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Coma and general anesthesia demonstrate important similarities
Date:12/29/2010

o part of the circuit is the basal ganglia, within the front of the brain, which is used to control certain actions. It does this in part by setting up two feedback loops. One is a negative feedback release on behavior, and that part of the circuit is always active when overall brain activity is reduced, Dr. Schiff says. For example, it works to stop a sleeping person from physically acting out their dreams.

The second feedback loop, however, releases the brake imposed by the first feedback loop, the researchers say. Certain drugs, such as the sleep aid zolpidem (Ambien), and propofol, a powerful general anesthetic with similar pharmacologic properties, can trigger that loop to function, producing what is known as "paradoxical excitation."

This phenomenon described in transitions observed in the early stages of general anesthesia appears to be common across all three states, because the drugs are triggering this same feedback loop, the authors explain. Most people given propofol become agitated and confused shortly after falling unconscious. Some people who use Ambien walk, eat and carry out other complex behaviors in an altered state of consciousness arising from sleep. Surprisingly, Ambien has also been reported to restore communication and behavioral responsiveness in some severely brain injured patients. The linkage of these disparate observations within a common circuit model is one of the key insights in the authors' integrative review.

Eventually the brake is switched back on in these three states -- giving way to sedation and deeper sleep, or in the case of the severely brain patient, the return to a state of diminished responsiveness.

There is another phenomenon that results from this circuit, the authors say. "Emergence delirium is the flip side," says Dr. Brown. "For example, when bringing a person out of general anesthesia, the brain is woken up enough to be active, but it is not coherent or organized, which can explai
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Contact: Andrew Klein
ank2017@med.cornell.edu
212-821-0560
New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College
Source:Eurekalert

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