Contemporary medical and surgical procedures have been completely transformed through the use of patient anaesthesia. Prior to the first use of diethyl ether as an anaesthetic in the United States in 1842, surgery, even for minor ailments, was often a painful process of last resort.

Nowadays the efficacy of anaesthesia is without question. Yet despite the development of ever more sophisticated compounds and methods of administration little is still known about how anaesthesia actually works.

Linda Geddes over at New Scientist has a fascinating article reviewing recent advancements in our understanding of anaesthesia, and its relevance in furthering our knowledge of consciousness in general.

[div class=attrib]From the New Scientist:[end-div]

I have had two operations under general anaesthetic this year. On both occasions I awoke with no memory of what had passed between the feeling of mild wooziness and waking up in a different room. Both times I was told that the anaesthetic would make me feel drowsy, I would go to sleep, and when I woke up it would all be over.

What they didn’t tell me was how the drugs would send me into the realms of oblivion. They couldn’t. The truth is, no one knows.

The development of general anaesthesia has transformed surgery from a horrific ordeal into a gentle slumber. It is one of the commonest medical procedures in the world, yet we still don’t know how the drugs work. Perhaps this isn’t surprising: we still don’t understand consciousness, so how can we comprehend its disappearance?

That is starting to change, however, with the development of new techniques for imaging the brain or recording its electrical activity during anaesthesia. “In the past five years there has been an explosion of studies, both in terms of consciousness, but also how anaesthetics might interrupt consciousness and what they teach us about it,” says George Mashour, an anaesthetist at the University of Michigan in Ann Arbor. “We’re at the dawn of a golden era.”

Consciousness has long been one of the great mysteries of life, the universe and everything. It is something experienced by every one of us, yet we cannot even agree on how to define it. How does the small sac of jelly that is our brain take raw data about the world and transform it into the wondrous sensation of being alive? Even our increasingly sophisticated technology for peering inside the brain has, disappointingly, failed to reveal a structure that could be the seat of consciousness.

Altered consciousness doesn’t only happen under a general anaesthetic of course – it occurs whenever we drop off to sleep, or if we are unlucky enough to be whacked on the head. But anaesthetics do allow neuroscientists to manipulate our consciousness safely, reversibly and with exquisite precision.

It was a Japanese surgeon who performed the first known surgery under anaesthetic, in 1804, using a mixture of potent herbs. In the west, the first operation under general anaesthetic took place at Massachusetts General Hospital in 1846. A flask of sulphuric ether was held close to the patient’s face until he fell unconscious.

Since then a slew of chemicals have been co-opted to serve as anaesthetics, some inhaled, like ether, and some injected. The people who gained expertise in administering these agents developed into their own medical specialty. Although long overshadowed by the surgeons who patch you up, the humble “gas man” does just as important a job, holding you in the twilight between life and death.

Consciousness may often be thought of as an all-or-nothing quality – either you’re awake or you’re not – but as I experienced, there are different levels of anaesthesia (see diagram). “The process of going into and out of general anaesthesia isn’t like flipping a light switch,” says Mashour. “It’s more akin to a dimmer switch.”

A typical subject first experiences a state similar to drunkenness, which they may or may not be able to recall later, before falling unconscious, which is usually defined as failing to move in response to commands. As they progress deeper into the twilight zone, they now fail to respond to even the penetration of a scalpel – which is the point of the exercise, after all – and at the deepest levels may need artificial help with breathing.

[div class=attrib]Read the entire article here.[end-div]

[div class=attrib]Image: Replica of the inhaler used by William T. G. Morton in 1846 in the first public demonstration of surgery using ether. Courtesy of Wikipedia. [end-div]