Escape From Oblivion: Neural Mechanisms of Emergence From General Anesthesia
Escape From Oblivion: Neural Mechanisms of Emergence From General Anesthesia
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DOI：
10.1213/ane.0000000000004006
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发表时间：
2019-04-01
影响因子：
5.7
通讯作者：
Solt, Ken
中科院分区：
文献类型：
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作者：
Kelz, Max B.;Garcia, Paul S.;Solt, Ken
全身麻醉剂如何抑制意识的问题自世纪中期以来一直存在，但直到最近，该领域才将重点转向对涌现的系统理解。一旦被认为是一个纯粹的被动过程，自发发生的麻醉药残留水平下降到临界值以下，从全身麻醉的出现已被重新考虑为一个主动和可控的过程。苏醒是由机制驱动的，这种机制与进入麻醉状态不同。在这篇叙述性综述中，我们重点关注麻醉剂出现的新兴科学认识，总结了当前对神经递质、神经调质和神经元组的认识，这些神经递质、神经调质和神经元组在大脑准备从遗忘中回归时为大脑做好了准备。我们还审查了可能的策略，可能会积极偏置大脑回到清醒状态的证据。
The question of how general anesthetics suppress consciousness has persisted since the mid-19th century, but it is only relatively recently that the field has turned its focus to a systematic understanding of emergence. Once assumed to be a purely passive process, spontaneously occurring as residual levels of anesthetics dwindle below a critical value, emergence from general anesthesia has been reconsidered as an active and controllable process. Emergence is driven by mechanisms that can be distinct from entry to the anesthetized state. In this narrative review, we focus on the burgeoning scientific understanding of anesthetic emergence, summarizing current knowledge of the neurotransmitter, neuromodulators, and neuronal groups that prime the brain as it prepares for its journey back from oblivion. We also review evidence for possible strategies that may actively bias the brain back toward the wakeful state.