçäo existente entre os hormônios pituitários e os peptídeos gastrointestinais, foi analisado o efeito do hormônio adrenocorticotrófico (ACTH) sobre a secreçäo do peptídeo intestinal vasoativo (VIP) e da galanina, em hipófise de ratos machos, usando um sistema de perfusäo, in vitro. Foram obtidas hipófises de ratos Wistar, adultos, machos, posteriormente divididas em quatro e perfundidas em soluçöes contendo diferentes concentraçöes de ACTH e, subsequentemente, soluçäo com KCl. Fraçöes de 1,5ml eram coletadas com intervalos de 3 minutos e analisadas para VIP e galanina, usando radioimunoensaio altamente específico. Algumas amostras foram também analisadas para 782 e substância P. Doses de 0,02µm; 0,1µm; 0,2µm e 0,4µm de ACTH produziram um incremento de 117,75 ñ 4,51//; 155,75 ñ 8,79//; 163,25 ñ 14,45// e 161,5 ñ 2,89// respectivamente, de VIP, partindo da linha basal de liberaçäo (P < 9.001). Entretanto, doses de 1µm e 2µm de ACTH suprimiram a liberaçäo de VIP para 73,5 ñ 5,55// e 46,5 ñ 4,39// respectivamente, comparando com o valor basal de liberaçäo (p < 0,001). Resultados para a liberaçäo de galanina foram similares. Doses de 0,02µm, 0,1µm; 0,2µm, e 0,4µm de ACTH produziram um incremento na liberaçäo de galanina de 129 ñ 3,99//; 136,25 ñ 7,75//; 142,75 ñ 9,13// e 133,25 ñ 9,13// sobre a liberaçäo basal (P < 0,001). Entretanto, as doses de 1µm e 2µm de ACTH provocaram uma supressäo de 51,5 ñ 6,63// e 50,0 ñ 13,29// respectivamente, comparados com a liberaçäo basal (100//) (P < 0.001). Doses de ACTH que afetam a secreçäo de VIP e galanina, näo tiveram efeito na liberaçäo de 782, nem na da substancia P...

The Effects of Non - depolarizing Neuromuscular Blockers on the Succinylcholine Induced Muscle Fasciculation , Postoperative Musle Pain and Relaxation / 대한마취과학회지

To study the effects of small amounts of non-depolarizing neuromuscular blockers on the muscle fasciculation, postoperative muscle pains and relaxation time by succinylcholine, three groups of patients were pretreated with vecuronium (0.01 mg/kg), pancuronium (0.015 mg/kg) and gallamine (0, 2 mg/kg) 3 minutes before succinylcholine injection, respectively and compared their results with control group-saline pretreated group. The results are as follows; 1) Intensity of muscle fasciculation deereased significantly in all groups with non-depolarizing neuromuscular blockers, and frequency had the fewest in pancuronium pretreated group than the others. 2) Intensity of postoperative muscle pains decreased significantly in groups pretreated with pancuronium and gallamine, and frequency had the fewest in gallamine pretreated group than the others. 3) Pretreatment with non-depolarzing neuromuscular blocker had no effects on the onset time of muscle relaxation of succinylcholine but recovery of muscle relaxation by succinylchoine was more rapidly occured than control group. Above results, it will be suggest that gallamine and pancuronium can be used more effectively to prevent muscle fasciculation and postoperative muscle pain without influence on succinylcholine-induced muscle relaxation.

A Case Report of Ventricular Dysrhythmia in a Patient with Sinus Bradycardia and Low Blood Pressure / 대한마취과학회지

Sinus Bradycardia per se does not necessitate therapy. In fact, its presence often implies good health or a good prognosis. A 56-year-old patient, whose pulse rate was about 35 beats per minute and blood pressure was 80/50 mmHg, underwent total gastrectomy under general anesthesia. Ventricular dysrhythmia occurred after the second dose of gallamine managed with lidocaine, and after the administration of atropine and ephednne managed with hydralazine. Authors report this case with the evaluation of references.

A Case Report of Ventricular Dysrhythmia in a Patient with Sinus Bradycardia and Low Blood Pressure / 대한마취과학회지

Sinus Bradycardia per se does not necessitate therapy. In fact, its presence often implies good health or a good prognosis. A 56-year-old patient, whose pulse rate was about 35 beats per minute and blood pressure was 80/50 mmHg, underwent total gastrectomy under general anesthesia. Ventricular dysrhythmia occurred after the second dose of gallamine managed with lidocaine, and after the administration of atropine and ephednne managed with hydralazine. Authors report this case with the evaluation of references.

Effect of Metocurine Iodide on Neuromuscular Blockade and Hemodynamics / 대한마취과학회지

Among nondepolarizing neuromuscular blocking agents, d-tubocurarine may cause blood pressure reduction due to ganglionic blockade and histamine release, while pancuronium and gallamine are associated with vagal blockade and heart rate acceleration. Metocurine, as a trimethylated derivative of d-tubocurarine synthesized by King in 1935, is known to have relatively long duration of action and produces little change in cardiovascular system. Despite its relative lack of cardiovascular effects, the accumulation of data with regard to human neuromus- cular pharmacology and the clinical use has been scant. One hundred and nine adult patients of either sex were anesthetized with thiopental sodium and 50% nitrous oxide with 1.5-2.5% enflurane. For evaluation of neuromuscular blocking effect of metocurine, train-of-four stimulation (2.0 Hz for 2 seconds) was applied at the wrist along the ulnar nerve distribution and the response was measured via ABM Datex. Systolic, diastolic blood pressure and heart rate were recorded continuously after administration of metocurine, d-tubocurarine or pancuronium. All data were analized by ANOVA, Scheffe test. The results are follows : 1) The mean onset times of metocurine 0.1, 0.2, 0.3 mg/kg groups were 119.5+/-40.0, 120.9+/-61.1, 84.8+/-61,1 seconds and the mean durations were 75.1+/-37.6, 104.9+/-42.1, 131.0+/-42.5 minutes respectively. 2) Single-bolus dose of metocurine 0.1, 0.2, and 0.3 mg/kg did not cause significant cardiovascular changes from the control values, but d-tubocurarine 0.3 mg/kg decreased mean systolic blood pressure significantly from 116.6+/-15.7 to 99.0+/-10.9 mmHg 2 minutes after injection. 3) Systolic blood pressures of metocurine 0.2 mg/kg (107.2+/-11.7 mmHg) and d-tubocurarine 0.3 mg/ kg (100.4+/-12.9 mmHg) were significantly different from that of pancuronivm 0.06 mg/kg (127.8+/-16. 0 mmHg) after 1 minute, and 2 minutes after injection, systolic blood pressure of metocurine 0.2 mg/ kg (110.2+/-14.3 mmHg) and d-tubocurarine 0.3 mg/kg (99.0+/-10.9 mmHg) were different from that of pancuronium 0.06 mg/kg (125.3+13.1 mmHg). Five minutes after injection, systolic pressure of d- tubocurarine 0.3mg/kg group (101.110.2mmHg) was significantly different from that of pancur-onium 0.06 mg/kg group (118.7+/-11.0 mmHg). 4) Diastolic blood pressure of d-tubocurarine 0.3 mg/kg (63.4+/-12.9 mmHg) was significantly differ- ent from that of pancuronium 0.06mg/kg (84.2+/-13.3mmHg) after 1 minute, and 2 minutes after injection, diastolic blood pressure or d-tubocurarine 0.3 mg/kg (65.4+/-11.3 mmHg) was different from that of pancuronium 0.06mg/kg (83.1+/-11.6mmHg). There was no significant difference among the groups with respect to heart rate. In summary, metocurine has relatively rapid onset and long duration of action, and used in a dose sufficient to provide surgical relaxation, it produces little change in cardiovascular system in contrast to d-tubocurarine or pancuronium. 1t is therefore suggested that metocurine may be recommended as a muscle relaxant for patients having cardiovascular disease.

Farmacocinética dos bloqueadores neuromusculares / Pharmacokinetics of neuromuscular relaxants

Os autores tecem comentários sobre a farmacocinética dos bloqueadores neuromusculares adespolarizantes e despolarizantes, enfatizando principalmente os aspectos da fisiopatologia que podem alterá-la, como a gravidez, hipotermia, idade avançada e insuficiência renal e hepática

Efeitos cardiovasculares dos relaxantes neuromusculares / Cardiovascular effects of neuromuscular relaxants

O autor faz uma revisäo das açöes farmacológicas dos relaxantes neuromusculares sobre o sistema cardiovascular. Os mecanismos básicos pelos quais os relaxantes neuromusculares induzem efeitos cardiovasculares säo sumarizados. Entre estes incluem a liberaçäo de histamina, bloqueio ganglionar, bloqueio dos receptores muscarínicos no sistema cardiovascular e a recaptaçäo das catecolaminas a nível neural. Consideraçöes sobre os mais recentes agentes, atracúrio e vecurônio, säo feitas, especialmente quanto aos seus efeitos hemodinâmicos

O pré-tratamento com relaxante neuromuscular adespolarizante: influência na funçäo pulmonar / Pretreatment with non-depolarizing neuromuscular relaxants: influence on pulmonary function

A influência do pré-tratamento com relaxante neuromuscular adespolarizante na funçäo pulmonar foi avaliada em 30 pacientes saudáveis, acordados e sem medicaçäo pré-anestésica. Os pacientes foram divididos em três grupos: grupo 1, recebeu pancurônio 1 mg; grupo 2, galamina 20 mg e grupo 3, alcurônio 2 mg por via venosa. Todos os pacientes tiveram uma diminuiçäo da capacidade vital (CV), fluxo eexpiratório de pico (FEP) e do volume expiratório forçado no 1§ segundo (VEF), mas apenas a diminuiçäo do FEP no grupo da galamina näo foi estatiscamente significativa. A mais pronunciada diminuiçäo da CV, do FEP e do VEF (15, 13 e 13% respectivamente) foi vista com o grupo que recebeu pancurônio. Dois pacientes (20%) no grupo 1 apresentaram sinais de dificuldade respiratória e necessitaram suporte ventilatório. Três pacientes do grupo 1 e um do grupo 2 foram incapazes de manter a cabeça elevada por 10 segundos. Três pacientes do grupo 2 (galamina) apresentaram taquicardia imediatamente após a injeçäo. Como conclusäo, temos que doses fixas de pancurônio, galamina e alcurônio näo devem ser recomendadas como rotina em pré-curarizaçäo

Study of awareness during noninhalational anaesthesia.

Forty-five adult patients underwent a noninhalational anaesthetic method for investigation of awareness during surgery and recall of events associated with surgery in postoperative period. All the patients were divided into two groups. The first group of patients were male and had upper abdominal operations. The second group were female and had lower abdominal operations. No significant difference was found between these two groups either in requirements of depth of anaesthesia or in the evidence of per-operative awakefulness. Eighty percent patients of both the groups showed various signs of peroperative awakefulness but did not recall any events associated with surgery in the postoperative period. There was no report of dream either.