CONTEXT The terms "palliative sedation" and "terminal sedation" have been used to refer to both proportionate palliative sedation, in which unconsciousness is a foreseen but unintended side effect, and palliative sedation to unconsciousness, in which physicians aim to make their patients unconscious until death. It has not been clear to what extent palliative sedation to unconsciousness is acce...

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 un...

Unconsciousness resulting from exposure to increased levels of head-to-foot (+Gz) acceleration stress (501 unconsciousness episodes) on a centrifuge in asymptomatic, healthy human subjects was investigated. A method for quantitatively measuring the kinetics of the unconsciousness and associated phenomenon was developed. In addition, a theoretical framework for describing the central nervous sys...

A unifying theory of general anesthetic-induced unconsciousness must explain the common mechanism through which various anesthetic agents produce unconsciousness. Functional-brain-imaging data obtained from 11 volunteers during general anesthesia showed specific suppression of regional thalamic and midbrain reticular formation activity across two different commonly used volatile agents. These f...

In unconscious status (e.g., deep sleep and anesthetic unconsciousness) where cognitive functions are not generated there is still a significant level of brain activity present. Indeed, the electrophysiology of the unconscious brain is characterized by well-defined thalamocortical rhythmicity. Here we address the ionic basis for such thalamocortical rhythms during unconsciousness. In particular...

who received certification before 2000 to participate in its Maintenance of Certification in Anesthesiology process. She suggests that this approach may contribute to skepticism related to maintenance of life-long learning and the board certification process. I would suggest that clinical competency is primarily an assessment best performed locally in health facilities and systems. Although boa...