Sleep And Anesthesia

Sleep and anesthesia resemble in many ways at a first glance. The most prominent common feature of course is the loss of consciousness, i.e. the loss of awareness of external stimuli. However a closer look at the loss of consciousness reveals already a difference between sleep and anesthesia: anesthesia is induced by an anesthetic drug whereas we may fall asleep without external cause. Other questions may arise about the difference of the two effects: do we dream during surgery under anesthesia, do we feel pain during sleep? Essentially, we may ask: what is common and what are the differences between sleep and anesthesia? To answer these questions, we may take a look at the neural origin of both effects and the involved physiological pathways. In which way do they resemble? Moreover, we ask what are the detailed features of normal sleep and general anesthesia as applied during surgery and which features exist in both phenomena? If yes in which way? To receive answers to these questions, it is necessary to consider several experimental techniques that reveal underlying neural mechanisms of sleep and anesthesia. Moreover, theoretical models of neural activity may model both phenomena and comes up with predictions or even theories on the underlying mechanisms. Such models may attack several different description levels, from the microscopic level of single neurons to the macroscopic level of neural populations. Such models may give deeper insight into the phenomena if their assumptions are based on experimental findings and their predictions can be compared to experimental results. This comparison step is essential for valuable theoretical models. The book is motivated by two successful workshops on anesthesia and sleep organized during the Computational Neuroscience Conferences in Toronto in 2007 and in Berlin 2009. It aims to cover all the previous aspects with a focus on the link to experimental findings. It elucidates important issues in theoretical models that at the same time reflect some current major research interests. Moreover it considers some diverse issues which are very important to get an overview of the fields. For instance, the book discusses not only neural activity in the brain but also the effects of general anesthesia on the cardio-vascular system and the spinal cord in the context of analgesia. In addition, it considers different experimental techniques on various spatial scales, such as fMRI and EEG-experiments on the macroscopic scale and single neuron and LFP-measurements on the microscopic scale. In total all book chapters reveal aspects of the neural correlates of sleep and anesthesia motivated by experimental data. This focus on the neural mechanism in the light of experimental data is the common feature of the topics and the chapters. In addition, the book aims to clarify the shared physiological mechanisms of both phenomena, but also reveal their physiological differences.

This issue of Sleep Medicine Clinics, Guest Edited by Frances Chung, MBBS FRCPC of the University of Toronto, will focus on Sleep and Neurorehabilitation. Article topics will include Sleep and Anesthesia; Neurobiology, Medicine, and Society; Upper airway, OSA and anesthesia ; Positions, sleep and anesthesia; Sleep Deprivation, OSA and inflammation; Preoperative Screening for OSA; and PAP therapy for perioperative patients.

In recent years our understanding of molecular mechanisms of drug action and interindividual variability in drug response has grown enormously. Meanwhile, the practice of anesthesiology has expanded to the preoperative environment and numerous locations outside the OR. Anesthetic Pharmacology: Basic Principles and Clinical Practice, 2nd edition, is an outstanding therapeutic resource in anesthesia and critical care: Section 1 introduces the principles of drug action, Section 2 presents the molecular, cellular and integrated physiology of the target organ/functional system and Section 3 reviews the pharmacology and toxicology of anesthetic drugs. The new Section 4, Therapeutics of Clinical Practice, provides integrated and comparative pharmacology and the practical application of drugs in daily clinical practice. Edited by three highly acclaimed academic anesthetic pharmacologists, with contributions from an international team of experts, and illustrated in full colour, this is a sophisticated, user-friendly resource for all practitioners providing care in the perioperative period.

Contrary to the popular belief, "Le sommeil n'est plus milieu s(lr" (J. Cocteau, cf. Cl. Gaultier, Pathologie respiratoire du sommeil, La Presse Medicale, 16, 561-563, 1987), and anesthesia is even less safe. Sudden Infant Death Syndrome, Obstructive Sleep Apnea, Ondine's Curse and various respiratory complications of general anesthesia are not so rare; as a matter of fact they happen much too frequently. The idea of organizing another symposium dealing with breathing in sleep and anesthesia has been discussed almost immediately after we said "good bye" to the Organizers of the excellent Paris meeting "The Regulation of Respiration during Sleep and Anesthesia" (R.S. Fitzgerald, H. Gautier, S. Lahiri eds., Advances in Experimental Medicine and Biology, vol. 99, Plenum, New York 1978). Taking into account the impressive amount of data that have emerged during the last few years, we have decided that we shall meet and discuss them; we hoped also that the publication of the scientific material might be useful for everybody interested in the physiology and pathophysiology of breathing, anesthesia and sleep. So we met in Warsaw under the auspices of the European Society for Clinical Respiratory Physiology and the Polish Academy of Sciences, we discussed vividly many fascinating papers presented by our Colleagues from Europe and America and Plenum Press has published the proceedings. I hope that the final result will satisfy the reader.

The definitive resource on the innovative use of DISE for obstructive sleep apnea Obstructive sleep apnea is the most prevalent sleep-related breathing disorder, impacting an estimated 1.36 billion people worldwide. In the past, OSA was almost exclusively treated with Continuous Positive Airway Pressure (CPAP), however, dynamic assessment of upper airway obstruction with Drug-Induced Sleep Endoscopy (DISE) has been instrumental in developing efficacious alternatives. Drug-Induced Sleep Endoscopy: Diagnostic and Therapeutic Applications by Nico de Vries, Ottavio Piccin, Olivier Vanderveken, and Claudio Vicini is the first textbook on DISE written by world-renowned sleep medicine pioneers. Twenty-four chapters feature contributions from an impressive group of multidisciplinary international experts. Foundational chapters encompass indications, contraindications, informed consent, organization and logistics, patient preparation, and drugs used in DISE. Subsequent chapters focus on treatment outcomes, the role of DISE in therapeutic decision making and upper airway stimulation, pediatric sleep endoscopy, craniofacial syndromes, advanced techniques, and more. Key Highlights Comprehensive video library highlights common and rare DISE findings A full spectrum of sleep disordered breathing and OSA topics, from historic to future perspectives Insightful clinical pearls on preventing errors and managing complications including concentric and epiglottis collapse Discussion of controversial DISE applications including oral appliances and positional and combination therapies This unique book is essential reading for otolaryngology residents, fellows, and surgeons. Clinicians in other specialties involved in sleep medicine will also benefit from this reference, including pulmonologists, neurologists, neurophysiologists, maxillofacial surgeons, and anesthesiologists.

During the 1976 Fall Meeting of the American Physiological Society Dr. Lahiri and I learned that no plans were being formu lated for holding a symposium on Respiratory Control during the 1977 International Congress. Not to hold such a symposium, we felt, would be the loss of a unique opportunity for us "regula tionists" to exchange ideas viva voce with our international colleagues. It would also break a tradition most recently enjoyed at Srinagar, India in 1974 and at Warsaw, Poland in 1971. After a time-consuming false start we had the good fortune to get advice from Dr. Pierre Dejours to make our plans known to Dr. Henry Gautier. This we did. There resulted an excellent three days of discussion and hospitality at the Faculte de Medecine Saint-Antoine in Paris immediately preceding the International Congress. The aim of the co-chairmen was to gather an international mixture of both the younger and more senior experts to discuss, argue, and maybe even agree on a point or two arising from their current investigations. We wanted to feature, however, recent research trying to determine the influence of sleep and anesthesia on the regulation of respiration. That the sessions were lively and presumably profitable was never more in evidence than when on the second day at 6:15 p.m. after fully nine hours of discussion, argumentation, and some agreement I counted 78 participants still participating.