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PubMed1990

Alfentanil potentiates midazolam-induced unconsciousness in subanalgesic doses.

The effects of alfentanil on the midazolam dose-response curve for hypnosis was studied with response to the verbal command as an end point in 95 patients. The analgesic effect of alfentanil was studied by measuring the threshold for pain caused by pressure on the trapezius muscle with the use of a dolorimeter in 21 patients. The study was randomized, double-blind, and performed on the unpremedicated patients with ASA physical status I or II. Alfentanil was found to reduce the midazolam ED50 value for the induction of anesthesia in a dose-dependent fashion. The smallest dose of alfentanil (3 micrograms/kg) that caused a marked shift of the midazolam dose-response curve to the left along the dose axis (from the ED50 of 270 micrograms/kg to the ED50 of 142 micrograms/kg, P less than 0.0005) represents approximately 2% of the alfentanil ED50 for induction of unconsciousness (130 micrograms/kg). Alfentanil (10 micrograms/kg) caused only a tendency for increase in the pain threshold, whereas a dose of 15 micrograms/kg significantly increased the pain threshold by 37% (P less than 0.05). The results demonstrate that alfentanil potentiates the hypnotic effect of midazolam in very small doses. The high potency of alfentanil in this respect, as compared to its analgesic potency, suggests a very specific mechanism of alfentanil-midazolam hypnotic interaction, one that most likely is based on a functional relationship between the GABA receptor-benzodiazepine receptor system and the opioid receptor system in mediation of hypnosis.

Adult↗
PubMed2003

Autonomy reconfigured: incorporating the role of the unconscious.

The principle of respect for autonomy has served as a pillar of American bioethics. Through its application in response to physician paternalism and as the basis for informed consent, it has attained preeminent status in the discipline. New challenges in health care warrant a re-examination of the origins of our autonomy. Developmental psychology, cognitive neuroscience, and behavioral neurology all emphasize the intimate relationship between our cognitive and emotional development, and through this, our conscious and unconscious minds. Our intellectual, and particularly our moral development, are instilled in us by our moral mentors, and consequently by our community as a whole. Autonomy and community are therefore inextricably interlinked, and our emphasis on liberty, rights, and privacy without the inclusion of family, community, and social responsibility is biologically unsound. Appreciation of this reality should lead to a more balanced set of bioethical norms.

Communication↗
PubMed1993

[Parenteral replacement of 1-T4 in hypothyroid patients with esophageal stenosis and unconsciousness].

Hypothyroid patients are usually treated with in an oral administration of 1-T4. When oral administration is impossible because of esophageal stenosis or unconsciousness in such patients, parenteral replacement is required. We prepared a solution of 1-T4 50 micrograms/ml for intravenous administration in Tohoku University Hospital as follows: 5mg of 1-T4 (Nakarai Co.) was dissolved in 1ml of 0.1N NaOH and diluted with 0.9% NaCl and sterilized with membrane filter. Two patients with esophageal stenosis due to thyroid cancer and esophageal cancer and one in a coma due to adrenal crisis had replacement with intravenous 1-T4. Initial doses of 12.5 micrograms or 25 micrograms diluted with 100ml of 0.9% NaCl containing 1% albumin were given by drip infusion. Every week 12.5 micrograms or 25 micrograms of 1-T4 was increased. By replacement of low doses, 50 micrograms or 75 micrograms, serum T4 reached a normal level. No adverse action was observed during or after parenteral replacement. The preparation of 1-T4 was stable at least for one year and 11 months. Parenteral replacement of T4 is a useful and safe method for patients who are unable to take drugs orally.

Aged↗
PubMed1995

[Unconsciousness due to hyponatremia in a patient with short stature with panhypopituitarism].

An unconscious woman of short stature (141 cm) was admitted to our hospital in March, 1994. She had hyponatremia (120 mEq/l) and had experienced massive bleeding during delivery. No increment of either plasma ACTH or cortisol levels was observed after insulin-induced hypoglycemia. However, urinary 17OHCS levels gradually increased after repeated intramuscular injections of ACTH. Plasma free T3 and free T4 levels were low. Neither plasma TSH nor prolactin (PRL) levels increased after an intravenous injection of TRH. Basal plasma LH, FSH and growth hormone (GH) levels were low and there were no observable responses to any of the stimulation tests. A magnetic resonance image (MRI) of her pituitary gland showed an empty sella. These results showed that she had a panhypopituitarism with primary empty sella. Replacement therapy with glucocorticoid was started and serum sodium levels normalized immediately. Levothyroxine was also administered. The possibility of pituitary dwarfism during her youth and a gradual postpartum reduction of other pituitary hormones may have caused an impairment of the hypothalamo-pituitary-adrenal axis.

Dwarfism, Pituitary↗
PubMed1992

Categorization: a fundamental of unconscious mental activity.

Association formation and categorization, phenomena below volition and awareness, are in the unconscious domain. They reflect automatic processes of brain circuitry. The formation and maintenance of associations and categories require as well as yield neural energy, energy arising from cerebral metabolic processes. Automatic categorization is a fundamental element in perceptual, motoric, and cognitive functions as emphasized by Edelman (1987) who, further, relates categorization to dynamic cerebral cortical fields and to limbic fields for the necessary affective component.

Aphasia↗
PubMed2004

The hallucination as the unconscious self.

This article describes the symbolic and phenomenological characteristics as well as the experiential process of the schizophrenic hallucination. Considerable attention is paid to insights derived from this type of treatment. Specifically, the concept of primary process is examined as well as the structural nature of the self in the schizophrenic psychosis. An internal three-dimensional model of a patient's unconscious hallucinatory self is presented.

Ego↗
PubMed2001

Hemophagocytic syndrome and adult Still's disease associated with meningoencephalitis and unconsciousness.

We describe a 19-year-old woman with hemophagocytic syndrome and adult Still's disease who showed rare features of central neurological involvement, including cerebellar symptoms and the sudden onset of unconsciousness with pleocytosis in the cerebrospinal fluid during the early course of the illness. As this patient's serum showed a high level of interferon-gamma and soluble interleukin 2 receptor, this might play a pathologic role in the development of central nervous system symptoms. Intensive treatment consisting of methylprednisolone pulse therapy followed by the oral administration of methylprednisolone and cyclosporine, as well as plasma exchange, was found to achieve good results.

Adult↗
PubMed1999

[Primary Sjögren's syndrome presenting as unconsciousness associated with IgA-lambda M-protein].

We describe the case of a 43-year-old woman who presented with primary Sjögren's syndrome (SS) which manifestated as unconsciousness due to M protein. A diagnosis of SS was made based on a ten-year history of dryness, a Shirmer test, and the histological findings of labial biopsy. A rouleaux formation was observed and serum protein electrophoresis revealed a monoclonal spike of 4.0 gm/dl in the gamma-region, which was characterized as IgA-lambda. Biopsy of the minor salivary glands showed marked polyclonal lymphoproliferation with lymphoid follicles, including both T cells and B cells as revealed by immunohistological staining. Therefore, the patient had a lymphoproliferative lesion of the minor salivary glands, which is also known as pseudolymphoma. We conclude that fainting associated with marked M protein may be manifestation of SS. Such cases should be followed carefully since the subsequent neoplastic transformation of pseudolymphomas have been previously reported.

Female↗
PubMed2006

Criteria for unconscious cognition: three types of dissociation.

To demonstrate unconscious cognition, researchers commonly compare a direct measure (D) of awareness for a critical stimulus with an indirect measure (I) showing that the stimulus was cognitively processed at all. We discuss and empirically demonstrate three types of dissociation with distinct appearances in D-I plots, in which direct and indirect effects are plotted against each other in a shared effect size metric. Simple dissociations between D and I occur when I has some nonzero value and D is at chance level; the traditional requirement of zero awareness is necessary for this criterion only. Sensitivity dissociations only require that I be larger than D; double dissociations occur whensome experimental manipulation has opposite effects on I and D. We show that double dissociations require much weaker measurement assumptions than do other criteria. Several alternative approaches can be considered special cases of our framework.

Cognition↗
PubMed2004

Unconscious perception and the classic dissociation paradigm: a new angle?

Reingold and Merikle's (1988, 1990) critique of the classic dissociation paradigm identified the exhaustiveness, exclusiveness, null sensitivity, and task comparability issues as inherent problems that severely undermine the utility of this paradigm. Snodgrass, Bernat, and Shevrin (2004) attempt to provide solutions to these problems and claim to propose a novel conceptual and methodological framework for the study of unconscious perception. Unfortunately, the present analysis indicates that the approach proposed by Snodgrass et al. involves the same problems as do previous implementations of the classic dissociation paradigm.

Dissociative Disorders↗
PubMed1999

A signal detection theory analysis of an unconscious perception effect.

The independent observation model (Macmillan & Creelman, 1991) is fitted to detection-identification data collected under conditions of heavy masking. The model accurately predicts a quantitative relationship between stimulus detection and stimulus identification over a wide range of detection performance. This model can also be used to offer a signal detection interpretation of the common finding of above-chance identification following a missed signal. While our finding is not a new one, the stimuli used in this experiment (redundant three-letter strings) differ slightly from those used in traditional signal detection work. Also, the stimuli were presented very briefly and heavily masked, conditions typical in the study of unconscious perception effects.

Adolescent↗
PubMedDate not supplied

[Characteristics of the strategy of intensive care of unconscious children].

Three major groups can be distinguished among children hospitalized in resuscitation and intensive care wards in a state of unconsciousness: patients with bacterial meningitis and meningoencephalitis, viral meningoencephalitis, and noninfectious involvement of the NCS. Common strategy of treatment of these patients is characterized by some specific features: etiotropic antibiotic therapy in group 1 patients, antiviral drugs in group 2, and mainly symptomatic measures in group 3. Immunotherapy used in each of these groups is substitute in group 1, immunomodulating and immunostimulating in group 2 and even more so in group 3. Better results in group 1 are due to highly effective etiotropic antibiotics and drugs.

Adolescent↗
PubMed2001

[An unconscious patients with ascending aortic aneurysm accompanied by aortic regurgitation successfully treated by emergency operation after cardiopulmonary resuscitation].

A-37-year-old woman in shock condition was transferred to our hospital after cardiopulmonary resuscitation for ventricular fibrillation. She was unconscious and suspected of suffering ischemic brain damage, with pathologic reflexes and weak brain stem reflexes. Brain CT scan showed cerebral edema without hemorrhage or infarction and an electroencephalograph revealed slow alpha-theta waves. Chest CT scan and echocardiogram showed ascending aortic aneurysm with sever aortic regurgitation. An emergent operation was performed for progression of heart failure. There were no distortion or dilatation of the sinus of Valsalva and annuloaortic ectasia and aortic valve leaflets were almost normal. We considered that the aortic valve dysfunction was cause by dilatation of the sinotubular junction. Ascending aortic and aortic valve replacement were carried out to shorten cardiopulmonary bypass time and to prevent the progression of brain damage. Mild hypothermia was employed as a neuroprotective procedure for three days after surgery. The patient's neurological symptoms, which were right hemiparesis, facial apraxia and motor aphasia, improved and she was discharged from the hospital on foot without any neurological complications on the 47th postoperative day and returned to work after two months.

Adult↗
PubMed1975

[The language of the unconscious].

The concept of consciousness, separate from that of vigilance, can be defined as the immediate knowledge of motor-perceptual activities on the cognitive assimilation of the real duration. The linguistic theories distinguish in the language first of all linguistic competence, it is grouping of signs or linguistic knowledge of the group, which one can compare to phenomenon of automatism, and secondly the spoken language or linguistic performance, a creative individual and voluntary act. The observation of aphasics and of a certain partial temporal epileptics permits to dissociate these two forms of language. That of the consciousness linked to the immediate observation of the self by ones' self could only be the creative word. The unconscious listener, separated from real time, without real creative ability, could only be the "-echo-souvenir" of the conscient person.

Aged↗
PubMed1975

[Tracheo-bronchial aspiration of foreign material by the unconscious patient (author's transl)].

180 cases of head trauma were classified according to the degree of impairment of consciousness, clinical and neurological symptoms and EEG patterns. Based on the radiological and clinical findings and blood gas analyses a study was made of the incidence and extent of aspiration of blood, vomit or debris into the tracheo-bronchial tree and of the resultant pulmonary complications. As loss of consciousness became more complete the incidence of aspiration and the amount of material inhaled increased. Clinically and radiologically proven aspiration occurred in 60 per cent of cases of severe head trauma. A comparison of two groups after they had been given first aid and artificial respiration showed that the paO2 values were significantly lower in patients with radiologically proven aspiration and infiltration of the lungs than they were in those with normal chest radiograms. These observations point to the relationship between the quantity of material inhaled and the extent of intra-pulmonary shunting. There was no difference in the incidence of aspiration between persons who had been intubated and those who had not been intubated prior to admission to hospital. Although in many cases of head trauma aspiration of blood immediately after the accident can not be prevented prompt intubation is the only measure that will mitigate the consequences of aspiration and prevent its recurrence. As the latter is a very real risk in the unconscious person intubation in these cases is a "must". The study also showed that aspiration of foreign material into the tracheobronchial system and the resultant pulmonary complications can be successfully treated even if the head trauma is very severe. In none of the cases studied was death attributable to these causes. Apart from intubation and bronchial toilet artificial respiration with oxygen-enriched gas mixtures has a decisive influence on the course of the aspiration-induced pulmonary complications.

Adult↗
PubMedDate not supplied

[EEG spectral characteristics at different stages of the unconscious visual set in two motivation conditions].

Multichannel EEG were recorded in young healthy subjects in two series of experiments during formation, actualization, and extinction of the visual unconscious set to the perception of unequal circles under conditions of increased motivation of subjects to the result of their performance. In the first series of experiments, subjects were promised to be rewarded (a small money price) for each correct response (the "general" rise of motivation). In the second series, subjects were promised to be rewarded for correct responses only in cases when one of the circles was larger than the other one (the "directed" rise of motivation). The dynamics of the EEG spectral power derived under these two conditions was compared with similar indices obtained earlier during formation of the same set without any special motivation of subjects (control). In all experimental conditions, before the presentation of the stimuli the EEG power in the alpha range was higher in subjects with the stable set. The dynamics of changes in the alpha power at set stages was principally similar in all conditions. In all the experimental conditions, in subjects with unstable set the EEG power in the delta range was highest at the stage of set actualization. The most pronounced generalized changes in the EEG power in the theta-range during the "general" rise of motivation in subjects with stable and unstable forms of set and greater variability of the reaction time to the probe stimulus suggest that the task performance under these conditions required greater tension than under conditions of the "directed" rise of motivation.

Adolescent↗
PubMed2003

Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses.

The placebo and nocebo effect is believed to be mediated by both cognitive and conditioning mechanisms, although little is known about their role in different circumstances. In this study, we first analyzed the effects of opposing verbal suggestions on experimental ischemic arm pain in healthy volunteers and on motor performance in Parkinsonian patients and found that verbally induced expectations of analgesia/hyperalgesia and motor improvement/worsening antagonized completely the effects of a conditioning procedure. We also measured the effects of opposing verbal suggestions on hormonal secretion and found that verbally induced expectations of increase/decrease of growth hormone (GH) and cortisol did not have any effect on the secretion of these hormones. However, if a preconditioning was performed with sumatriptan, a 5-HT(1B/1D) agonist that stimulates GH and inhibits cortisol secretion, a significant increase of GH and decrease of cortisol plasma concentrations were found after placebo administration, although opposite verbal suggestions were given. These findings indicate that verbally induced expectations have no effect on hormonal secretion, whereas they affect pain and motor performance. This suggests that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved, whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play, even though a conditioning procedure is performed.

Aged↗
PubMed1992

[Communication with patients--the effect of verbal and nonverbal communication on the unconscious patient].

Communication, both verbal and non-verbal, is a greatly neglected skill at present. Two reasons given for this state of affairs are lack of time and lack of interest in others. Since it is difficult to separate verbal and non-verbal communication, the effects of both types were studied, whether or not they occurred simultaneously. Empirical evidence shows that unconscious patients are highly sensitive to the nature of communication, and that their intracranial pressures rise or fall concomitant in the way in which a conversation is being conducted within hearing distance. Music and touch seem to have similar consequences. The influence of communication is, however, not confined to intracranial pressure changes. The sympathetic and parasympathetic nervous systems are also affected, with associating changes in the heart rate. Messages of acceptance or rejection may be conveyed verbally or non-verbally. Communication with patients appears to be decisive, and should therefore warrant far greater attention than it receives at present.

Clinical Nursing Research↗