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Sedation; Is it Sleep, Is it Amnesia, What’s the Difference?

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Pediatric Sedation Outside of the Operating Room

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Abstract

This chapter presents recent concepts of the neuroanatomical physiology supporting conscious memory and consciousness. The relationships between sedation, anesthesia, and memory are elaborated. Emphasis is placed on the differences between drug-induced sedation and amnesia. Parallels to sleep physiology are discussed. Memory processes important in learning information from the outside world to form a permanent conscious memory are described in some detail. How the interaction of drug-induced amnestic and sedative properties impairs these processes is presented. Notably amnestic drugs allow conscious memories to be learned, but these are quickly forgotten. Interference with consolidation processes after learning is postulated as the basis for forgetting in the presence of amnestic drug. A review of commonly used sedative and anesthetic agents is undertaken with emphasis on their effects on conscious memory. Propofol, midazolam, and likely ketamine are true amnestic agents. Dexmedetomidine likely has mainly sedative effects. Finally, a number of pediatric case studies are presented to illustrate the clinical implications of amnestic versus sedative drug actions. Preventing unexpected awareness which is subsequently remembered is emphasized, with some recommendations on how to manage such a situation.

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Notes

  1. 1.

    Certain authorities consider dreaming as a form of consciousness as well.

  2. 2.

    http://psychclassics.yorku.ca/Ebbinghaus/memory7.htm last accessed 11/26/2019

  3. 3.

    Memories of a certain age, autobiographical memories, are very resistant to any intervention (though they are malleable, “sepia memories”). Thus HM who could form no new memories still had vivid recollections of memories of childhood, etc.

  4. 4.

    GABA is an inhibitory neurotransmitter, so it turns the receptor “off.”

  5. 5.

    The hypothesis that nitrous oxide could be used as an alternative to ECT to treat major depression is intriguing (http://www.sciencedirect.com/science/article/pii/S0306987709007786 last accessed 6/1/2013), as ketamine (or its oral congeners) is a drug of keen interest to rapidly treat major depression while drugs targeting other receptor systems are ramping up to their antidepressant effect. Berman et al. [198], and Zarate et al. [199].

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  1. Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Robert A. Veselis & Vittoria Arslan-Carlon

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    Keira P. Mason, MD

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Veselis, R.A., Arslan-Carlon, V. (2021). Sedation; Is it Sleep, Is it Amnesia, What’s the Difference?. In: Mason, MD, K.P. (eds) Pediatric Sedation Outside of the Operating Room. Springer, Cham. https://doi.org/10.1007/978-3-030-58406-1_14

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