Frontiers in Bioscience-Scholar (FBS) is published by IMR Press from Volume 13 Issue 1 (2021). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with Frontiers in Bioscience.
Using neuroimaging to uncover awareness in brain-injured and anesthetized patients
*Author to whom correspondence should be addressed.
We cast a novel perspective on two distinct populations: patients who become accidentally intraoperatively aware after receiving general anesthesia and severely brain-injured patients who are diagnosed as being in a vegetative state. In both cases, patients are behaviorally non-responsive —and on this basis presumed to lack consciousness— yet, retain covert awareness. In both contexts, detecting consciousness is highly challenging, yet highly important for ensuring adequate patient care. Although great strides have been made in the development of depth-of-anesthesia monitors, these monitors have significant limitations. On the other hand, recent neuroimaging studies on severely brain-injured patients have developed neurobiologically-informed markers of conscious awareness that hold potential for improving monitoring of covert awareness during general anesthesia. Further research is required to determine the implementation of these assessments in the surgical context, and this approach provides promising avenues for improved detection of intraoperative awareness and prevention of accidental awareness under general anesthesia.