Consciousness, Awareness, and Anesthesia

275 Pages·2010·2.44 MB·English

by  George A. Mashour MD PhD

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Consciousness, Awareness, and Anesthesia
Hypnosis,amnesia,andimmobilityarethreemajortherapeuticendpointsofgeneralanesthesia.
Inonetotwocasesoutofathousand,hypnosisandamnesiaarenotachieved–oftenleavinga
patientparalyzedbutcapableofexperiencingandrememberingintraoperativeevents.Awareness
duringgeneralanesthesiaisoneofthemostdreadedcomplicationsofsurgeryandisfearedby
patientsandcliniciansalike.Despitenumerousadvancesinthefield,manyunresolvedquestions
persist.Someofthedifficultiesinthedetectionandpreventionofawarenessduringanesthesia
relatetotheunderlyingcomplexitiesoftheneuroscientificbasisofconsciousness.Consciousness,
Awareness, and Anesthesia is a multidisciplinary approach to both the scientific problem of
consciousnessandtheclinicalproblemofawarenessduringgeneralanesthesia.Aninternational
cadre of authors with expertise in anesthesiology, neurobiology, and philosophy provides a
cutting-edge perspective. No other book on the subject has drawn from such a breadth of
scholarship.
Dr.GeorgeA.MashourreceivedhisMDandPhDinneurosciencefromGeorgetownUni-
versityandwasawardedFulbrightscholarshipsforneuroscienceresearchinBerlinandBonn.
HecompletedhisresidencyandchiefresidencyinanesthesiologyattheMassachusettsGeneral
HospitalandHarvardMedicalSchool,aswellasfellowshiptraininginneuroanesthesiologyat
theUniversityofMichigan.Heiscurrentlythedirectorofneuroanesthesiology,aswellasan
assistantprofessorofanesthesiologyandneurosurgery,attheUniversityofMichiganMedical
School.Hismainclinicalinterestsareneuroanesthesiologyandneurocriticalcare.Dr.Mashour’s
majorscholarlyfocusisconsciousnessandanesthesia.Heiscreditedwithdevelopingthecog-
nitiveunbindingparadigmofgeneralanesthesiaandadvocatingfortheroleofanesthesiology
inthestudyofconsciousness.Inhisclinicalresearch,Dr.Mashouristheprincipalinvestigator
of a 30,000-patient study focused on the prevention of awareness during general anesthesia.
Hehaspublishedandlecturedextensivelyonthesubjectsofconsciousnessandintraoperative
awareness.Dr.Mashouristherecipientofnumerousawardsforhisworkasaclinician,scholar,
andeducator.
Thisbookisdedicatedtomywonderfulwife,CynthiaJaneSchoen,who
suffusesmyownconsciousexperiencewithbothloveandlight.
Consciousness,
Awareness, and
Anesthesia
Editedby
George A. Mashour
UniversityofMichiganMedicalSchool
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore,
São Paulo, Delhi, Dubai, Tokyo
Cambridge University Press
The Edinburgh Building, Cambridge CB2 8RU, UK
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521518222
© Cambridge University Press 2010
This publication is in copyright. Subject to statutory exception and to the
provision of relevant collective licensing agreements, no reproduction of any part
may take place without the written permission of Cambridge University Press.
First published in print format 2010
ISBN-13 978-0-511-67719-9 eBook (NetLibrary)
ISBN-13 978-0-521-51822-2 Hardback
Cambridge University Press has no responsibility for the persistence or accuracy
of urls for external or third-party internet websites referred to in this publication,
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Contents
Contributors pagevii
Preface:Consciousness,awareness,andanesthesia ix
GeorgeA.Mashour
1 Relevanceofsleepneurobiologyforcognitiveneuroscience
andanesthesiology 1
GiancarloVanini,HelenA.Baghdoyan,andRalphLydic
2 Theneurobiologyofconsciousness 24
ChristofKochandFlorianMormann
3 Memoryformationduringgeneralanesthesia 47
ChantalKerssensandMichaelAlkire
4 Dreamingduringanesthesia 74
KateLeslie
5 Etiologyandriskfactorsofintraoperativeawareness 90
MohamedGhoneim
6 Monitoringanestheticdepth 114
GerhardSchneider
7 Currentcontroversiesinintraoperativeawareness:I 131
PaulS.Garc´ıaandPeterSebel
8 Currentcontroversiesinintraoperativeawareness:II 148
BenjaminJ.Palanca,AdamSearleman,andMichaelS.Avidan
9 Awarenessduringgeneralanesthesiainthepediatricpopulation 172
AndrewJ.DavidsonandRachelHutchens
10 Psychologicalconsequencesofintraoperativeawareness 188
ClaesLennmarkenandGunillaSydsjo
v
vi Contents
11 Medicolegalconsequencesofintraoperativeawareness 204
KarenB.DominoandChristopherD.Kent
12 Complaintsofawarenessaftersedationandregionalanesthesia:
Theroleofpatientexpectations 221
RoyK.Esaki
13 Philosophical implications of awareness during general anesthesia 233
EricLaRock
Index 253
Contributors
MichaelAlkire MohamedGhoneim
AnesthesiaandPerioperativeCare, DepartmentofAnesthesia,University
UniversityofCalifornia,Irvine ofIowa
MichaelS.Avidan
RachelHutchens
DepartmentofAnesthesiology,
DepartmentofPsychologicalScience,
WashingtonUniversitySchoolof
LaTrobeUniversity
Medicine
ChristopherD.Kent
HelenA.Baghdoyan
DepartmentofAnesthesiologyand
DepartmentofAnesthesiology,
PainMedicine,Universityof
UniversityofMichiganMedical
Washington
School
AndrewJ.Davidson ChantalKerssens
DepartmentofAnaesthesiaandPain DepartmentofAnesthesiology,Emory
Management,RoyalChildren’s University
Hospital,Australia
ChristofKoch
KarenB.Domino
DivisionofBiology,California
DepartmentofAnesthesiologyand
InstituteofTechnology
PainMedicine,Universityof
Washington
EricLaRock
DepartmentofPhilosophy,Oakland
RoyK.Esaki
University
DepartmentofAnesthesia,Stanford
UniversitySchoolofMedicine
ClaesLennmarken
PaulS.Garc´ıa DepartmentofAnaesthesiaand
DepartmentofAnesthesiology,Emory IntensiveCare,UniversityHospital,
University Sweden
vii
viii Contributors
KateLeslie GerhardSchneider
DepartmentofAnaesthesiaandPain DepartmentofAnesthesiology,
Management,RoyalMelbourne TechnnischeUniversita¨tMu¨nchen,
Hospital,Australia,and Germany
DepartmentofPharmacology,
UniversityofMelbourne,Australia AdamSearleman
MedicalScientistTrainingProgram,
RalphLydic
WashingtonUniversitySchoolof
DepartmentofAnesthesiology,
Medicine
UniversityofMichiganMedical
School
PeterSebel
GeorgeA.Mashour DepartmentofAnesthesiology,Emory
DepartmentsofAnesthesiologyand University
Neurosurgery,Universityof
MichiganMedicalSchool GunillaSydsjo
DivisionofObstetricsand
FlorianMormann
Gynaecology,UniversityHospital,
DivisionofBiology,California
Sweden
InstituteofTechnology
BenjaminJ.Palanca GiancarloVanini
DepartmentofAnesthesiology, DepartmentofAnesthesiology,
WashingtonUniversitySchoolof UniversityofMichiganMedical
Medicine School