| 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. © Springer Nature Switzerland AG 2021. All rights reserved. |
