Unresponsiveness ≠ unconsciousness.
Unresponsiveness ≠ unconsciousness.
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DOI：
10.1097/aln.0b013e318249d0a7
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发表时间：
2012-04
期刊：
影响因子：
8.8
通讯作者：
Sleigh JW
中科院分区：
文献类型：
--
作者：
Sanders RD;Tononi G;Laureys S;Sleigh JW
意识是主观经验。在睡眠和麻醉期间，意识都很常见，做梦就是明证。做梦的一个决定性特征是，虽然我们有意识，但我们并没有体验到我们的环境--我们是断开的。除了诱导行为无反应，麻醉的一个关键目标是通过诱导无意识或意识与环境的脱节来防止手术(连接意识)的体验。对隔离前臂技术的回顾表明，麻醉期间意识、连通性和反应性是分离的；在临床条件下，中位数37%的患者表现出连通性意识。我们描述了可以解释这一现象的潜在神经生物学结构：在光麻醉期间，服从自发行为反应的皮质下机制被禁用，但皮质丘脑网络内的信息整合继续产生意识，未受干扰的去甲肾上腺素能信号保持连接。这些概念强调了开发麻醉方案和麻醉深度监测器的必要性，这些监测器专门针对意识、连通性和反应性机制。
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.