Write down the physiology of sleep. How does it differ from anaesthesia?

What phases occur in various stages of anaesthesia? -Normal Sleep-1] NREM-N1/N2/N3 (delta) -2] REM-a) Tonic-parasympathetically driven state -no eye movement b) Phasic-Sympathetically driven state -rapid eye movement -muscle twitches -respiratory variables -Sleep is a state of unconsciousness in which the brain is relatively more responsive to internal than external stimuli. It is a heightened anabolic state; accentuating the growth and rejuvenation of the immune, nervous, skeletal and muscular system. -Sleep proceeds in cycles of REM and NREM, the order normally being N1->N2->N3->N2->NREM -Sleep and other characteristics of sleep are commonly assessed by Polysomnography in a specialized sleep lab. -Measurements taken include i) EEG of brain waves ii) EOG of eye movements iii) EMG of skeletal muscles -In humans, each sleep cycle lasts from 90 to 110 minutes on average

-NREM-N1-alpha waves-8-13 Hz to theta waves 4-74 Hz, myoclonus -N2-sleep spindle-11 to 16 Hz, K-Complexes, muscular activity as measured by EMG decreases -occupies 45-55% of total sleep -N3-deep or slow wave sleep-theta wave-0.5 to 2Hz -parasomnia, nocturnal enuresis, sleep walking and somniloquy Occur -REM-20-25%of total sleep -rapid eye movement -rapid low voltage EEG DIFFERENCE BETWEEN GA AND SLEEP SLEEP Distinctive EEG patterns GA GA EEG most similar to that of a comatose brain Emergence from GA parallels recovery from coma Controlled by anaesthetic

Controlled by sleep wake cycle, circadian rhythm, switch of sleep is the ventriculolateral Preoptic nucleus of the anterior Hypothalamus

The predictable cycling of sleep, the reversal of relative external unresponsiveness are features that assist in distinguishing sleep from other states of consciousness. STAGES OF ANAESTHESIA -Four stages of anaesthesia -Stage 1-Induction -period between initial administration of the induction agents and loss of consciousness. -patient can carry on a conversation. -Stage 2-excitement stage -period following loss of consciousness -marked by excited and delirious activities -RR and HR become irregular -there may be vomiting, breath holding, and pupillary dilatation -since these may lead to airway compromise, rapidly acting drugs are used to minimize time in this stage and reach stage 3 as far as possible. -Stage 3-Surgical anaesthesia -skeletal muscle relaxation, patients breathing becomes

regular, eye movements slow and then stop -divided into 4 planes Plane 1-eyes initially rolling, and then become fixed Plane 2-loss of corneal and laryngeal reflexes Plane 3-pupils dilate and loss of light reflex Plane 4-intercostal paralysis, shallow abdominal respiration, dilated Pupils. -Stage 4-overdose -stage where too much medication given relative to the amount of surgical stimulation and the patient has severe brain stem or medullary depression. -this results in a cessation of respiration and potential cardiovascular collapse. -this stage is lethal, without cardiovascular and respiratory support