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Torsade de pointes ventricular tachycardia during, but not necessarily caused by, sevoflurane anesthesia.

The onset of TGA is relatively sudden, and in approximately one third of patients, is triggered by a precipitating event such as physical exertion, sexual intercourse, heat, cold, or general anesthesia (2,3). Unfortunately, we are unable to determine an exact onset because our patient awoke from surgery with the amnesia. TGA episodes resolve gradually over several hours to a day (3). After several hours of profound anterograde and retrograde amnesia, our patient’s memory was restored within 1 min of receiving flumazenil, which is the expected response time of the drug (4). Although possible, it is difficult to believe that this could be coincidental. If our patient experienced TGA, it is even more difficult to believe that the episode resolved at the exact time at which flumazenil was administered. We agree with Dr. Ghoneim that our case study contradicts the current literature on benzodiazepines and memory by suggesting that midazolam may cause retrograde amnesia. It is of interest, however, that the midazolam package, insert (5) lists retrograde amnesia as an adverse reaction. As suggested in our case study, further research is needed in this area.