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Correspondence  |   December 2010
On Memory, General Anesthesia, and Sleep
Author Notes
  • University of Iowa, Iowa City.
Article Information
Correspondence
Correspondence   |   December 2010
On Memory, General Anesthesia, and Sleep
Anesthesiology 12 2010, Vol.113, 1480-1481. doi:10.1097/ALN.0b013e3181fabf6e
Anesthesiology 12 2010, Vol.113, 1480-1481. doi:10.1097/ALN.0b013e3181fabf6e
To the Editor:
I read with great interest the erudite editorial that accompanied the article by Pham et al.  2 by my colleague, Professor Lichtor.1 In their article, Pham et al.  2 found no evidence of implicit memory formation during anesthesia in children.
Without providing clear and concise answers, Lichtor1 asks the following question: Is memory formation during anesthesia similar to what goes on during sleep?  General anesthesia abolishes explicit or conscious memory except in the rare cases of awareness during anesthesia.3 The evidence for memory formation beyond unconsciousness is controversial. It may occur only during light anesthesia, short of consciousness.4 When it occurs, there is only evidence of perceptual, but not conceptual, priming.5 As for sleep, Lichtor1 notes there is evidence that it contributes to the consolidation of some types of explicit memory. There are also some reports that it enhances the learning of motor and perceptual skills.6 
Lichtor1 asks another question: Would patients have better postoperative control of pain and anxiety if therapeutic instructions are given both preoperatively and intraoperatively?  My answer has to be negative. For patients to comprehend instructions during anesthesia, there must be conceptual priming, which does not occur during anesthesia—except at its lightest levels (e.g.  , nitrous oxide, opioids, and muscle relaxants),7 where conscious encoding of stimuli is still possible.5 After a 1988 report that claimed improved recovery and reduced hospital stay for patients after surgery,8 nearly all credible and controlled studies failed to replicate this finding or other beneficial findings relating to postsurgical analgesia, nausea and vomiting, cessation of smoking, and so on.9 The suggestion by Lichtor1 that anesthesia might be similar to sleep processes that facilitate memory consolidation cannot be true because anesthetics abolish memory by suppression  of consolidation.10–12 
Finally, although Hermann Ebbinghaus introduced many important ideas and methods for memory research (with himself as the sole subject) in the late 19th century, I would attribute the introduction of implicit or nonconscious forms of human memory to the literature at a much later date. The first suggestion that conscious or implicit memory exists was in 1957, when Scoville and Milner reported the case of patient H.M., who after surgery for epilepsy was unable to convert a new short-term memory into a permanent long-term memory.13 He could, however, learn new motor skills without any awareness that he had ever before performed the tasks. Research into implicit memory exploded in the early 1980s.13 
The above comments should not, however, obscure my agreement with my colleague's outstanding statement that, “although there are some similarities between anesthesia and sleep, general anesthesia is not really the same as sleep.”
University of Iowa, Iowa City.
References
Lichtor JL: Anesthesia teaching: Is it a brave new world? Anesthesiology 2010; 112:1063–4Lichtor, JL
Pham X, Smith KR, Sheppard SJ, Bradshaw C, Lo E, Davidson AJ: Implicit memory formation during routine anesthesia in children: A double-masked randomized controlled trial. Anesthesiology 2010; 112:1097–104Pham, X Smith, KR Sheppard, SJ Bradshaw, C Lo, E Davidson, AJ
Ghoneim MM: Awareness during anesthesia. Anesthesiology 2000; 92:597–602Ghoneim, MM
Kerssens C, Alkire M: Memory formation during general anesthesia, Consciousness, Awareness, and Anesthesia. Edited by Mashour GA. New York, Cambridge University Press, 2010, pp 47–73Kerssens, C Alkire, M Mashour GA New York Cambridge University Press
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Ghoneim MM, Block RI, Dhanaraj VJ, Todd MM, Choi WW, Brown CK: Auditory evoked responses and learning and awareness during general anesthesia. Acta Anaesthesiol Scand 2000; 44:133–43Ghoneim, MM Block, RI Dhanaraj, VJ Todd, MM Choi, WW Brown, CK
Evans C, Richardson PH: Improved recovery and reduced postoperative stay after therapeutic suggestions during general anesthesia. Lancet 1988; 2:491–3Evans, C Richardson, PH
Block RI, Ghoneim MM, Sum Ping ST, Ali MA: Efficacy of therapeutic suggestions for improved postoperative recovery presented during general anesthesia. Anesthesiology 1991; 75:746–55Block, RI Ghoneim, MM Sum Ping, ST Ali, MA
Veselis RA, Pryor KO: Propofol amnesia: what's going on in the brain? Suppressing the Mind: Anesthetic Modulation of Memory and Consciousness. Edited by Hudits A, Pearce R. New York, Humana Press, 2010, pp 215–43Veselis, RA Pryor, KO Edited by Hudits A, Pearce R New York Humana Press
Veselis RA, Pryor KO, Reinsel RA, Mehta M, Pan H, Johnson R Jr: Low-dose propofol-induced amnesia is not due to a failure of encoding: Left inferior prefrontal cortex is still active. Anesthesiology 2008; 109:213–24Veselis, RA Pryor, KO Reinsel, RA Mehta, M Pan, H Johnson, R
Alkire MT, Beydoun T, Miyashita T, McReynolds JR, Guzowski JF: Toward the mechanism of anesthetic-induced amnesia: Anesthetics shut down memory consolidation by inhibiting hippocampal Arc-protein synthesis in the rat [abstract]. Anesth Analg 2007; 104:S213Alkire, MT Beydoun, T Miyashita, T McReynolds, JR Guzowski, JF
Schater DL: Searching for memory. New York, Basic Books, 1996, pp 161–91Schater, DL New York Basic Books