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Anesthesia awareness versus memory impairment: can we reach an optimal balance to avoid both?

A noteworthy endpoint of general anesthesia is the loss of memory. However, a ghastly difficulty of narcosis is the anesthesia awareness, a rare condition that happens when surgical patients can review their surroundings or an occasion identified with their surgery while they are under general anesthesia. Amid general anesthesia, the amnesia is, for the most part, accomplished with general anesthetic drugs, either intravenous or inhaled. In this process, diverse classes of drugs can be administered to achieve the goal of memory loss. There exists a “seesaw balance” between anesthesia awareness and memory impairment, i.e. light anesthesia is prone to cause intraoperative awareness, whereas deep anesthesia would damage memory irreversibly. How can the clinical anesthesia maintain the “balance” where neither anesthesia awareness nor memory impairment occurred? Is the intraoperative monitor good enough in keep these two terrible things away? Therefore, beginning from a brief portrayal of anesthesia awareness and memory impairment, then we concentrate on the anesthesia monitoring, the way to avoid the likelihood of both awareness and memory impairment amid general anesthesia. Through in-depth discussion, we proposed that a theoretical optimal anesthesia interval or window exists by depicting individual curves of consciousness and memory changes upon general anesthesia. Although it is not that easy for getting such predictable curves prior to anesthesia using currently available techniques, its clinical implications are indubitable, and it is hopeful for us to avoiding both anesthesia awareness and memory impairment via relying on this anesthesia interval or window.

Author(s): Liming Lei, Xiaofeng Shen, Shiqin Xu, Wei Wang, Yusheng Liu, Haibo Wu, Fuzhou Wang