Open AccessEscape From Oblivion: Neural Mechanisms of Emergence From General Anesthesia
Author(s) -
Max B. Kelz,
Paul S. García,
George A. Mashour,
Ken Solt
Publication year - 2019
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.404
H-Index - 201
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1213/ane.0000000000004006
Subject(s) - consciousness , medicine , narrative review , general anesthetics , neuroscience , anesthetic , cognitive science , state (computer science) , narrative , focus (optics) , process (computing) , epistemology , anesthesia , psychology , intensive care medicine , linguistics , philosophy , physics , algorithm , computer science , optics , operating system
The question of how general anesthetics suppress consciousness has persisted since the mid-19th century, but it is only relatively recently that the field has turned its focus to a systematic understanding of emergence. Once assumed to be a purely passive process, spontaneously occurring as residual levels of anesthetics dwindle below a critical value, emergence from general anesthesia has been reconsidered as an active and controllable process. Emergence is driven by mechanisms that can be distinct from entry to the anesthetized state. In this narrative review, we focus on the burgeoning scientific understanding of anesthetic emergence, summarizing current knowledge of the neurotransmitter, neuromodulators, and neuronal groups that prime the brain as it prepares for its journey back from oblivion. We also review evidence for possible strategies that may actively bias the brain back toward the wakeful state.