Dissociative Anesthesia

PENDER, JOHN W.

doi:10.1001/jama.1971.03180200050011

Cited by 39 publications

(8 citation statements)

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“…We used cellular scale population recording techniques in mice and humans to investigate changes in microscale activity patterns across anesthetic depth and recovery from anesthesia. Our results appear at odds with a recent report (Schroeder et al, 2016), where mLOC occurred despite unchanged levels of overall activity during ketamine-induced dissociative anesthesia (Pender, 1971). But, whereas most first-line anesthetics decrease cerebral metabolism (Laaksonen et al, 2018;Pilge et al, 2014), ketamine differentially affects cerebral hemodynamics and neural firing with a net neutral effect (Cavazzuti et al, 1987;Laaksonen et al, 2018).…”

Section: Discussioncontrasting

confidence: 99%

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness

et al. 2019

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Section: Discussioncontrasting

confidence: 99%

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness

et al. 2019

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“…There is a large class of NMDA receptor antagonists, that inhibit the excitatory action of NMDA receptors. These anesthetics induce so-called dissociative anesthesia (Pender, 1970 ) leading to amnesia and analgesia without depressing respiration, but also characterized by distorted perceptions of sight and sound and feelings of dissociation from the environment. An example of a dissociative anesthetic drug is the inhalational anesthetic xenon which—amongst other actions—binds primarily to the extra-synaptic glycine site of NMDA receptors (Dickinson et al, 2007 ) and attenuates long-term potentiation present in the hippocampus by reducing extrasynaptic receptor currents (Kratzer et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Anesthetic action on extra-synaptic receptors: effects in neural population models of EEG activity

Hashemi

Hutt

Sleigh

2014

Front. Syst. Neurosci.

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The role of extra-synaptic receptors in the regulation of excitation and inhibition in the brain has attracted increasing attention. Because activity in the extra-synaptic receptors plays a role in regulating the level of excitation and inhibition in the brain, they may be important in determining the level of consciousness. This paper reviews briefly the literature on extra-synaptic GABA and NMDA receptors and their affinity to anesthetic drugs. We propose a neural population model that illustrates how the effect of the anesthetic drug propofol on GABAergic extra-synaptic receptors results in changes in neural population activity and the electroencephalogram (EEG). Our results show that increased tonic inhibition in inhibitory cortical neurons cause a dramatic increase in the power of both δ− and α− bands. Conversely, the effects of increased tonic inhibition in cortical excitatory neurons and thalamic relay neurons have the opposite effect and decrease the power in these bands. The increased δ-activity is in accord with observed data for deepening propofol anesthesia; but is absolutely dependent on the inclusion of extrasynaptic (tonic) GABA action in the model.

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“…Moreover, NMDAR antagonists lead to stereotyped behaviour and psychiatric symptoms that are strikingly similar to those seen in patients with anti-NMDAR encephalitis [27]. The NMDAR antagonist ketamine is a dissociative anaesthetic, characterized by catalepsy, amnesia, and marked analgesia without loss of consciousness or muscle relaxation in patients [39]. Purposeless movements, an increase in muscle tone and resistance to passive motion have been observed since the beginning of ketamine use [39].…”

Section: Clinical Relevancementioning

confidence: 99%

“…The NMDAR antagonist ketamine is a dissociative anaesthetic, characterized by catalepsy, amnesia, and marked analgesia without loss of consciousness or muscle relaxation in patients [39]. Purposeless movements, an increase in muscle tone and resistance to passive motion have been observed since the beginning of ketamine use [39]. These clinical presentations parallel the clinical signs of dissociative coma.…”

Section: Clinical Relevancementioning

confidence: 99%

Reanalysis of the patients who were diagnosed with hystero-epilepsy by Charcot

Komagamine¹,

Kokubun²,

Hirata³

2020

Preprint

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Background: The term "hysteria" is now recognized to refer to non-organic and functional disorders. Jean-Martin Charcot once attempted to identify the lesions responsible for hysteria as an organic disorder in his later years, but his effort failed. He classi ed hysteria as usual and grand. Grand hysteria was also called hystero-epilepsy, which became obsolete after Charcot's death and has been an enigma in modern neurology. After anti-NMDA receptor (NMDAR) encephalitis was established in the twenty-rst century, a paradigm shift emerged in the interpretation of acute onset of neuropsychiatric symptoms. Patients with anti-NMDAR encephalitis demonstrate a characteristic multistage progression and stereotypical movements, including opisthotonic posture, which are analogous to the staging progressions and ' arc de cercle' observed in Charcot's hystero-epilepsy.Methods: To elucidate the full picture of Charcot's hystero-epilepsy, we reviewed the patients presented in "the Tuesday Lessons".Results: Eleven patients were shown to have hystero-epilepsy by Charcot himself. Of the 11 patients, 4 patients had acute-onset neuropsychiatric symptoms, and 2 patients had a condition that resembled anti-NMDAR encephalitis. Although the clinical courses were similar to those of anti-NMDAR encephalitis, we could not make conclusive diagnoses of anti-NMDAR encephalitis without examinations due to the lack of evidence of teratomas. One patient with alcohol withdrawal syndrome and one patient with chronic pain and morphine withdrawal syndrome were also classi ed as having hystero-epilepsy by Charcot. The other patients, who manifested chronic courses or varying hypnosis-induced neurological symptoms, could be diagnosed with conversion and dissociative disorders today.Conclusions: Charcot's hystero-epilepsy has been suspected of being a syndrome encompassing conversion and dissociative disorders, drug withdrawal syndrome, and anti-NMDAR encephalitis-like manifestations. Charcot's observations combined with the current progress in molecular biology suggest that a common dysfunctional basis exists, such as glutamate/NMDAR system dysfunction, among these conditions.

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Dissociative Anesthesia

Cited by 39 publications

References 0 publications

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness

Anesthetic action on extra-synaptic receptors: effects in neural population models of EEG activity

Reanalysis of the patients who were diagnosed with hystero-epilepsy by Charcot

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