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PubMed2004

The outcome of abdominoplasty performed under conscious sedation: six-year experience in 153 consecutive cases.

The use of conscious sedation is rapidly gaining acceptance and popularity in plastic surgery. At the present time, many procedures are performed using intravenous sedation and local anesthesia. The purpose of this article was to examine the safety and outcome of full abdominoplasties performed under conscious sedation at the authors' institution. Over a 6-year period from 1997 to 2002, 266 abdominoplasties were performed by the two senior authors. One hundred thirteen of these (42 percent) were performed under a general or regional anesthetic because a concurrent procedure was performed that precluded the use of conscious sedation (64 hysterectomies, 18 hernia repairs, six urogynecologic procedures, 10 breast reductions, and one laparoscopic cholecystectomy) or because of patient and surgeon preference (14 cases). One hundred fifty-three abdominoplasties (58 percent) were performed under conscious sedation using intravenous midazolam and fentanyl along with a local anesthetic. No patients had an unplanned conversion to deep sedation or general anesthesia. Eighty percent of these cases were performed with a concurrent procedure (80 liposuctions, 19 breast augmentations, 20 mastopexies, three capsulotomies, and 13 varied facial aesthetic procedures). In addition, 12 patients had concurrent hernia repairs (five ventral and seven umbilical) under conscious sedation. Mean follow-up was 10 months (range, 1 to 56 months). There were no intraoperative complications and no major postoperative complications. The minor complication rate was 11.1 percent (10 seromas requiring needle aspiration in the office, three superficial wound infections, two cases of marginal skin necrosis, one stitch abscess, and one pseudobursa requiring reexcision). Seven revisions were performed for suboptimal scars (5 percent). The results of this study demonstrate that abdominoplasties can be performed under conscious sedation in a safe and cost-effective manner for almost all patients. This type of procedure is well tolerated, has a low complication rate, and has high patient satisfaction. Increasing experience and small modifications in local anesthesia and surgical technique have strengthened the authors' conviction that conscious sedation is the preferred method of anesthesia for most patients undergoing abdominoplasty.

Abdominal Wall↗
PubMed2005

Residual cognitive function in comatose, vegetative and minimally conscious states.

PURPOSE OF REVIEW: The clinical evaluation of cognition in non-communicative severely brain-damaged patients is inherently difficult. In addition to novel behavioural 'consciousness-scales', the role of para-clinical markers of consciousness, such as event related potentials and functional neuroimaging is reviewed. RECENT FINDINGS: New behavioural scales for vegetative and minimally conscious patients have been shown to reduce diagnostic error but regrettably remain underused in clinical routine. Electrophysiological studies have confirmed their role in estimating outcome and possibly cognition. Several recent functional neuroimaging studies have shown residual cortical function in undeniably vegetative patients. This cortical activation, however, seems limited to primary 'low-level' areas and does not imply 'higher-order' integration, considered necessary for conscious perception. Minimally conscious patients show large-scale high-order cerebral activation, apparently dependent upon the emotional relevance of the stimulation. SUMMARY: Careful clinical assessment of putative 'conscious behaviour' in vegetative and minimally conscious patients is the first requirement for their proper diagnosis and management. Complementary functional neuroimaging and electrophysiological studies will have a major impact on future clinical decision making and may guide selective therapeutic options. At present, more experimental evidence and the elucidation of methodological and ethical controversies are awaited prior to their routine clinical use.

Cognition↗
PubMed1995

Shyness and public self-consciousness: additive or interactive relation with social interaction?

Shy people are characterized as engaging in self-derogatory thinking leading to anxiousness and inhibition, while people who are publicly self-conscious are focused on the impression they create on others. In addition, public self-consciousness has been described as an antecedent of shyness. In the present research, we tested additive versus interactive hypotheses about the association of shyness and public self-consciousness with dysfunctional social interaction. Undergraduate men varying in shyness and public self-consciousness engaged in a conversation with an unfamiliar woman confederate. Following the conversation, subjects completed self-report measures focusing on their responses during the conversation. Only main effects for shyness and public self-consciousness were found, supporting an additive hypothesis. Shyness was related to all dependent variables reflecting a negative self-bias, while public self-consciousness was not. In particular, shyness was inversely related to the balance of subjects' positive and negative thoughts and to reported use of protective as well as avoidance of acquisitive self-presentation responses. Public self-consciousness was positively related to use of protective self-presentation responses but unrelated to acquisitive responses.

Adult↗
PubMedDate not supplied

The role of health consciousness in predicting attention to health warning messages.

PURPOSE: Guided by information processing theory and the health belief model, this paper considers the relationship between health consciousness among the general population and attention to environmental health warnings about alcohol consumption. Mechanisms of exposure to three dominant types of impersonal alcohol-related health messages in the environment are explored. DESIGN: Cross-sectional survey using telephone interview data. SUBJECTS: A representative nationwide sample of adults was interviewed in 1993 (n = 1026), with a response rate of 63%. MEASURES: Key variables include exposure to warning labels on alcoholic beverages, to point-of-sale posters, and to advertisements in the media, as well as respondents' alcohol consumption, health problems (indicative of salience of health warnings), and level of health consciousness assessed by items tapping concern with nutrition and seeking information on health topics. RESULTS: In the total sample, over a third had seen a warning label or poster and almost all had seen an advertisement about the risks associated with alcohol consumption in 1993. Survey respondents scored very high on five individual items that make up the health consciousness scale introduced here, with 69% endorsing all items. The scale demonstrated good internal reliability (alpha = .70) and was significantly correlated (p < .01) with not enjoying getting drunk and with usually reading product warning labels, suggesting construct validity. Yet the hypothesized strong relationships between health consciousness and attention to health warnings about drinking were not observed; nor was salience of messages a predictor of recall. Importantly, high proportions of underage drinkers and young adults at elevated risk for drinking problems are reached by container warning label messages. Mechanisms of exposure recall vary based on message source, with "container label recall" associated with heavier drinking, younger age, and purchasing patterns; "poster recall" associated with purchasing and health consciousness; and "advertisement recall" associated with heavy consumption and younger age. CONCLUSIONS: These results are contrary to predictions from skeptics of broad-based informational interventions, who argue that only the already-health conscious are attentive to health warnings about the risks of alcohol consumption. These data suggest that the label is reaching intended target audiences, especially younger people, males, and heavier alcohol consumers. Future research in predicting attention to impersonal health warnings in the environment should continue to improve the assessment of constructs such as salience and health consciousness, and should further test the applicability of available theoretical models. Subsequent research should also consider additional measures to tap mechanisms of exposure to impersonal health messages to enable a better understanding of the population that is not being reached by such public health interventions.

Adolescent↗
PubMed2003

Dental anxiety and personality: investigating the relationship between dental anxiety and self-consciousness.

This study investigated whether personality plays a role in a condition called dental anxiety. Specifically, the study examined the relationship between dental anxiety (the negative response to the stress elicited from a dental interaction) and self-consciousness (the tendency to evaluate aspects of oneself that are subject to private and public display). The purpose of this study was to identify the characteristics possessed by dentally anxious individuals who face potential health risks because of their avoidance. Sixty York University undergraduate students were recruited by convenience sampling to participate. These subjects completed Corah's Dental Anxiety Scale and the Self-Consciousness Scale. The Self-Consciousness Scale consists of three subscales, including private self-consciousness, public self-consciousness, and social anxiety. Results indicated an 0.54 significant correlation between dental anxiety and self-consciousness. The public self-consciousness and social anxiety subscales correlated the most with dental anxiety. Furthermore, the data did not indicate a significant moderating relationship for gender between the two aforementioned variables. These results contribute to the establishment of personality characteristics as one of the dimensions determining dental anxiety.

Adult↗
PubMed2006

The practice of conscious sedation by Senior Dental Surgeons in the Health Board Dental Service in the Republic of Ireland.

OBJECTIVE: To establish the nature and extent of the practice of conscious sedation by Senior Dental Surgeons in the Health Board Dental Service (HBDS) in the Republic of Ireland and to determine the barriers to the use of conscious sedation. DESIGN: Postal questionnaire survey. SETTING: The Health Board Dental Service in the Republic of Ireland in 2002. SUBJECTS AND MATERIALS: Questionnaires were sent to fifty-five Senior Dental Surgeons working in the HBDS. RESULTS: Fifty questionnaires (90.9%) were returned. Less than a quarter of Senior Dental Surgeons reported current sedation use in their area. Oral sedation was the most commonly used method with few using relative analgesia and less using intravenous sedation. Forty percent of Senior Dental Surgeons surveyed reported receiving training in conscious sedation as an undergraduate. Nearly 60% of those surveyed reported using conscious sedation in a previous employment. All respondents said the main barrier to the use of conscious sedation in the HBDS was the lack of training opportunities on the subject in Ireland. CONCLUSIONS: Conscious sedation techniques other than oral, are used to a very limited extent in the HBDS in Ireland. There is great interest amongst Senior Dental Surgeons in the increased use of conscious sedation techniques. A lack of training opportunities is the main barrier to the expansion of their use.

Adult↗
PubMed1986

[Prognostic significance of initial loss of consciousness in cerebrovascular disorders].

An initial loss of consciousness is of grave prognostic significance in patients with acute ischaemic cerebrovascular disorders, both as regards the early course as well as the long-term prognosis. The aim of this study was to assess the prognostic importance of an initial loss of consciousness in patients who had survived the acute stage. Thus, 133 out of 139 patients suffering from ischaemic cerebrovascular disorders who survived the first 3 weeks after a stroke were clinically re-examined after a mean follow-up period of more than two years. The other 6 patients had died as a result of a second stroke in the post-acute period. Patients with an initial loss of consciousness suffered cerebrovascular disturbances or fatal strokes in the follow-up period slightly more frequently than patients without an initial loss of consciousness. However, there were no convincing differences between the two groups. Indeed, on follow up, patients with an initial loss of consciousness were slightly less socially disabled than patients without an initial loss of consciousness. The results suggest that an initial loss of consciousness is no longer a factor of prognostic importance in patients who have survived the initial stage.

Brain Ischemia↗
PubMed1998

Epileptic seizures and pseudoseizures from the viewpoint of the hierarchy of consciousness.

Epileptic seizures and pseudoseizures in temporal lobe epilepsies were studied from the viewpoint of the hierarchy of consciousness. Twenty-two patients with temporal lobe epilepsies (TLE) who showed true amnesia or impairment of consciousness developing from the dreamy state, even though their actions and movement continued, were selected among 160 patients with TLE, nine patients with manifested pseudoseizures, pseudoseizure status, and complex partial seizure status (CPSE) were investigated. Twelve patients in whom impairment of consciousness followed the dreamy state recognized their own existence and maintained some self-directed consciousness. The other 10 patients with amnesia were aware of their goals. Furthermore, pseudostatus ranged from epileptic seizures during pseudoseizure status to pseudoseizures during status epilepticus (SE). In some cases of CPS, awareness and self-directed consciousness were only partially pseudoseizures, disorders of self-directed consciousness are assumed to influence awareness and arousal.

Adult↗
PubMed1993

How does a serial, integrated and very limited stream of consciousness emerge from a nervous system that is mostly unconscious, distributed, parallel and of enormous capacity?

Much of the nervous system can be viewed as a massively parallel, distributed system of highly specialized but unconscious processors. Conscious experience on the other hand is traditionally viewed as a serial stream that integrates different sources of information but is limited to only one internally consistent content at any given moment. Global Workspace theory suggests that conscious experience emerges from a nervous system in which multiple input processors compete for access to a broadcasting capability; the winning processor can disseminate its information globally throughout the brain. Global workspace architectures have been widely employed in computer systems to integrate separate modules when they must work together to solve a novel problem or to control a coherent new response. The theory articulates a series of increasingly complex models, able to account for more and more evidence about conscious functioning, from perceptual consciousness to conscious problem-solving, voluntary control of action, and directed attention. Global Workspace theory is consistent with, but not reducible to, other theories of limited-capacity mechanisms. Global workspace architectures must show competition for input to a neural global workspace and global distribution of its output. Brain structures that are demonstrably required for normal conscious experience can carry out these two functions. The theory makes testable predictions, especially for newly emerging, high-speed brain imaging technology.

Consciousness↗
PubMed2005

The remote roots of consciousness in fruit-fly selective attention?

A mechanistic study of consciousness need not be confined to human complexity. Other animals also display key behaviors and responses that have long been intimately tied to the measure of consciousness in humans. Among them are some very well-defined and measurable endpoints: selective attention, sleep and general anesthesia. That these three variables associated with changes in consciousness might exist even in a fruit-fly does not necessarily imply that a fly is "conscious", but it does suggest that some of the problems central to the field of consciousness studies could be investigated in a model organism such as Drosophila melanogaster. Demonstrating suppression of unattended stimuli, which is central to attention studies in humans, is now possible in Drosophila by measuring neural correlates of visual selection. By combining such studies with an eventual understanding of suppression in other arousal states in the fly, such as sleep and general anesthesia, we might be unraveling mechanisms relevant to consciousness as well.

Anesthesia, General↗
PubMedDate not supplied

Some essential differences between consciousness and attention, perception, and working memory.

When "divided attention" methods were discovered in the 1950s their implications for conscious experience were not widely appreciated. Yet when people process competing streams of sensory input they show both selective processes and clear contrasts between conscious and unconscious events. This paper suggests that the term "attention" may be best applied to the selection and maintenance of conscious contents and distinguished from consciousness itself. This is consistent with common usage. The operational criteria for selective attention, defined in this way, are entirely different from those used to assess consciousness. To illustrate the scientific usefulness of the distinction it is applied to Posner's (1994) brain model of visual attention. It seems that features that are often attributed to attention-like limited capacity-may more accurately be viewed as properties of consciousness.

Attention↗
PubMed1999

Conscious behavior explained.

Current neurobiological research on temporal binding in binocular rivalry settings contributes to a better understanding of the neural correlate of perceptual consciousness. This research can easily be integrated into a theory of conscious behavior, but if it is meant to promote a naturalistic theory of perceptual consciousness itself, it is confronted with the notorious explanatory gap argument according to which any statement of psychophysical correlations (and their interpretation) leaves the phenomenal character of, e.g., states of perceptual consciousness open. It is argued that research on temporal binding plays no role in a naturalistic theory of consciousness if the gap argument can be solved on internal philosophical grounds or if it turns out to be unsolvable at the time being. But there may be a way to dissolve or deconstruct it, and the accessibility of this way may well depend on scientific progress, including neurobiological research on the neural correlate of perceptual consciousness.

Brain↗
PubMed2000

Consciousness, content, and metacognitive judgments.

Because metacognition consists in our having mental access to our cognitive states and mental states are conscious only when we are conscious of them in some suitable way, metacognition and consciousness shed important theoretical light on one another. Thus, our having metacognitive access to information carried by states that are not conscious helps confirm the hypothesis that a mental state's being conscious consists in having a noninferential higher-order thought about that state. This higher-order-thought hypothesis readily explains the appearance to consciousness of confabulatory mental states-states that do not actually occur. This fits well with, and helps refine, the "No-Magic Hypothesis" advanced by Nelson and Narens (1990).

Cognition↗
PubMed2002

Cortical movement preparation before and after a conscious decision to move.

The idea that our conscious decisions determine our actions has been challenged by a report suggesting that the brain starts to prepare for a movement before the person concerned has consciously decided to move (Libet, Gleason, Wright, & Pearl, 1983). Libet et al. claimed that their results show that our actions are not consciously initiated. The current article describes two experiments in which we attempted to replicate Libet et al.'s comparison of participants' movement-related brain activity with the reported times of their decisions to move and also the reported times of their decisions of which hand to move. We also looked at the distribution of participants' reports over time to evaluate an alternative explanation of Libet et al.'s (1983) results. Although the Readiness Potential was usually present before all of the decisions to move, consistent with the findings of Keller and Heckhausen (1990) and Libet et al. (1983), we found that many reported decision times were before the onset of the Lateralized Readiness Potential, which measures hand-specific movement preparation. The latter finding is consistent with the conclusion that the LRP always started after the conscious decision to move. We conclude that even though activity related to movement anticipation may be present before a conscious decision to move, the cortical preparation necessary for the movement to happen immediately may not start until after the conscious decision to move.

Cerebral Cortex↗
PubMedDate not supplied

Consciousness and information selection.

The selection of information is considered from the point of view of the process necessary for its conscious apprehension, in the context of the limited memory of consciousness, and the discrete and slow mode of its operation. Published data and the results of our own observations touching upon the neurophysiology of consciously apprehended and consciously nonapprehended processes are cited. The advantages of consciously apprehended information over consciously nonapprehended information, associated with the possibility of its participation in the voluntary regulation of functions of the organism and in the organization of the abstract-verbal mode of communication, are underscored.

Consciousness↗
PubMedDate not supplied

An account of consciousness in physical and functional terms: a target for research in the neurosciences.

The neurophysiology of mental events cannot be fully understood unless that of consciousness is understood. As the first step in a top-down approach to that problem, one needs to find an account of consciousness as a property of the biological organism that can be clearly defined as such. However, if it is to deliver what must be expected of it, it should address what is commonly meant by the word consciousness. Unless the last condition is satisfied, the theory will fail to deliver what must ultimately be expected of it. Although current interest lies mainly in the higher functions of consciousness, such as its role in language and social relationships, the common usage of the word relates to modes of awareness that are not denied to creatures lacking language or social relationships. The basic features to be covered include awareness of the surrounding world, of the self, and of one's thoughts and feelings; the subjective qualities of phenomenal experience (qualia); the conditions a brain event must satisfy to enter consciousness; and the main divisions of mental events, such as sensations, feelings, perceptions, desires, volitions, and mental images. In the first four chapters we argue that these basic features of consciousness can all be accounted for in terms of just three categories of internal representations, each supported by the empirical evidence and each accurately definable in physical and functional terms. In the fifth, and last, chapter we take a closer look at two of the categories and what these in particular suggest as the most relevant lines of research in the contemporary spectrum of the neurosciences.

Animals↗
PubMedDate not supplied

Consciousness: a neurobiological approach.

Consciousness and the disorders of consciousness can be more fully understood once they are integrated with the neurobiology of mental events. After a review of animal and human research, we found several anatomical structures in the central nervous system are required for consciousness. Identification of the critical structures, however, depends on what is meant by consciousness. In the general sense of mental responsivity, the reticular activating system must be intact. Consciousness has also been defined as the awareness of the sights, sounds, and feelings of everyday experience. In this sense, the system of sensory inputs and outputs of the anterior temporal cortex, amygdala, and the hippocampus must be functional. There is no neural evidence for "higher" consciousness.

Animals↗
PubMed1996

Effects of lorazepam and diazepam on conscious and automatic memory processes.

Recent studies exploring benzodiazepine memory effects have used the distinction between explicit and implicit tasks. There is now increasing evidence that implicit tasks can be "contaminated" by conscious uses of memory and that unconscious (automatic) use of memory can contaminate explicit tasks, leading to mistaken estimates of their respective influences on memory performance. The aim of the present double-blind, double-placebo study was to assess the memory effects of diazepam and lorazepam using a process-dissociation procedure in a stem-completion task, this procedure providing uncontaminated estimates of conscious and automatic memory processes. The memory task was administrated to 60 healthy volunteers randomly assigned to one of three parallel groups (placebo, diazepam 0.3 mg/kg, lorazepam 0.038 mg/kg). Lorazepam markedly reduced conscious as well as automatic influences of memory. Diazepam also reduced conscious uses of memory, albeit to a lesser extent than lorazepam, but did not decrease the influence of automatic memory. Secondary analyses showed that when the deleterious effect on conscious uses of memory was equated between a diazepam subgroup and the lorazepam group, only lorazepam impaired the automatic use of memory. This study strongly suggests a qualitative difference in the memory effects of the two benzodiazepines. It has some implications regarding the relationships between states of consciousness and memory processes.

Adult↗