Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
Br J Anaesth. 2018 Jul;121(1):210-218. doi: 10.1016/j.bja.2018.03.008.
Mechanisms of anaesthetic actions on memory have largely focused on easily definable aspects of episodic memory, with emphasis on particular drug interactions on specific memory processes. However, the memory landscape of the perioperative experience includes many facets that lie outside these conceptualisations. These include patient recall of preoperative conversations, patient beliefs regarding allergies and unusual/uncommon anaesthetic events, memories of awareness, and particularly vivid dreams during anaesthesia. In no small part, memories are influenced by a patient's interpretations of events in light of their own belief systems. From the practitioner's point of view, relating fully to the patient's experience requires some framework of understanding. The purpose of this review is to highlight research over the previous decades on belief systems and their interactions with autobiographical memory, which organises episodic memories into a personally relevant narrative. As a result, memory is a set of continuously malleable processes, and is best described as a (re)constructive rather than photographic instantiation. Belief systems are separate but closely interacting processes with autobiographical memory. The interaction of a constantly evolving set of memories with belief systems can explain phenomena such as illusions, distortions, and (re)constructions of factitious events. How anaesthetics and our patient interactions influence these behaviours, and vice versa, will be important questions to explore and define with future research.
麻醉作用于记忆的机制主要集中在对情景记忆的易于定义的方面，重点是特定药物对特定记忆过程的特定相互作用。然而，围手术期体验的记忆景观包括许多概念化之外的方面。这些方面包括患者对术前谈话的回忆、患者对过敏和不常见/不寻常麻醉事件的看法、意识的记忆，以及麻醉期间特别生动的梦境。在很大程度上，记忆受到患者根据自己的信仰体系对事件的解释的影响。从从业者的角度来看，充分了解患者的体验需要某种理解框架。本综述的目的是强调过去几十年来关于信仰体系及其与自传体记忆相互作用的研究，自传体记忆将情景记忆组织成个人相关的叙述。因此，记忆是一系列不断可塑的过程，最好将其描述为（重新）构建而不是摄影实例。信仰体系是与自传体记忆分开但密切相互作用的过程。不断变化的记忆集与信仰体系的相互作用可以解释错觉、扭曲和虚构事件的（重新）构建等现象。麻醉和我们与患者的互动如何影响这些行为，反之亦然，将是未来研究需要探索和定义的重要问题。
