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doi: 10.1097/ALN.0b013e31826f8b9a

Unresponsiveness versus Unconsciousness

Pinsker, M. Craig M.D., Ph.D.

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To the Editor:

The review article1 writes about connectedness as an aspect of anesthesia. This is a major insight into what we mean by the term anesthesia. In 1986, I had defined anesthesia as paralysis defined as nonmovement, attenuation of the stress response, and unconsciousness.2 Unconsciousness I divided into amnesia and hypnosis, consistent with the classic terms used for anesthesia. The article was written as a protest to the arguments as to what is a real anesthetic at that time. Connectedness better defines a problem that I described in that only amnesia was typically used to prove that we had unconsciousness. The review clearly shows that amnesia should not be our only goal. Like most good theories, connectedness opens the door to more questions. Connected to what?
If we cut a nerve, it will respond. Is connectedness lost if it never gets past the spinal nerves, as in spinal anesthesia? If the impulse gets through the spine, where in the brain must it be unconnected for us to consider that we have fulfilled the criteria of our job as anesthesiologists? From chronic pain patients, there is a general understanding that a memory exists in nerve tissue, not just the higher centers. Should our goal be to make all nerve tissue unresponsive?
M. Craig Pinsker, M.D., Ph.D.
, Glen Allen, Virginia.
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1. Sanders RD, Tononi G, Laureys S, Sleigh JW. Unresponsiveness ≠ unconsciousness. Anesthesiology. 2012;116:946–59

2. Pinsker MC. Anesthesia: A pragmatic construct. Anesth Analg. 1986;65:819–20

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