Anesth Pain Med.  2022 Oct;17(4):343-351. 10.17085/apm.22227.

General anesthesia and sleep: like and unlike

• Jung J
• Kim T

• KMID: 2535332
• DOI: http://doi.org/10.17085/apm.22227

Abstract

General anesthesia and sleep have long been discussed in the neurobiological context owing to their commonalities, such as unconsciousness, immobility, non-responsiveness to external stimuli, and lack of memory upon returning to consciousness. Sleep is regulated by complex interactions between wake-promoting and sleep-promoting neural circuits. Anesthetics exert their effects partly by inhibiting wake-promoting neurons or activating sleep-promoting neurons. Unconscious but arousable sedation is more related to sleep-wake circuitries, whereas unconscious and unarousable anesthesia is independent of them. General anesthesia is notable for its ability to decrease sleep propensity. Conversely, increased sleep propensity due to insufficient sleep potentiates anesthetic effects. Taken together, it is plausible that sleep and anesthesia are closely related phenomena but not the same ones. Further investigations on the relationship between sleep and anesthesia are warranted.

Keyword

General anesthesia; Neural pathways; Neurobiology; Sleep

Figure

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  Fig. 1. Similarities and differences in the mechanism of action of general anesthesia and sleep. General anesthesia and sleep have similar properties, as there is some degree of overlap in their neuronal circuitry. Sleep and anesthesia can be initiated by inhibiting the wake-promoting pathway or activating the sleep-promoting pathway. However, other mechanisms are thought to be used to reach the “Unconscious, Not arousable” state by general anesthesia, but the exact mechanism is not yet understood. LC: locus coeruleus, DRN: dorsal raphe nuclei, PPT: pedunculopontine tegmental nucleus, LDT: laterodorsal tegmental nucleus, VTA: ventral tegmental area, PB: parabrachial nucleus, TMN: tuberomammillary nuclei, LH: lateral hypothalamus, BF: basal forebrain, VLPO: ventrolateral preoptic area, PZ: parafacial zone, nNOS: neuronal nitric oxide synthase (nNOS)-containing neurons in the cortex, PPT: pedunculopontine tegmental nucleus, LDT: laterodorsal tegmental nucleus, SLD: sublaterodorsal nucleus. Figure were created using BioRender.com.

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