Correspondence  |   November 2017
A Deeper Look at Anesthesia Depth
Author Notes
  • Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts. rknapp@tuftsmedicalcenter.org
  • This letter was sent to the author of the original article referenced above, who declined to respond.—Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief.
    This letter was sent to the author of the original article referenced above, who declined to respond.—Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief.×
  • (Accepted for publication July 26, 2017)
    (Accepted for publication July 26, 2017)×
Article Information
Correspondence
Correspondence   |   November 2017
A Deeper Look at Anesthesia Depth
Anesthesiology 11 2017, Vol.127, 904-905. doi:10.1097/ALN.0000000000001849
Anesthesiology 11 2017, Vol.127, 904-905. doi:10.1097/ALN.0000000000001849
The editorial by Garcia and Sleigh1  provided an outstanding discussion of ketamine’s complexities. Their conclusion, that we use a flawed concept of anesthesia depth, was insightful and provides a reason as well as an opportunity to suggest something more meaningful.
Anesthetic “depth” is one of our profession’s oldest and most used metaphors. As a metaphor, greater depth has long held connotations of an increased anesthetic dose and a traditionally strong connection to our observations of deep sleep.
In the past, this did not pose a particular problem, but now it does. Connecting greater depth to deeper sleep tends to push our thinking toward a unitary concept of anesthetic action, even though the unitary concept has been discredited. In this way, our most common metaphor actually hampers our using more appropriate concepts of anesthetic actions and interactions.
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