title: General anesthesia and altered states of arousal: a systems neuroscience analysis.
abstract: Placing a patient in a state of general anesthesia is crucial for safely and humanely performing most surgical and many nonsurgical procedures. How anesthetic drugs create the state of general anesthesia is considered a major mystery of modern medicine. Unconsciousness, induced by altered arousal and/or cognition, is perhaps the most fascinating behavioral state of general anesthesia. We perform a systems neuroscience analysis of the altered arousal states induced by five classes of intravenous anesthetics by relating their behavioral and physiological features to the molecular targets and neural circuits at which these drugs are purported to act. The altered states of arousal are sedation-unconsciousness, sedation-analgesia, dissociative anesthesia, pharmacologic non-REM sleep, and neuroleptic anesthesia. Each altered arousal state results from the anesthetic drugs acting at multiple targets in the central nervous system. Our analysis shows that general anesthesia is less mysterious than currently believed.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. enb@neurostat.mit.edu
authors.forename: Emery N
authors.initials: EN
authors.lastname: Brown
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Purdon
authors.forename: Christa J
authors.initials: CJ
authors.lastname: Van Dort
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000777:Anesthetics / Q000494:pharmacology*; D000818:Animals; D001143:Arousal / Q000187:drug effects*; D001921:Brain / Q000187:drug effects / Q000378:metabolism; D018682:GABA Agents / Q000494:pharmacology; D006212:Hallucinations / Q000139:chemically induced; D006801:Humans; D009488:Neurosciences / Q000379:methods*; D009638:Norepinephrine / Q000378:metabolism; D011957:Receptors, Opioid / Q000819:agonists / Q000378:metabolism
chemical_list: D000777:Anesthetics; D018682:GABA Agents; D011957:Receptors, Opioid; D009638:Norepinephrine