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Dreaming and awareness during dexmedetomidine- and propofol-induced unresponsiveness
Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, Turku,Finland / Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, Turku,Finland.
Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland / Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
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2018 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 121, no 1, p. 260-269Article in journal (Refereed) Published
Abstract [en]

Background: 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. Methods: Healthy participants received dexmedetomidine (n = 23) or propofol (n = 24) in stepwise increments until loss of responsiveness (LOR1). During TCI we attempted to arouse them for interview (return of responsiveness, ROR1). After the interview, if unresponsiveness ensued with the same dose (LOR2), the procedure was repeated (ROR2). Finally, the concentration was increased 1.5-fold to achieve presumable loss of consciousness (LOC), infusion terminated, and the participants interviewed upon recovery (ROR3). An emotional sound stimulus was presented during LORs and LOC, and memory for stimuli was assessed with recognition task after recovery. Interview transcripts were content analysed. Results: Of participants receiving dexmedetomidine, 18/23 were arousable from LOR1 and LOR2. Of participants receiving propofol, 10/24 were arousable from LOR1 and two of four were arousable from LOR2. Of 93 interviews performed, 84% included experiences from periods of unresponsiveness (dexmedetomidine 90%, propofol 74%). Internally generated experiences (dreaming) were present in 86% of reports from unresponsive periods, while externally generated experiences (awareness) were rare and linked to brief arousals. No within drug differences in the prevalence or content of experiences during infusion vs after recovery were observed, but participants receiving dexmedetomidine reported dreaming and awareness more often. Participants receiving dexmedetomidine recognised the emotional sounds better than participants receiving propofol (42% vs 15%), but none reported references to sounds spontaneously. Conclusion: Anaesthetic-induced unresponsiveness does not induce unconsciousness or necessarily even disconnectedness.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 121, no 1, p. 260-269
Keywords [en]
awareness, consciousness, dexmedetomidine, interview, propofol
National Category
Psychology
Research subject
Consciousness and Cognitive Neuroscience
Identifiers
URN: urn:nbn:se:his:diva-16026DOI: 10.1016/j.bja.2018.03.014ISI: 000439025500070PubMedID: 29935581Scopus ID: 2-s2.0-85046688138OAI: oai:DiVA.org:his-16026DiVA, id: diva2:1236363
Conference
10th International Symposium on Memory and Awareness in Anesthesia (MAA), Helsinki, Finland, June 19-21, 2017
Available from: 2018-08-02 Created: 2018-08-02 Last updated: 2018-10-22Bibliographically approved

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Revonsuo, AnttiValli, Katja

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