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.

Leading investigators critically evaluate the latest information on how anesthetics work at the molecular, cellular, organ, and whole animal level. These distinguished experts review anesthetic effects on memory, consciousness, and movement and spell out in detail both the anatomic structures and physiological processes that are their likely targets, as well as the cellular and molecular mechanisms by which they operate. Comprehensive and authoritative, Neural Mechanisms of Anesthesia draws together and critically reviews all the recent research on anesthetic mechanisms, highlighting the precise routes along which these substances operate, and how this deeper understanding will lead to the design of effective drugs free ofundesirable side effects.

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.

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.

Winner, 2017 Mark and Evette Moran Nib Literary Award You know how it is when you go under. The jab, the countdown, the— —and then you wake. This book is about what happens in between. Until a hundred and seventy years ago many people chose death over the ordeal of surgery. Now hundreds of thousands undergo operations every day. Anaesthesia has made it possible. But how much do we really know about what happens to us on the operating table? Can we hear what’s going on around us? Is pain still pain if we are not awake to feel it, or don’t remember it afterwards? How does the unconscious mind deal with the body’s experience of being cut open and ransacked? And how can we help ourselves through it? Haunting, lyrical, sometimes shattering, Anaesthesia leavens science with personal experience to bring an intensely human curiosity to the unknowable realm beyond consciousness. What really happens to us when we are anaesthetised? By this I mean not what happens to the pinging, crackling apparatus of our nerves and spinal cords and brains, but what happens to us—to the person who is me or the person who is you—as doctors go about the messy business of slicing and delving within us? Kate Cole-Adams is a Melbourne writer and journalist. Her non-fiction work Anaesthesia won the Mark and Evette Moran Nib Literary Award, 2017 and the 2017 Australian and New Zealand College of Anaesthetists Media Award. It was shortlisted for the Victorian Premier’s Literary Award for Non-fiction, 2017. Her novel Walking to the Moon is also published by Text. ‘Anaesthesia is mesmerising...This rich and thorough study looks more deeply into questions about the nature of consciousness than many of us who undergo an anaesthetic are likely, or willing, to ponder.’ Australian Book Review ‘A work of splendid richness and depth, driven by a curiosity so intense that it hazards at times the extreme boundaries of the sayable.’ Helen Garner ‘Kate Cole-Adams has been fascinated with our funny non-being during surgery for a long time, and Anaesthesia feels like a book that’s taken over a decade to write, which it is. It also feels like you’re having a decade’s worth of conversations with a dogged, but generous and resourceful thinker, with someone (she is both a journalist and a novelist) who can crack open a complex idea, and then run with it.’ Readings 'An obsessive, mystical, terrifying, and even phantasmagorical exploration of anesthesia’s shadowy terra incognita.’ The New Yorker 'Remarkable in its attention to historical detail and quality of the primary sources...practising anaesthetists should read what has become the single best account of our profession’s most philosophically fragile constructs—consciousness and self... Cole-Adams has distilled and articulated the art of our profession.’ Anaesthesia Intensive Care journal (published by Australian Society of Anaesthetists) ‘Extraordinarily well-researched and delicately structured, this is a book with few parallels. Exceptional writing illuminates a topic that affects most of us, but that few of us understand.’ Judges’ Report, Victorian Premier’s Literary Awards, 2018 ‘Comfortably numb. A close-up look at anaesthesia is equal parts social history, popular science and report on experience.’ NZ Listener ‘Anaesthesia is not just an account of medical research but a poetic exploration of the mysteries of the human mind.’ Australian ‘Should be compulsory reading for all anaesthetists, others responsible for the care of surgical patients, and medical students who wish to achieve a true perspective of today’s anaesthesia.’ medicSA ‘Cole-Adams’s prose is sinuous, at times intoxicating, and witty.’ Sydney Morning Herald ‘A troubling, anxious subject that most of us would rather avoid or deflect with dark humour. Cole-Adams has illuminated it in a memorable way. The book is a gift not of oblivion but of awareness.’ Inside Story ‘For the interested reader, it’s an outline of the science, with an emphasis on the unknown. For the practitioner, it’s a patient experience, eloquently expressed. There’s much more the anaesthesia than meets the eye, and this book provides a glimpse into the depths.’ Conversation ‘A fascinating mix of historical background, moving—sometimes shocking—surgical stories, interviews with experts and case studies. Surprisingly, it seems relatively little is really known about exactly how effective and affective anaesthetic is. Despite that, I found this book an oddly reassuring study.’ North and South NZ ‘Kate Cole-Adams has written a book that defies familiar categories. It is a personal memoir, a history, a scientific study, and a philosophical enquiry into the unconscious, and by drawing all these strands together the author has delivered a masterpiece.’ Jamie Grant, head judge, Waverley Council Nib Literary Awards ‘This is a surprising delight of a book about the invention and use of anaesthetics, but it is also about the concept of consciousness. It is a book about the fear of death, the fear of a lack of control, the fear of an imminent operation, the way a life can be plagued by a general feeling of anxiety and how dreams play a part in this.’ Krissy Kneen, Feminist Writers Festival, Favourite Reads of 2017 ‘Kate Cole-Adams’s Anaesthesia propelled me towards new ways of thinking about thinking itself: experience and consciousness and how we make in and make up this world.’ Ashley Hay, Australian, Books of the Year 2017