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Miller Anesthesiology.
Chapter 13 Awakening Focus of this issue 1.
Concepts related to arousal 2.
Brain regions, nuclei, and neurons that promote arousal 3.
The mechanism of action of anesthetics in the thalamus-cortex and cortex-cortexBy Danny & Cat & Characteristics of Miao Conceptual Awareness Awakening (maintaining a awake state) and cognition (subjective feeling) 01 When cognitive neuroscientists and philosophers use the term "cognitive awareness), they are limited to expressing "subjective experience"
.
However, in clinical anesthesiology, the term "cognition" is used to express consciousness and explicit episodic memory, which is inaccurate
.
02 Associative consciousness and separation consciousness Associated consciousness is an experience caused by environmental stimuli (such as surgery), while separation consciousness is an endogenous experience (such as a dream)
.
03 Consciousness and Response Individuals can clearly experience stimuli (such as the command "Open your eyes!"), but fail to respond (such as the patient's muscle paralysis during surgery and still be conscious)
.
Mechanisms of action of related regional anesthetics that promote arousal 1.
The thalamus 1.
The thalamus is involved in arousal, sensory processing (specific nuclei), and cortical information integration (non-specific and nuclei) 2.
Switches for anesthesia state transitions 3.
Most inhalation and nuclei Intravenous anesthetics (except ketamine) continue to inhibit thalamic metabolism 2.
Cortico-subcortical connections Propofol, sevoflurane, and dexmedetomidine lead to disruption of the connection between non-specific neural nuclei (integrated functions) and the cerebral cortex; Furthermore, recent studies have shown that ketamine temporarily blocks neuronal firing and gamma oscillations in the rat thalamocortical network
.
3.
Intercortical connections between propofol, sevoflurane, ketamine, and benzodiazepines lead to disruption of the frontal-parietal network functional connectivity; at the same time, the study found that anesthetics did not uniformly reduce functional connectivity, and the local meridian network The connectivity remains intact, but the functional connectivity of the cortical network is isolated in time and space
.
4.
Monitoring of dynamic changes during propofol induction period, cortical dynamic changes decreased during general anesthesia, the diversity of dynamic changes was impaired, but the dynamic changes tended to be stable; the redistribution of connections between discretely distributed neural structures may indicate recovery of consciousness during awakening process
.
Chapter 13 Awakening Focus of this issue 1.
Concepts related to arousal 2.
Brain regions, nuclei, and neurons that promote arousal 3.
The mechanism of action of anesthetics in the thalamus-cortex and cortex-cortexBy Danny & Cat & Characteristics of Miao Conceptual Awareness Awakening (maintaining a awake state) and cognition (subjective feeling) 01 When cognitive neuroscientists and philosophers use the term "cognitive awareness), they are limited to expressing "subjective experience"
.
However, in clinical anesthesiology, the term "cognition" is used to express consciousness and explicit episodic memory, which is inaccurate
.
02 Associative consciousness and separation consciousness Associated consciousness is an experience caused by environmental stimuli (such as surgery), while separation consciousness is an endogenous experience (such as a dream)
.
03 Consciousness and Response Individuals can clearly experience stimuli (such as the command "Open your eyes!"), but fail to respond (such as the patient's muscle paralysis during surgery and still be conscious)
.
Mechanisms of action of related regional anesthetics that promote arousal 1.
The thalamus 1.
The thalamus is involved in arousal, sensory processing (specific nuclei), and cortical information integration (non-specific and nuclei) 2.
Switches for anesthesia state transitions 3.
Most inhalation and nuclei Intravenous anesthetics (except ketamine) continue to inhibit thalamic metabolism 2.
Cortico-subcortical connections Propofol, sevoflurane, and dexmedetomidine lead to disruption of the connection between non-specific neural nuclei (integrated functions) and the cerebral cortex; Furthermore, recent studies have shown that ketamine temporarily blocks neuronal firing and gamma oscillations in the rat thalamocortical network
.
3.
Intercortical connections between propofol, sevoflurane, ketamine, and benzodiazepines lead to disruption of the frontal-parietal network functional connectivity; at the same time, the study found that anesthetics did not uniformly reduce functional connectivity, and the local meridian network The connectivity remains intact, but the functional connectivity of the cortical network is isolated in time and space
.
4.
Monitoring of dynamic changes during propofol induction period, cortical dynamic changes decreased during general anesthesia, the diversity of dynamic changes was impaired, but the dynamic changes tended to be stable; the redistribution of connections between discretely distributed neural structures may indicate recovery of consciousness during awakening process
.
