Document Detail

Unresponsiveness ≠ unconsciousness.
MedLine Citation:
PMID:  22314293     Owner:  NLM     Status:  MEDLINE    
Consciousness is subjective experience. During both sleep and anesthesia, consciousness is common, evidenced by dreaming. A defining feature of dreaming is that, while conscious, we do not experience our environment; we are disconnected. Besides inducing behavioral unresponsiveness, a key goal of anesthesia is to prevent the experience of surgery (connected consciousness), by inducing either unconsciousness or disconnection of consciousness from the environment. Review of the isolated forearm technique demonstrates that consciousness, connectedness, and responsiveness uncouple during anesthesia; in clinical conditions, a median 37% of patients demonstrate connected consciousness. We describe potential neurobiological constructs that can explain this phenomenon: during light anesthesia the subcortical mechanisms subserving spontaneous behavioral responsiveness are disabled but information integration within the corticothalamic network continues to produce consciousness, and unperturbed norepinephrinergic signaling maintains connectedness. These concepts emphasize the need for developing anesthetic regimens and depth of anesthesia monitors that specifically target mechanisms of consciousness, connectedness, and responsiveness.
Robert D Sanders; Giulio Tononi; Steven Laureys; Jamie W Sleigh
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Anesthesiology     Volume:  116     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-23     Completed Date:  2012-05-04     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  946-59     Citation Subset:  AIM; IM    
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MeSH Terms
Anesthesia / methods
Consciousness / physiology*
Dreams / physiology,  psychology
Electroencephalography / methods,  psychology
Sleep / physiology
Unconsciousness / physiopathology*,  psychology
Wakefulness / physiology
Grant Support
DP1 OD000579/OD/NIH HHS; DP1 OD000579-05/OD/NIH HHS; G0802353//Medical Research Council; //Medical Research Council
Comment In:
Anesthesiology. 2012 Nov;117(5):1140; author reply 1140   [PMID:  23095543 ]

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