Abstract
The anesthetic state and natural sleep share many neurobiological features and yet are two distinct states. The hallmarks of general anesthesia include hypnosis, analgesia, akinesia and anxiolysis. These are the principal parameters by which the anesthetic state differs from natural sleep. These properties are mediated by systemic administration of a combination of agents producing balanced anesthesia. The exact nature of anesthetic narcosis is dose dependent and agent specific. It exhibits a relative lack of nociceptive response and active suppression of motor and autonomic reflexes. Surgical anesthesia displays a signature electroencephalogram pattern of burst suppression that differs from rapid eye movement sleep, representing more widespread disruption of thalamocortical connectivity, impairing information integration and processing. These differences underpin successful anesthetic action. This review explores the differences between natural sleep and anesthetic-induced unconsciousness as induced by balanced anesthesia.
Highlights
Immobility during anesthesia is produced by active inhibition of neural circuits in the brainstem and spinal cord, which leads to suppression of reflex withdrawal from noxious stimuli and loss of protective reflexes that are maintained during sleep
Sleep, like anesthesia, is characterized by amnesia, it is thought to play a key role in memory consolidation and cognitive development
Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript
Summary
The anesthetic state and natural sleep share many neurobiological features and yet are two distinct states. The hallmarks of general anesthesia include hypnosis, analgesia, akinesia and anxiolysis These are the principal parameters by which the anesthetic state differs from natural sleep. Surgical anesthesia displays a signature electroencephalogram pattern of burst suppression that differs from rapid eye movement sleep, representing more widespread disruption of thalamocortical connectivity, impairing information integration and processing Anesthesia displays a more widespread disruption of brain connectivity compared with natural sleep, impairing information integration and processing These differences are essential to successful anesthetic action. Anesthetics that act through GABAA receptors, for example propofol, are associated with beta oscillations; beta oscillations are seen to decrease in NREM sleep [7] Another point to note in the case of propofol, general anesthesia has been shown to reverse sleep debt [8]. There are some fundamental physiological differences present that suggest that the two states are not as close neural correlates as is often described
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