Unresponsiveness ≠ unconsciousness
Open accessAbstract
Consciousness is subjective experience. During both sleep and anesthesia, consciousness is common, evidenced by dreaming. A defining feature of dreaming is that, while conscious, we do not experience our environment; we are disconnected. Besides inducing behavioral unresponsiveness, a key goal of anesthesia is to prevent the experience of surgery (connected consciousness), by inducing either unconsciousness or disconnection of consciousness from the environment. Review of the isolated forearm technique demonstrates that consciousness, connectedness, and responsiveness uncouple during anesthesia; in clinical conditions, a median 37% of patients demonstrate connected consciousness. We describe potential neurobiological constructs that can explain this phenomenon: during light anesthesia the subcortical mechanisms subserving spontaneous behavioral responsiveness are disabled but information integration within the corticothalamic network continues to produce consciousness, and unperturbed norepinephrinergic signaling maintains connectedness. These concepts emphasize the need for developing anesthetic regimens and depth of anesthesia monitors that specifically target mechanisms of consciousness, connectedness, and responsiveness.
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Just across the threshold of lost responsiveness, there can still be fragments of experience or disconnected states of conscious processing.
“On the other end of the spectrum, just across the threshold of lost responsiveness (Sanders et al., 2012), there can still be fragments of experience or disconnected states of conscious processing (Huang et al., 2018b; Ní Mhuircheartaigh et al., 2013).”
From Conscious Processing and the Global Neuronal Workspace Hypothesis (2020) · cites this paper as Sanders et al., 2012
There is debate about the degree to which consciousness is present in sleep and during anesthetic sedation.
“and the degree to which it is present in sleep [13] and during anesthetic sedation [14,15].”
From Tests for consciousness in humans and beyond (2024) · cites this paper as [15]
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- Authors
- Sanders, R. D., Tononi, G., Laureys, S., Sleigh, J. W., & Warner, D. S.
- Affiliations
- Imperial College London (GB)
- University of Wisconsin–Madison (US)
- University of Liège (BE)
- University of Auckland (NZ)
- Chelsea and Westminster Hospital (GB)
- Venue
- Anesthesiology
- Published
- 2012-04-01
- Volume
- 116
- Issue
- 4
- Pages
- 946-959
- ISSN
- 0003-3022 (ISSN-L)
- PMC
- PMC3311716
- OpenAlex
- W4237872303
- Cited by
- 474
- References
- 126
- Citations by year
- 2026: 20 · 2025: 54 · 2024: 43 · 2023: 37 · 2022: 34 · 2021: 34 · 2020: 42 · 2019: 25 · 2018: 46 · 2017: 28 · 2016: 27 · 2015: 22 · 2014: 27 · 2013: 25 · 2012: 9
- FWCI
- 6.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anesthesiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- ResearchSpace (University of Auckland) (submittedVersion, cc-by)
- Funders
- European Commission
- National Institutes of Health (DP1OD000579)
- Medical Research Council
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Life Sciences › Neuroscience › Developmental Neuroscience › Anesthesia and Neurotoxicity Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Philosophy and Theoretical Science
- Keywords
- consciousness, anesthesia, sleep, dreams, depth of anesthesia monitoring, corticothalamic network, norepinephrine, subcortical mechanisms
- MeSH terms
- Anesthesia, Animals, Consciousness, Dreams, Electroencephalography, Humans, Sleep, Unconsciousness, Wakefulness
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