Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens

Linassi, Federico; Zanatta, Paolo; Tellaroli, Paola; Ori, Carlo; Carron, Michele

doi:10.1016/j.bja.2018.02.019

Cited by 38 publications

(23 citation statements)

References 44 publications

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“…In that case, the mental content can be similar to dreaming (Radek et al, 2018), or more distorted like ketamine-induced psychedelic subjective experiences. Connected consciousness in anesthesia refers to the subjective experience of self, and perception of information from the environment, which may happen in episodes of variable duration, and are not that rare (Sanders et al, 2017; Linassi et al, 2018; Radek et al, 2018). Such episodes can be observed immediately after laryngoscopy and tracheal intubation in approximately 5% of patients (Sanders et al, 2017).…”

Section: Introduction: General Anesthesia Is More Complex Than Simplymentioning

confidence: 99%

General Anesthesia: A Probe to Explore Consciousness

Bonhomme

Staquet

Montupil

et al. 2019

Front. Syst. Neurosci.

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General anesthesia reversibly alters consciousness, without shutting down the brain globally. Depending on the anesthetic agent and dose, it may produce different consciousness states including a complete absence of subjective experience (unconsciousness), a conscious experience without perception of the environment (disconnected consciousness, like during dreaming), or episodes of oriented consciousness with awareness of the environment (connected consciousness). Each consciousness state may potentially be followed by explicit or implicit memories after the procedure. In this respect, anesthesia can be considered as a proxy to explore consciousness. During the recent years, progress in the exploration of brain function has allowed a better understanding of the neural correlates of consciousness, and of their alterations during anesthesia. Several changes in functional and effective between-region brain connectivity, consciousness network topology, and spatio-temporal dynamics of between-region interactions have been evidenced during anesthesia. Despite a set of effects that are common to many anesthetic agents, it is still uneasy to draw a comprehensive picture of the precise cascades during general anesthesia. Several questions remain unsolved, including the exact identification of the neural substrate of consciousness and its components, the detection of specific consciousness states in unresponsive patients and their associated memory processes, the processing of sensory information during anesthesia, the pharmacodynamic interactions between anesthetic agents, the direction-dependent hysteresis phenomenon during the transitions between consciousness states, the mechanisms of cognitive alterations that follow an anesthetic procedure, the identification of an eventual unitary mechanism of anesthesia-induced alteration of consciousness, the relationship between network effects and the biochemical or sleep-wake cycle targets of anesthetic agents, as well as the vast between-studies variations in dose and administration mode, leading to difficulties in between-studies comparisons. In this narrative review, we draw the picture of the current state of knowledge in anesthesia-induced unconsciousness, from insights gathered on propofol, halogenated vapors, ketamine, dexmedetomidine, benzodiazepines and xenon. We also describe how anesthesia can help understanding consciousness, we develop the above-mentioned unresolved questions, and propose tracks for future research.

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Section: Introduction: General Anesthesia Is More Complex Than Simplymentioning

confidence: 99%

General Anesthesia: A Probe to Explore Consciousness

Bonhomme

Staquet

Montupil

et al. 2019

Front. Syst. Neurosci.

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“…Minimum standards for monitoring all patients during anaesthesia and recovery should be followed. Monitoring depth of anaesthesia (for example, using a bispectral index monitor) should be considered to avoid accidental awareness during surgery, particularly when total intravenous anaesthesia is used or when end‐tidal anaesthetic concentrations are not monitored during inhalational anaesthesia in obese patients. When neuromuscular blockade is planned, monitoring of neuromuscular function (most commonly with a peripheral nerve stimulator) is mandatory for the safe conduct of anaesthesia to reduce the likelihood of residual muscle weakness after surgery.…”

Section: Resultsmentioning

confidence: 99%

Perioperative care of the obese patient

Carron

Fakhr

Ieppariello

et al. 2020

British Journal of Surgery

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Background Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta‐analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non‐obese populations were used. Results and conclusion Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.

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“…Clinical parameters from the monitor or clinical signs being directly observed might work sometimes. The isolated forearm technique (IFT) was thought as the current gold standard for connected consciousness monitoring and was used to remind the anesthetist (21). Electroencephalogram derived bispectral index (BIS) or electroencephalogram (EEG) was once proved to be critical in preventing intraoperative awareness with explicit recall compared with clinical signs in most clinical researches (8)(9)(10)12).…”

Section: Discussionmentioning

confidence: 99%