British journal of anaesthesia
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Life-threatening anaphylaxis occured in approximately 1 in 10,000 anaesthetics (NAP6 UK).
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Selfhood is linked to brain processes that enable the experience of a person as a distinct entity, capable of agency. This framework naturally incorporates a continuum of both non-conscious and conscious self-related information processing, and includes a hierarchy of components, such as awareness of existence (core self), embodied self (sentience), executive self (agency/volition), and various other higher-order cognitive processes. Consciousness relates to, but is not congruent, with selfhood; understanding the processes required for selfhood can explain the partial consciousness seen in anaesthesia. ⋯ With increasing concentrations of anaesthetics, it is not uncommon for patients to become depersonalised (i.e. to lose sentience and agency), but retain many higher-order functions and a disembodied self-awareness, until quite high concentrations are reached. In this respect, general anaesthesia differs significantly from physiological sleep, where it appears that loss of agency and sentience parallels, or lags behind, the decrease in self-awareness. Interestingly, connectivity within the posterior brain regions is maintained even to quite high concentrations of anaesthetics, potentially representing a pathognomonic marker of the core self that possibly is involved in maintaining a reduced energy state of homeostasis.
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Mechanisms of anaesthetic actions on memory have largely focused on easily definable aspects of episodic memory, with emphasis on particular drug interactions on specific memory processes. However, the memory landscape of the perioperative experience includes many facets that lie outside these conceptualisations. These include patient recall of preoperative conversations, patient beliefs regarding allergies and unusual/uncommon anaesthetic events, memories of awareness, and particularly vivid dreams during anaesthesia. ⋯ Belief systems are separate but closely interacting processes with autobiographical memory. The interaction of a constantly evolving set of memories with belief systems can explain phenomena such as illusions, distortions, and (re)constructions of factitious events. How anaesthetics and our patient interactions influence these behaviours, and vice versa, will be important questions to explore and define with future research.
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Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists. There is little published information on management and outcomes of perioperative anaphylaxis in the UK. ⋯ Management of perioperative anaphylaxis could be improved, especially with respect to administration of epinephrine, cardiac compressions, and i.v. fluid. Sequelae were common.
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Experiences during anaesthetic-induced unresponsiveness have previously been investigated by interviews after recovery. To explore whether experiences occur during drug administration, we interviewed participants during target-controlled infusion (TCI) of dexmedetomidine or propofol and after recovery. ⋯ NCT01889004.