La anestesia general y el sueño fisiológico, una visión fenomenológica integradora / An integrative phenomenological approach, general anesthesia, and physiological sleep

General anaesthesia is often homologated to physiological sleep whereas they only share some of the same characteristics. The differences are remarkable in electroencephalographic characteristics and in the way in which the state of disconnection from the environment is established. General anaesthesia and surgery are phenomena that alter the physiological cycles of postoperative sleep depending on the drugs used, the neurological depression achieved, the functional reserve of the patient and specific phenomena of neuroinflammation triggered by the surgery. Anaesthesia shares very partially the mechanisms that trigger sleep but shares a common phenomenon: the sleep inertia; They do share a common phenomenon: the inertia of awake- ning, possibly enhanced by anaesthesia in susceptible patients. Given the physiological importance of sleep in the postoperative reparative process, it is essential to recognize which patients are likely to influence their reconnection and to take preventive actions to minimize the impact on postoperative sleep architecture. This article describes the differences and similarities between anaesthetic and physiological sleep, including electroencephalographic differences, the effect of different anaesthetics on postoperative sleep architecture, the phenomenon of common inertia and neuroinflammation.

La anestesia general se la homologado frecuentemente al sueño fisiológico cuando solo comparten algunas de sus características. Las diferencias son llamativas en características electroencefalográficas y en la forma de instalar el estado de desconexión al medio. La anestesia general y la cirugía son fenómenos que alteran los ciclos fisiológicos del sueño posoperatorio dependiendo de las drogas, la depresión neurológica alcanzado, la reserva funcional del paciente y fenómenos específicos de neuroinflama- ción desencadenados por la cirugía. La anestesia comparte muy parcialmente los mecanismos que desencadenan el sueño. Si comparten un fenómeno común: la inercia del despertar, eventualmente potenciada por la anestesia. Dada la importancia fisiológica del sueño en el proceso reparativo post operatorio, son fundamentales el reconocimiento de los pacientes susceptibles de enlentecer su reconexión y eventuales acciones preventivas para minimizar efectos en la arquitectura del sueño posoperatorio y su requerimiento en el proceso de recuperación. El presente artículo, describe las diferencias y similitudes entre el sueño anestésico y el fisiológico, incluyendo las diferencias electroencefalograficas entre ambos, el impacto de diferentes anestésicos en la arquitectura del sueño posoperatorio, el fenómeno de la inercia común, comentando algunas acciones que ayudarían a disminuir estos problemas.

Effects of zolpidem and zaleplon on cognitive performance after emergent morning awakenings at Tmax: a randomized placebo-controlled trial.

STUDY OBJECTIVES: Prescription sleep aids are frequently used in the general population and even more frequently in spaceflight. To evaluate the risk to operational safety, a ground-based, double-blind, placebo-controlled study on the emergent awakening effects of zolpidem and zaleplon was conducted. METHODS: N = 34 participants (age M = 42.1 ± 9.7; 25 males; 9 Astronauts, 7 Astronaut candidates, and 18 Flight Controllers) were investigated for three nights separated by M = 10 days. They were randomized to ingestion of one of the following at lights out: placebo, 10 mg zaleplon, and either 5 mg (N = 20) or 10 mg (N = 14) zolpidem. They were awakened abruptly by alarm at the expected PK,max (1 hr after lights out for zaleplon; 1.5 hr for placebo/zolpidem). Participants were required to turn off the alarm and perform a cognitive test battery twice, separated by a 20-30 min reading break. They then returned to sleep and were awakened to perform the same cognitive tasks at an average of 6.7 hr after drug ingestion. RESULTS: Relative to placebo, the effects of 10 mg zaleplon and 5 mg zolpidem on cognitive performance were minor. In contrast, 10 mg zolpidem adversely affected cognitive throughput (p < 0.001), psychomotor vigilance (p < 0.001), working memory (p < 0.01), delayed word recall (p < 0.05), and subjective sleepiness (p < 0.01) at the first emergent awakening. At terminal awakening, neither cognitive performance nor subjective sleepiness was impaired after ingestion of zaleplon or zolpidem (5 mg and 10 mg) compared with placebo. CONCLUSIONS: Presleep ingestion of sleep medications, especially 10 mg zolpidem, poses a risk for performance errors after emergent awakenings near the expected PK,max. REGISTRATION: Optimize Astronaut Sleep Medication Efficacy and Individual Effects (clinicaltrials.gov ID NCT03526575).