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Consciousness and Anesthesia

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Total Intravenous Anesthesia and Target Controlled Infusions

Abstract

There is as yet no generalised theory of anaesthesia. This lack of understanding of the mechanisms underpinning general anaesthesia is partly due to a lack of convergence of the various methodologies employed to explore these. However, this gap is also fundamentally due to the absence of a universally accepted definition of consciousness. Cognitive neuroscience has seen a relatively recent resurgence of interest in the study of consciousness that has successfully brought together sleep and anaesthesia research in an attempt to address this deficiency. Investigations into the neurophysiological mechanisms of consciousness and of general anaesthesia mutually inform each other. Sleep shares behavioural phenotypes with the state of anaesthesia, but critically differs in arousal by external stimuli and the rhythmic cycling between different stages. Exploring the relationship of general anaesthesia to sleep has provided substantial insights into the mechanisms of anaesthesia. Basic science, animal and lesion studies over the past several decades provide ample evidence for the fact that anaesthesia and sleep affect key neurochemical circuits in the brainstem, the basal forebrain, the thalamus and the cortex. However, as yet unanswered is the hierarchical organisation in these systems and how disparate pharmacological and pathological entities generate a comparable behavioural state of unconsciousness and unresponsiveness. This chapter will aim to bring together an overview of the current knowledge and recent evidence surrounding the neural, chemical and network substrates underlying consciousness and two common conditions of altered states of consciousness (sleep and anaesthesia).

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Authors and Affiliations

  1. Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK

    Ram Adapa MBBS, MD, FRCA, PhD

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  1. Ram Adapa MBBS, MD, FRCA, PhD
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Correspondence to Ram Adapa MBBS, MD, FRCA, PhD .

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  1. Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Anthony R. Absalom

  2. Department of Anesthesia, Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA

    Keira P. Mason

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Adapa, R. (2017). Consciousness and Anesthesia. In: Absalom, A., Mason, K. (eds) Total Intravenous Anesthesia and Target Controlled Infusions. Springer, Cham. https://doi.org/10.1007/978-3-319-47609-4_4

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