• Kaspar Meyer.
• From the Institute of Anesthesiology, University Hospital, University of Zürich, Zürich, Switzerland, and the Brain and Creativity Institute, University of Southern California, Los Angeles, California.
• Anesthesiology. 2015 Jun 1;122(6):1415-31.

AbstractDespite considerable progress in the identification of the molecular targets of general anesthetics, it remains unclear how these drugs affect the brain at the systems level to suppress consciousness. According to recent proposals, anesthetics may achieve this feat by interfering with corticocortical top-down processes, that is, by interrupting information flow from association to early sensory cortices. Such a view entails two immediate questions. First, at which anatomical site, and by virtue of which physiological mechanism, do anesthetics interfere with top-down signals? Second, why does a breakdown of top-down signaling cause unconsciousness? While an answer to the first question can be gleaned from emerging neurophysiological evidence on dendritic signaling in cortical pyramidal neurons, a response to the second is offered by increasingly popular theoretical frameworks that place the element of prediction at the heart of conscious perception.

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