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Linassi F, Zanatta P, Spano L, Burelli P, Farnia A, Carron M. Schnider and Eleveld Models for Propofol Target-Controlled Infusion Anesthesia: A Clinical Comparison. Life (Basel) 2023; 13:2065. [PMID: 37895446 PMCID: PMC10608783 DOI: 10.3390/life13102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Various pharmacokinetic/pharmacodynamic (PK/PD) models have been developed to accurately dose propofol administration during total intravenous anesthesia with target-controlled infusion (TIVA-TCI). We aim to clinically compare the performance of the Schnider model and the new and general-purpose Eleveld PK/PD model during TIVA-TCI. METHODS We conducted a prospective observational study at a single center, enrolling 78 female patients, including 37 adults (aged < 65 years) and 41 elderly patients (aged ≥ 65 years). These patients underwent breast surgery with propofol-remifentanil TIVA-TCI guided by the bispectral index (BIS) for depth of anesthesia monitoring (target value 40-60) and the surgical plethysmographic index (SPI) for antinociception monitoring (target value 20-50) without neuromuscular blockade. The concentration at the effect site of propofol (CeP) at loss of responsiveness (LoR) during anesthesia maintenance (MA) and at return of responsiveness (RoR), the duration of surgery and anesthesia (min), the time to RoR (min), the propofol total dose (mg), the deepening of anesthesia events (DAEs), burst suppression events (BSEs), light anesthesia events (LAEs) and unwanted spontaneous responsiveness events (USREs) were considered to compare the two PK/PD models. RESULTS Patients undergoing BIS-SPI-guided TIVA-TCI with the Eleveld PK/PD model showed a lower CeP at LoR (1.7 (1.36-2.25) vs. 3.60 (3.00-4.18) μg/mL, p < 0.001), higher CePMA (2.80 (2.55-3.40) vs. 2.30 (1.80-2.50) μg/mL, p < 0.001) and at RoR (1.48 (1.08-1.80) vs. 0.64 (0.55-0.81) μg/mL, p < 0.001) than with the Schnider PK/PD model. Anesthetic hysteresis was observed only in the Schnider PK/PD model group (p < 0.001). DAEs (69.2% vs. 30.8%, p = 0.001) and BSEs (28.2% vs. 5.1%, p = 0.013) were more frequent with the Eleveld PK/PD model than with the Schnider PK/PD model in the general patient population. DAEs (63.2% vs. 27.3%, p = 0.030) and BSEs (31.6% vs. 4.5%, p = 0.036) were more frequent with the Eleveld PK/PD model than with the Schnider PK/PD model in the elderly. CONCLUSIONS The Schnider and Eleveld PK/PD models impact CePs differently. A greater incidence of DAEs and BSEs in the elderly suggests more attention is necessary in this group of patients undergoing BIS-SPI-guided TIVA-TCI with the Eleveld PK/PD than with the Schnider model.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, Università Degli Studi di Padova, Via Marzolo 5, 35131 Padova, Italy
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Paolo Zanatta
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Leonardo Spano
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, 35100 Padova, Italy
| | - Paolo Burelli
- Department of Breast Oncologic Surgery, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Antonio Farnia
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, 31100 Treviso, Italy
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, 35100 Padova, Italy
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Cardone P, Bodart O, Kirsch M, Sanfilippo J, Virgillito A, Martial C, Simon J, Wannez S, Sanders RD, Laureys S, Massimini M, Vandewalle G, Bonhomme V, Gosseries O. Depth of sedation with dexmedetomidine increases transcranial magnetic stimulation-evoked potential amplitude non-linearly. Br J Anaesth 2023; 131:715-725. [PMID: 37596183 DOI: 10.1016/j.bja.2023.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Cortical excitability is higher in unconsciousness than in wakefulness, but it is unclear how this relates to anaesthesia. We investigated cortical excitability in response to dexmedetomidine, the effects of which are not fully known. METHODS We recorded transcranial magnetic stimulation (TMS) and EEG in frontal and parietal cortex of 20 healthy subjects undergoing dexmedetomidine sedation in four conditions (baseline, light sedation, deep sedation, recovery). We used the first component (0-30 ms) of the TMS-evoked potential (TEP) to measure cortical excitability (amplitude), slope, and positive and negative peak latencies (collectively, TEP indices). We used generalised linear mixed models to test the effect of condition, brain region, and responsiveness on TEP indices. RESULTS Compared with baseline, amplitude in the frontal cortex increased by 6.52 μV (P<0.001) in light sedation, 4.55 μV (P=0.003) in deep sedation, and 5.03 μV (P<0.001) in recovery. Amplitude did not change in the parietal cortex. Compared with baseline, slope increased in all conditions (P<0.02) in the frontal but not parietal cortex. The frontal cortex showed 5.73 μV higher amplitude (P<0.001), 0.63 μV ms-1 higher slope (P<0.001), and 2.2 ms shorter negative peak latency (P=0.001) than parietal areas. Interactions between dexmedetomidine and region had effects over amplitude (P=0.004) and slope (P=0.009), with both being higher in light sedation, deep sedation, and recovery compared with baseline. CONCLUSIONS Transcranial magnetic stimulation-evoked potential amplitude changes non-linearly as a function of depth of sedation by dexmedetomidine, with a region-specific paradoxical increase. Future research should investigate other anaesthetics to elucidate the link between cortical excitability and depth of sedation.
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Affiliation(s)
- Paolo Cardone
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium; Department of Neurology, University of Liège, Liège, Belgium
| | - Murielle Kirsch
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anaesthesia and Intensive Care Medicine, University of Liège, Liège, Belgium
| | - Julien Sanfilippo
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium
| | | | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium
| | - Jessica Simon
- Psychology and Neuroscience of Cognition, University of Liège, Liège, Belgium
| | - Sarah Wannez
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Camperdown, Australia; Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium; Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, University Laval, Québec City, QC, Canada
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; IRCCS Fondazione Don Gnocchi, Milan, Italy
| | - Gilles Vandewalle
- Sleep and Chronobiology Lab, GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium
| | - Vincent Bonhomme
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anaesthesia and Intensive Care Medicine, University of Liège, Liège, Belgium; University Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier Régional de la Citadelle (CHR Citadelle), Liège, Belgium.
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium.
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Assadzadeh S, Annen J, Sanz L, Barra A, Bonin E, Thibaut A, Boly M, Laureys S, Gosseries O, Robinson PA. Method for quantifying arousal and consciousness in healthy states and severe brain injury via EEG-based measures of corticothalamic physiology. J Neurosci Methods 2023; 398:109958. [PMID: 37661056 DOI: 10.1016/j.jneumeth.2023.109958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/09/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Characterization of normal arousal states has been achieved by fitting predictions of corticothalamic neural field theory (NFT) to electroencephalographic (EEG) spectra to yield relevant physiological parameters. NEW METHOD A prior fitting method is extended to distinguish conscious and unconscious states in healthy and brain injured subjects by identifying additional parameters and clusters in parameter space. RESULTS Fits of NFT predictions to EEG spectra are used to estimate neurophysiological parameters in healthy and brain injured subjects. Spectra are used from healthy subjects in wake and sleep and from patients with unresponsive wakefulness syndrome, in a minimally conscious state (MCS), and emerged from MCS. Subjects cluster into three groups in parameter space: conscious healthy (wake and REM), sleep, and brain injured. These are distinguished by the difference X-Y between corticocortical (X) and corticothalamic (Y) feedbacks, and by mean neural response rates α and β to incoming spikes. X-Y tracks consciousness in healthy individuals, with smaller values in wake/REM than sleep, but cannot distinguish between brain injuries. Parameters α and β differentiate deep sleep from wake/REM and brain injury. COMPARISON WITH EXISTING METHODS Other methods typically rely on laborious clinical assessment, manual EEG scoring, or evaluation of measures like Φ from integrated information theory, for which no efficient method exists. In contrast, the present method can be automated on a personal computer. CONCLUSION The method provides a means to quantify consciousness and arousal in healthy and brain injured subjects, but does not distinguish subtypes of brain injury.
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Affiliation(s)
- S Assadzadeh
- School of Physics, The University of Sydney, NSW 2006, Australia; Center for Integrative Brain Function, The University of Sydney, NSW 2006, Australia
| | - J Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - L Sanz
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - A Barra
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - E Bonin
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - A Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - M Boly
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA; Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - S Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium; Joint International Research Unit on Consciousness, CERVO Brain Research Centre, U Laval, Canada; International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - O Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - P A Robinson
- School of Physics, The University of Sydney, NSW 2006, Australia; Center for Integrative Brain Function, The University of Sydney, NSW 2006, Australia.
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Sun F, Wang Y, Li Y, Li Y, Wang S, Xu F, Wang X. Variation in functional networks between clinical and subclinical discharges in childhood absence epilepsy: A multi-frequency MEG study. Seizure 2023; 111:109-121. [PMID: 37598560 DOI: 10.1016/j.seizure.2023.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE Two types of spike-and-wave discharges (SWDs) exist in childhood absence epilepsy (CAE): clinical discharges are prolonged and manifest primarily as impaired consciousness, whereas subclinical discharges are brief with few objectively visible symptoms. This study aimed to compare neural functional network and default mode network (DMN) activity between clinical and subclinical discharges to better understand the underlying mechanism of CAE. METHODS Using magnetoencephalography (MEG) data from 21 patients, we obtained 25 segments each of clinical discharges and subclinical discharges. Amplitude envelope correlation analysis was used to construct functional networks and graph theory was used to calculate network topological data. We then compared differences in functional connectivity within the DMN between clinical and subclinical discharges. All statistical comparisons were performed using paired-sample tests. RESULTS Compared to subclinical discharges, the functional network of clinical discharges exhibited higher synchronization - particularly in the parahippocampal gyrus - as early as 10 s before the seizure. Additionally, the functional network of clinical SWDs presented an anterior shift of key nodes in the alpha frequency band. Regarding clinical discharge progression, there were gradual increases in the parameter node strengths (S), clustering coefficients (C), and global efficiency (E) of the functional networks, while the path lengths (L) decreased. These changes were most prominent at the onset of discharges and followed by some recovery in the high-frequency bands, but no significant change in the low-frequency bands. Furthermore, connections within the DMN during the discharge period were significantly stronger for clinical discharge compared to subclinical discharges. CONCLUSIONS These findings suggest that a more regular network before abnormal discharges in clinical discharges contributes to SWD explosion and that the parahippocampal gyrus plays an important role in maintaining oscillations. An absence seizure is a gradual process and the emergence of SWDs may be accompanied by initiation of inhibitory mechanisms. Enhanced functional connectivity among DMN brain regions may indicate that patients have entered a state of introspection, and functional abnormalities in the parahippocampal gyrus may be associated with patients' transient memory loss.
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Affiliation(s)
- Fangling Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yanzhang Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Siyi Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Fengyuan Xu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
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Bacchi S, Tan S, Slee M. Toward a common clinical lexicon of consciousness. Intern Emerg Med 2023; 18:1851-1853. [PMID: 37422543 PMCID: PMC10504159 DOI: 10.1007/s11739-023-03359-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Stephen Bacchi
- Department of Neurology, Flinders Medical Centre, SA Health, Flinders Drive, Bedford Park, SA, 5042, Australia.
- College of Medicine and Public Health, Flinders University of South, Adelaide, Australia.
- University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA, 5000, Australia
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, SA Health, Flinders Drive, Bedford Park, SA, 5042, Australia
- College of Medicine and Public Health, Flinders University of South, Adelaide, Australia
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56
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McCulloch TJ, Sanders RD. Depth of anaesthesia monitoring: time to reject the index? Br J Anaesth 2023; 131:196-199. [PMID: 37198033 DOI: 10.1016/j.bja.2023.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
Depth of anaesthesia monitors can fail to detect consciousness under anaesthesia, primarily because they rely on the frontal EEG, which does not arise from a neural correlate of consciousness. A study published in a previous issue of the British Journal of Anaesthesia showed that indices produced by the different commercial monitors can give highly discordant results when analysing changes in the frontal EEG. Anaesthetists could benefit from routinely assessing the raw EEG and its spectrogram, rather than relying solely on an index produced by a depth of anaesthesia monitor.
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Affiliation(s)
- Timothy J McCulloch
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia.
| | - Robert D Sanders
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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57
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Zilio F, Gomez-Pilar J, Chaudhary U, Fogel S, Fomina T, Synofzik M, Schöls L, Cao S, Zhang J, Huang Z, Birbaumer N, Northoff G. Altered brain dynamics index levels of arousal in complete locked-in syndrome. Commun Biol 2023; 6:757. [PMID: 37474587 PMCID: PMC10359418 DOI: 10.1038/s42003-023-05109-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
Complete locked-in syndrome (CLIS) resulting from late-stage amyotrophic lateral sclerosis (ALS) is characterised by loss of motor function and eye movements. The absence of behavioural indicators of consciousness makes the search for neuronal correlates as possible biomarkers clinically and ethically urgent. EEG-based measures of brain dynamics such as power-law exponent (PLE) and Lempel-Ziv complexity (LZC) have been shown to have explanatory power for consciousness and may provide such neuronal indices for patients with CLIS. Here, we validated PLE and LZC (calculated in a dynamic way) as benchmarks of a wide range of arousal states across different reference states of consciousness (e.g., awake, sleep stages, ketamine, sevoflurane). We show a tendency toward high PLE and low LZC, with high intra-subject fluctuations and inter-subject variability in a cohort of CLIS patients with values graded along different arousal states as in our reference data sets. In conclusion, changes in brain dynamics indicate altered arousal in CLIS. Specifically, PLE and LZC are potentially relevant biomarkers to identify or diagnose the arousal level in CLIS and to determine the optimal time point for treatment, including communication attempts.
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Affiliation(s)
- Federico Zilio
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padua, Italy.
| | - Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - Ujwal Chaudhary
- BrainPortal Technologies GmbH, Mannheim, Germany
- ALS Voice gGmbH, Mössingen, Germany
| | - Stuart Fogel
- School of Psychology, University of Ottawa, Ottawa, Canada
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Tatiana Fomina
- Department for Empirical Inference, Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Shumei Cao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zirui Huang
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
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Nemirovsky IE, Popiel NJM, Rudas J, Caius M, Naci L, Schiff ND, Owen AM, Soddu A. An implementation of integrated information theory in resting-state fMRI. Commun Biol 2023; 6:692. [PMID: 37407655 DOI: 10.1038/s42003-023-05063-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
Integrated Information Theory was developed to explain and quantify consciousness, arguing that conscious systems consist of elements that are integrated through their causal properties. This study presents an implementation of Integrated Information Theory 3.0, the latest version of this framework, to functional MRI data. Data were acquired from 17 healthy subjects who underwent sedation with propofol, a short-acting anaesthetic. Using the PyPhi software package, we systematically analyze how Φmax, a measure of integrated information, is modulated by the sedative in different resting-state networks. We compare Φmax to other proposed measures of conscious level, including the previous version of integrated information, Granger causality, and correlation-based functional connectivity. Our results indicate that Φmax presents a variety of sedative-induced behaviours for different networks. Notably, changes to Φmax closely reflect changes to subjects' conscious level in the frontoparietal and dorsal attention networks, which are responsible for higher-order cognitive functions. In conclusion, our findings present important insight into different measures of conscious level that will be useful in future implementations to functional MRI and other forms of neuroimaging.
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Affiliation(s)
- Idan E Nemirovsky
- Western Institute for Neuroscience, Department of Physics and Astronomy, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
| | - Nicholas J M Popiel
- Cavendish Laboratory, University of Cambridge, Cambridge, CB3 0HE, United Kingdom
| | - Jorge Rudas
- Institute of Biotechnology, Universidad Nacional de Colombia, Cra 45, Bogotá, Colombia
| | - Matthew Caius
- Western Institute for Neuroscience, Department of Physics and Astronomy, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
- Department of Medical Biophysics, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Lorina Naci
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Nicholas D Schiff
- Feil Family Brain Mind Research Institute, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Adrian M Owen
- Department of Physiology and Pharmacology and Department of Psychology, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Andrea Soddu
- Western Institute for Neuroscience, Department of Physics and Astronomy, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
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Kim YJ, Yoon HK, Kang YJ, Oh SJ, Hur M, Park HP, Lee HC. Autonomic responses during bladder hydrodistention under general versus spinal anaesthesia in patients with interstitial cystitis/bladder pain syndrome: a randomized clinical trial. Sci Rep 2023; 13:9248. [PMID: 37286619 DOI: 10.1038/s41598-023-36537-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
Blocking the abrupt increase in systolic blood pressure associated with autonomic response during bladder hydrodistention in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) is essential for patient safety. We conducted this study to compare autonomic responses during bladder hydrodistention in patients with IC/BPS under general and spinal anaesthesia. Thirty-six patients were randomly allocated to a general anaesthesia (GA, n = 18) or a spinal anaesthesia (SA, n = 18) group. Blood pressure and heart rate were measured continuously and ΔSBP, defined as maximum increases in SBP during bladder hydrodistention from baseline, was compared between groups. Heart rate variability was analysed using electrocardiograms. The post-anaesthesia care unit assessed postoperative pain using a numeric (0-10) rating scale. Our analyses yield a significantly greater ΔSBP (73.0 [26.0-86.1] vs. 2.0 [- 4.0 to 6.0] mmHg), a significantly lower root-mean-square of successive differences in heart rate variability after bladder hydrodistention (10.8 [7.7-19.8] vs. 20.6 [15.1-44.7] ms), and significantly higher postoperative pain scores (3.5 [0.0-5.5] vs. 0.0 [0.0-0.0]) in the GA compared to the SA group. These findings suggest that SA has advantages over GA for bladder hydrodistention in preventing an abrupt increase in SBP and postoperative pain in IC/BPS patients.
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Affiliation(s)
- Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yu Jin Kang
- Department of Urology, Pohang St Mary's Hospital, Pohang-si, Gyeongsangbuk-do, South Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Min Hur
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Linassi F, Kreuzer M, Kratzer S, Olivieri S, Zanatta P, Schneider G, Carron M. Unwanted spontaneous responsiveness and burst suppression in patients undergoing entropy-guided total intravenous anesthesia with target-controlled infusion: An observational prospective trial. J Clin Anesth 2023; 86:111045. [PMID: 36680980 DOI: 10.1016/j.jclinane.2022.111045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/14/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVE To estimate the incidence of unwanted spontaneous responsiveness and burst suppression (BSupp) in patients undergoing state entropy (SE) and surgical pleth index (SPI)-guided total intravenous anesthesia (TIVA) with target-controlled infusion (TCI). DESIGN Observational, prospective, single-center study. SETTINGS Operating room. PATIENTS 107 adult (<65 years) and elderly (≥65 years) women undergoing breast surgery. INTERVENTIONS Propofol-remifentanil TIVA-TCI-guided by SE for depth of anesthesia monitoring (target value 40-60) and SPI for antinociception monitoring (target value 20-50) without neuromuscular blockade. MEASUREMENTS Age; body mass index; American Society of Anesthesiologists physical status classification; concentration at the effect site of propofol (CeP) and remifentanil (CeR) at loss of responsiveness (LoR), median during anesthesia maintenance (MdM), and at return of responsiveness (RoR); propofol infusion duration; incidence of postoperative delirium (POD) with Confusing Assessment Method for the Intensive Care Unit. MAIN RESULTS During SE-SPI-guided TIVA-TCI, 13.1% of patients showed unwanted spontaneous responsiveness, whereas 45.8% showed BSupp. Unwanted spontaneous responsiveness was observed mainly in adults (p < 0.05), and higher CeP RoR (p < 0.05) was registered. BSupp was observed mainly in patients showing a lower CeP MdM (p < 0.01) and CeP RoR (p < 0.05). Unwanted spontaneous responsiveness and BSupp were not associated with significant differences in CeRs. An age-related hysteresis effect was observed, resulting in higher CeP LoR than CeP RoR (p < 0.001). 12.2% of patients showed POD. Only preoperative serum albumin was associated with increased likelihood of POD (p = 0.046). CONCLUSIONS The SE-SPI-guided TIVA-TCI did not prevent unwanted spontaneous responsiveness and BSupp. CeP RoR may be used as a proxy for anesthetic sensitivity.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, via Marzolo 5, 35131, Padova, Italy; Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy.
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Stephan Kratzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Sara Olivieri
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Piazzale Aristide Stefani 1, Verona 37121, Italy
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Hachenberg T, Scheller B. [Accidental Awareness during General Anaesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:380-390. [PMID: 37385244 DOI: 10.1055/a-1768-5161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Accidental awareness during general anaesthesia (AAGA) is a rare but severe complication. The reported incidence of AAGA may depend on the assessment of intraoperative awareness with explicit recall and there are substantial variations between subspecialties and groups of patients. The majority of prospective studies using structured interviews reported an incidence of AAGA at 0.1-0.2% during general anaesthesia, however, higher values were observed in paediatric (0.2-1.2%) and obstetric patients (0.47%). Risk factors that predispose to AAGA are patient conditions, ASA status, female gender, patient age, history of AAGA, surgical procedure, anaesthetic drug type, muscle relaxation, dosages of hypnotic or analgesic drugs, monitoring and malfunction of anaesthesia systems. Preventive strategies include careful assessment of risk factors, avoidance of underdosages of hypnotics and analgetics during general anaesthesia and monitoring of depth of anaesthesia in risk patients. The health-related consequences can be serious and psychopharmacological and psychotherapeutic interventions are indicated in patients who have experienced AAGA.
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Gervais C, Boucher LP, Villar GM, Lee U, Duclos C. A scoping review for building a criticality-based conceptual framework of altered states of consciousness. Front Syst Neurosci 2023; 17:1085902. [PMID: 37304151 PMCID: PMC10248073 DOI: 10.3389/fnsys.2023.1085902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
The healthy conscious brain is thought to operate near a critical state, reflecting optimal information processing and high susceptibility to external stimuli. Conversely, deviations from the critical state are hypothesized to give rise to altered states of consciousness (ASC). Measures of criticality could therefore be an effective way of establishing the conscious state of an individual. Furthermore, characterizing the direction of a deviation from criticality may enable the development of treatment strategies for pathological ASC. The aim of this scoping review is to assess the current evidence supporting the criticality hypothesis, and the use of criticality as a conceptual framework for ASC. Using the PRISMA guidelines, Web of Science and PubMed were searched from inception to February 7th 2022 to find articles relating to measures of criticality across ASC. N = 427 independent papers were initially found on the subject. N = 378 were excluded because they were either: not related to criticality; not related to consciousness; not presenting results from a primary study; presenting model data. N = 49 independent papers were included in the present research, separated in 7 sub-categories of ASC: disorders of consciousness (DOC) (n = 5); sleep (n = 13); anesthesia (n = 18); epilepsy (n = 12); psychedelics and shamanic state of consciousness (n = 4); delirium (n = 1); meditative state (n = 2). Each category included articles suggesting a deviation of the critical state. While most studies were only able to identify a deviation from criticality without being certain of its direction, the preliminary consensus arising from the literature is that non-rapid eye movement (NREM) sleep reflects a subcritical state, epileptic seizures reflect a supercritical state, and psychedelics are closer to the critical state than normal consciousness. This scoping review suggests that, though the literature is limited and methodologically inhomogeneous, ASC are characterized by a deviation from criticality, though its direction is not clearly reported in a majority of studies. Criticality could become, with more extensive research, an effective and objective way to characterize ASC, and help identify therapeutic avenues to improve criticality in pathological brain states. Furthermore, we suggest how anesthesia and psychedelics could potentially be used as neuromodulation techniques to restore criticality in DOC.
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Affiliation(s)
- Charles Gervais
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Centre for Advanced Research in Sleep Medicine & Integrated Trauma Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal, Montréal, QC, Canada
| | - Louis-Philippe Boucher
- Centre for Advanced Research in Sleep Medicine & Integrated Trauma Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal, Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Guillermo Martinez Villar
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Centre for Advanced Research in Sleep Medicine & Integrated Trauma Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal, Montréal, QC, Canada
- Department of Biomedical Sciences, Université de Montréal, Montréal, QC, Canada
| | - UnCheol Lee
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Catherine Duclos
- Centre for Advanced Research in Sleep Medicine & Integrated Trauma Centre, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’île-de-Montréal, Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, QC, Canada
- CIFAR Azrieli Global Scholars Program, Toronto, ON, Canada
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Maschke C, Duclos C, Owen AM, Jerbi K, Blain-Moraes S. Aperiodic brain activity and response to anesthesia vary in disorders of consciousness. Neuroimage 2023; 275:120154. [PMID: 37209758 DOI: 10.1016/j.neuroimage.2023.120154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/28/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023] Open
Abstract
In the human electroencephalogram (EEG), oscillatory power peaks co-exist with non-oscillatory, aperiodic activity. Although EEG analysis has traditionally focused exclusively on oscillatory power, recent investigations have shown that the aperiodic EEG component can distinguish conscious wakefulness from sleep and anesthetic-induced unconsciousness. This study investigates the aperiodic EEG component of individuals in a disorder of consciousness (DOC); how it changes in response to exposure to anesthesia; and how it relates to the brain's information richness and criticality. High-density EEG was recorded from 43 individuals in a DOC, with 16 of these individuals undergoing a protocol of propofol anesthesia. The aperiodic component was defined by the spectral slope of the power spectral density. Our results demonstrate that the EEG aperiodic component is more informative about the participants' level of consciousness than the oscillatory component, especially for patients that suffered from a stroke. Importantly, the pharmacologically induced change in the spectral slope from 30-45 Hz positively correlated with individual's pre-anesthetic level of consciousness. The pharmacologically induced loss of information-richness and criticality was associated with individual's pre-anesthetic aperiodic component. During exposure to anesthesia, the aperiodic component was correlated with 3-month recovery status for individuals with DOC. The aperiodic EEG component has been historically neglected; this research highlights the necessity of considering this measure for the assessment of individuals in DOC and future research that seeks to understand the neurophysiological underpinnings of consciousness.
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Affiliation(s)
- Charlotte Maschke
- Montreal General Hospital, McGill University Health Centre, Montreal, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Canada
| | - Catherine Duclos
- Hôpital du Sacré-Cœur de Montréal, Centre intégré universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montréal, Québec Canada; Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Québec Canada
| | - Adrian M Owen
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada; Western Institute for Neuroscience, Western University, London, Ontario, Canada; Department of Psychology, Western University, London, Ontario, Canada
| | - Karim Jerbi
- Cognitive & Computational Neuroscience Lab, Psychology Department, University of Montreal, Québec, Canada; MILA (Québec Artificial Intelligence Institute), Montréal, Québec, Canada; Centre UNIQUE (Union Neurosciences & Intelligence Artificielle), Montréal, Québec, Canada
| | - Stefanie Blain-Moraes
- Montreal General Hospital, McGill University Health Centre, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
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Weinrich JA, Liu CD, Jewell ME, Andolina CR, Bernstein MX, Benitez J, Rodriguez-Rosado S, Braz JM, Maze M, Nemenov MI, Basbaum AI. Paradoxical increases in anterior cingulate cortex activity during nitrous oxide-induced analgesia reveal a signature of pain affect. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.03.534475. [PMID: 37066151 PMCID: PMC10104003 DOI: 10.1101/2023.04.03.534475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
The general consensus is that increases in neuronal activity in the anterior cingulate cortex (ACC) contribute to pain's negative affect. Here, using in vivo imaging of neuronal calcium dynamics in mice, we report that nitrous oxide, a general anesthetic that reduces pain affect, paradoxically, increases ACC spontaneous activity. As expected, a noxious stimulus also increased ACC activity. However, as nitrous oxide increases baseline activity, the relative change in activity from pre-stimulus baseline was significantly less than the change in the absence of the general anesthetic. We suggest that this relative change in activity represents a neural signature of the affective pain experience. Furthermore, this signature of pain persists under general anesthesia induced by isoflurane, at concentrations in which the mouse is unresponsive. We suggest that this signature underlies the phenomenon of connected consciousness, in which use of the isolated forelimb technique revealed that pain percepts can persist in anesthetized patients.
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Affiliation(s)
- Jarret Ap Weinrich
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
| | - Cindy D Liu
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
- Neuroscience Graduate Program, University of California San Francisco, San Francisco, CA 94158, USA
| | - Madison E Jewell
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
| | - Christopher R Andolina
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
| | - Mollie X Bernstein
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
| | - Jorge Benitez
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
| | - Sian Rodriguez-Rosado
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
| | - Joao M Braz
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
| | - Mervyn Maze
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA 94158, USA
| | - Mikhail I Nemenov
- Lasmed, Mountain View, CA 94043, USA
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94035, USA
| | - Allan I Basbaum
- Department of Anatomy, University of California San Francisco, San Francisco, CA 94158, USA
- Neuroscience Graduate Program, University of California San Francisco, San Francisco, CA 94158, USA
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Mirra A, Gamez Maidanskaia E, Carmo LP, Levionnois O, Spadavecchia C. How is depth of anaesthesia assessed in experimental pigs? A scoping review. PLoS One 2023; 18:e0283511. [PMID: 36952576 PMCID: PMC10035875 DOI: 10.1371/journal.pone.0283511] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/09/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Despite the large number of pigs involved in translational studies, no gold standard depth of anaesthesia indicators are available. We undertook a scoping review to investigate and summarize the evidence that sustains or contradicts the use of depth of anaesthesia indicators in this species. METHODS Medline, Embase and CAB abstract were searched up to September 22nd 2022. No limits were set for time, language and study type. Only original articles of in vivo studies using pigs or minipigs undergoing general anaesthesia were included. The depth of anaesthesia indicators reported in the selected papers were divided in two categories: A, indicators purposely investigated as method to assess depth of anaesthesia; B, indicators reported but not investigated as method to assess depth of anaesthesia. RESULTS Out of 13792 papers found, 105 were included after the screening process. Category A: 17 depth of anaesthesia indicators were found in 19 papers. Studies were conducted using inhalant anaesthetics as the main anaesthetic agent in the majority of the cases (13/19 = 68.4%), while 3/19 (15.8%) used propofol. The most investigated depth of anaesthesia indicators were bispectral index (8/19 = 42.1%) and spectral edge frequency 95% (5/19 = 26.3%). Contrasting results about the specific usefulness of each depth of anaesthesia indicators were reported. Category B: 23 depth of anaesthesia indicators were found in 92 papers. The most reported depth of anaesthesia indicators were: motor response following a stimulus (37/92 = 40.2%), depth of anaesthesia scores (21/92 = 23.3%), bispectral index (16/92 = 17.8%) and spectral edge frequency 95% (9/92 = 9.8%). CONCLUSION Results highlight the lack of scientifically valid and reliable indicators to ensure adequate depth of anaesthesia in pigs.
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Affiliation(s)
- Alessandro Mirra
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Ekaterina Gamez Maidanskaia
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Luís Pedro Carmo
- Department of Clinical Research und Public Health (DCR-VPH), Vetsuisse Faculty, Veterinary Public Health Institute, University of Bern, Bern, Switzerland
- Norwegian Veterinary Institute, Ås, Norway
| | - Olivier Levionnois
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Claudia Spadavecchia
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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66
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Choe M, Jin SH, Kim JS, Chung CK. Propofol anesthesia-induced spatiotemporal changes in cortical activity with loss of external and internal awareness: An electrocorticography study. Clin Neurophysiol 2023; 149:51-60. [PMID: 36898318 DOI: 10.1016/j.clinph.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To understand the underlying mechanism of consciousness, investigating spatiotemporal changes in the cortical activity during the induction phase of unconsciousness is important. Loss of consciousness induced by general anesthesia is not necessarily accompanied by a uniform inhibition of all cortical activities. We hypothesized that cortical regions involved in internal awareness would be suppressed after disruption of cortical regions involved in external awareness. Thus, we investigated temporal changes in cortex during induction of unconsciousness. METHODS We recorded electrocorticography data of 16 epilepsy patients and investigated power spectral changes during induction phase from awake state to unconsciousness. Temporal changes were assessed at 1) the start point and 2) the interval of normalized time between start and end of power change (Δ tnormalized). RESULTS We found that the power increased at frequencies < 46 Hz, and decreased in range of 62-150 Hz, in global channels. In temporal changes of power change, superior parietal lobule and dorsolateral prefrontal cortex started to change early, but the changes were completed over a prolonged interval, whereas angular gyrus and associative visual cortex showed a delayed change and rapid completion. CONCLUSIONS Loss of consciousness induced by general anesthesia results first from disrupted communication between self and external world, followed by disrupted communication within self, with decreased activities of superior parietal lobule and dorsolateral prefrontal cortex, and later, attenuated activities of angular gyrus. SIGNIFICANCE Our findings provided neurophysiological evidence for the temporal changes in consciousness components induced by general anesthesia.
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Affiliation(s)
- Mikyung Choe
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seung-Hyun Jin
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - June Sic Kim
- The Research Institute of Basic Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea; Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
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Jafarian AA, Khatibi A, Mesbah Kiaei M, Alebouyeh MR, Alimian M, Habibi A, Amniati S. Comparison of Effects of Stress and Midazolam on Retrograde and Anterograde Amnesia in Patients Undergoing General Anesthesia. Anesth Pain Med 2023; 13:e134300. [PMID: 37404263 PMCID: PMC10317029 DOI: 10.5812/aapm-134300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 07/20/2023] Open
Abstract
Background The identification of different factors affecting anesthesia and physiological changes during anesthesia can be effective in improving the quality of anesthesia. Midazolam is a benzodiazepine that has been used for many years for sedation under anesthesia. Stress is also an important factor affecting memory and other physiological changes, such as blood pressure and heart rate. Objectives his study aimed to investigate the effects of stress on retrograde and anterograde amnesia among patients undergoing general anesthesia. Methods This multi-center, parallel, stratified, randomized controlled trial was performed on patients undergoing non-emergency abdominal laparotomy. The patients were divided into high- and low-stress groups according to the Amsterdam Preoperative Anxiety and Information Scale. Then, both groups were randomly divided into three subgroups receiving 0, 0.02, or 0.04 mg/kg of midazolam. Recall cards were shown to patients at 4 minutes, 2 minutes, and immediately before injection to determine retrograde amnesia and at 2 minutes, 4 minutes, and 6 minutes after injection to determine anterograde amnesia. Hemodynamic changes were recorded during intubation. The chi-square and multiple regression tests were used to analyze the data. Results Midazolam injection was associated with the development of anterograde amnesia in all groups (P < 0.05); however, it had no effect on the development of retrograde amnesia (P < 0.05). Midazolam could decrease the systolic and diastolic blood pressure and heart rate during intubation (P < 0.05). Stress also caused retrograde amnesia in patients (P < 0.05); nevertheless, it had no effect on anterograde amnesia (P > 0.05). Stress and midazolam injection could not affect the oxygen levels during intubation. Conclusions The results showed that midazolam injection could induce anterograde amnesia, hypotension, and heart rate; nonetheless, it had no effect on retrograde amnesia. Stress was associated with retrograde amnesia and increased heart rate; however, it was not associated with anterograde amnesia.
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Affiliation(s)
- Ali Akbar Jafarian
- Department of Anesthesiology and Pain Medicine, Motahari Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Khatibi
- Firouzgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mesbah Kiaei
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood-Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahzad Alimian
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Habibi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saied Amniati
- Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Dong K, Zhang D, Wei Q, Wang G, Chen X, Zhang L, Liu J. An integrated information theory index using multichannel EEG for evaluating various states of consciousness under anesthesia. Comput Biol Med 2023; 153:106480. [PMID: 36630828 DOI: 10.1016/j.compbiomed.2022.106480] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/06/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The integrated information theory (IIT) of consciousness introduces a measure Φ to quantify consciousness in a physical system. Directly related to this, general anesthesia aims to induce reversible and safe loss of consciousness (LOC). We sought to propose an electroencephalogram (EEG)-based IIT index ΦEEG to evaluate various states of consciousness under general anesthesia. METHODS Based on the definition of mutual information, we estimated the ΦEEG by maximizing the integrated information under various time lags. We used the binning method to cut the nonGaussian EEG data for estimating mutual information. We tested two EEG databases collected from propofol- (n=20) and sevoflurane-induced (n=15) anesthesia, and especially, we compared the ΦEEG of drowsy (n=7) and responsive participants (n=13) under propofol anesthesia. We compared the effectiveness of ΦEEG with the estimated bispectral index (eBIS). RESULTS In all EEG frequency bands, we observed a negative correlation between ΦEEG and end-tidal sevoflurane concentration under sevoflurane-induced anesthesia (p<0.001,BF10>6000). Under propofol-induced anesthesia, drowsy participants in moderate sedation (6.96±0.26(mean±SD)) showed decreased alpha-band ΦEEG compared with baseline (7.40±0.53,p=0.016,BF10=3.58), no significant difference was observed for responsive participants. Oppositely, the responsive participants in moderate sedation (-5.32±0.38) showed decreased eBIS compared with baseline (-4.94±0.40,p=0.03,BF10=2.41). CONCLUSIONS These findings may enable monitors of the anesthetic state that can distinguish consciousness and unconsciousness rather than the changes of anesthetic concentrations. The alpha-band ΦEEG is promising for deriving the gold standard for depth of anesthesia monitoring.
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Affiliation(s)
- Kangli Dong
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, Zhejiang, China.
| | - Delin Zhang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310027, Zhejiang, China
| | - Qishun Wei
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, Zhejiang, China
| | - Guozheng Wang
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, Zhejiang, China
| | - Xing Chen
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, Zhejiang, China
| | - Lu Zhang
- The Department of Rehabilitation, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310027, Zhejiang, China
| | - Jun Liu
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, Zhejiang, China; Research Institute of Zhejiang University-Taizhou, Taizhou 318012, Zhejiang, China.
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Lennertz R, Pryor KO, Raz A, Parker M, Bonhomme V, Schuller P, Schneider G, Moore M, Coburn M, Root JC, Emerson JM, Hohmann AL, Azaria H, Golomb N, Defresne A, Montupil J, Pilge S, Obert DP, van Waart H, Seretny M, Rossaint R, Kowark A, Blair A, Krause B, Proekt A, Kelz M, Sleigh J, Gaskell A, Sanders RD. Connected consciousness after tracheal intubation in young adults: an international multicentre cohort study. Br J Anaesth 2023; 130:e217-e224. [PMID: 35618535 PMCID: PMC10375493 DOI: 10.1016/j.bja.2022.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Connected consciousness, assessed by response to command, occurs in at least 5% of general anaesthetic procedures and perhaps more often in young people. Our primary objective was to establish the incidence of connected consciousness after tracheal intubation in young people aged 18-40 yr. The secondary objectives were to assess the nature of these responses, identify relevant risk factors, and determine their relationship to postoperative outcomes. METHODS This was an international, multicentre prospective cohort study using the isolated forearm technique to assess connected consciousness shortly after tracheal intubation. RESULTS Of 344 enrolled subjects, 338 completed the study (mean age, 30 [standard deviation, 6.3] yr; 232 [69%] female). Responses after intubation occurred in 37/338 subjects (11%). Females (13%, 31/232) responded more often than males (6%, 6/106). In logistic regression, the risk of responsiveness was increased with female sex (odds ratio [ORadjusted]=2.7; 95% confidence interval [CI], 1.1-7.6; P=0.022) and was decreased with continuous anaesthesia before laryngoscopy (ORadjusted=0.43; 95% CI, 0.20-0.96; P=0.041). Responses were more likely to occur after a command to respond (and not to nonsense, 13 subjects) than after a nonsense statement (and not to command, four subjects, P=0.049). CONCLUSIONS Connected consciousness occured after intubation in 11% of young adults, with females at increased risk. Continuous exposure to anaesthesia between induction of anaesthesia and tracheal intubation should be considered to reduce the incidence of connected consciousness. Further research is required to understand sex-related differences in the risk of connected consciousness.
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Affiliation(s)
- Richard Lennertz
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Kane O Pryor
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Aeyal Raz
- Department of Anesthesiology, Rambam Health Care Center, Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Maggie Parker
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Vincent Bonhomme
- University Department of Anesthesia and Intensive Care Medicine, CHR Citadelle and CHU Liege, Liège, Belgium, and Anesthesia and Intensive Care Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Peter Schuller
- Department of Anaesthesia, Cairns Hospital, Queensland, Australia
| | - Gerhard Schneider
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Anaesthesiology and Intensive Care, Munich, Germany
| | - Matt Moore
- Department of Anesthesiology, University of Auckland, Auckland, New Zealand
| | - Mark Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - James C Root
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Haya Azaria
- Department of Anesthesiology, Rambam Health Care Center, Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Neta Golomb
- Department of Anesthesiology, Rambam Health Care Center, Affiliated with the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Aline Defresne
- University Department of Anesthesia and Intensive Care Medicine, CHR Citadelle and CHU Liege, Liège, Belgium, and Anesthesia and Intensive Care Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Javier Montupil
- University Department of Anesthesia and Intensive Care Medicine, CHR Citadelle and CHU Liege, Liège, Belgium, and Anesthesia and Intensive Care Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium
| | - Stefanie Pilge
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Anaesthesiology and Intensive Care, Munich, Germany
| | - David P Obert
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Anaesthesiology and Intensive Care, Munich, Germany
| | - Hanna van Waart
- Department of Anesthesiology, University of Auckland, Auckland, New Zealand
| | - Marta Seretny
- Department of Anesthesiology, University of Auckland, Auckland, New Zealand
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
| | - Ana Kowark
- Department of Anesthesiology, Medical Faculty University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Blair
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Bryan Krause
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Alex Proekt
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Max Kelz
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Jamie Sleigh
- Department of Anaesthesiology, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Amy Gaskell
- Department of Anaesthesiology, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Camperdown, Australia; Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia.
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Mélotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, Belorgeot M, Laureys S, Gosseries O. Links Between Swallowing and Consciousness: A Narrative Review. Dysphagia 2023; 38:42-64. [PMID: 35773497 DOI: 10.1007/s00455-022-10452-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.
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Affiliation(s)
- Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium.
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Audrey Maudoux
- Sensation and Perception Research Group, GIGA, University and University Hospital of Liège, Liège, Belgium
- Otorhinolaryngology Head and Neck Surgery Department, Robert Debré University Hospital, APHP, Paris, France
| | - Rajanikant Panda
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
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Huang Z, Mashour GA, Hudetz AG. Functional geometry of the cortex encodes dimensions of consciousness. Nat Commun 2023; 14:72. [PMID: 36604428 PMCID: PMC9814511 DOI: 10.1038/s41467-022-35764-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
Consciousness is a multidimensional phenomenon, but key dimensions such as awareness and wakefulness have been described conceptually rather than neurobiologically. We hypothesize that dimensions of consciousness are encoded in multiple neurofunctional dimensions of the brain. We analyze cortical gradients, which are continua of the brain's overarching functional geometry, to characterize these neurofunctional dimensions. We demonstrate that disruptions of human consciousness - due to pharmacological, neuropathological, or psychiatric causes - are associated with a degradation of one or more of the major cortical gradients depending on the state. Network-specific reconfigurations within the multidimensional cortical gradient space are associated with behavioral unresponsiveness of various etiologies, and these spatial reconfigurations correlate with a temporal disruption of structured transitions of dynamic brain states. In this work, we therefore provide a unifying neurofunctional framework for multiple dimensions of human consciousness in both health and disease.
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Affiliation(s)
- Zirui Huang
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA. .,Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.
| | - George A Mashour
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.,Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, 48109, USA.,Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Anthony G Hudetz
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.,Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, 48109, USA
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Lyu J, Cai H, Chen Y, Chen G. Brain areas modulation in consciousness during sevoflurane anesthesia. Front Integr Neurosci 2022; 16:1031613. [PMID: 36619239 PMCID: PMC9811387 DOI: 10.3389/fnint.2022.1031613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Sevoflurane is presently one of the most used inhaled anesthetics worldwide. However, the mechanisms through which sevoflurane acts and the areas of the brain associated with changes in consciousness during anesthesia remain important and complex research questions. Sevoflurane is generally regarded as a volatile anesthetic that blindly targets neuronal (and sometimes astrocyte) GABAA receptors. This review focuses on the brain areas of sevoflurane action and their relation to changes in consciousness during anesthesia. We cover 20 years of history, from the bench to the bedside, and include perspectives on functional magnetic resonance, electroencephalogram, and pharmacological experiments. We review the interactions and neurotransmitters involved in brain circuits during sevoflurane anesthesia, improving the effectiveness and accuracy of sevoflurane's future application and shedding light on the mechanisms behind human consciousness.
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73
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Xia MC, Guo J, Ding Y, Shi ZQ, Du F, Wang K, Miao CH, Liang C. Dexmedetomidine Preserves Activity of Neurons in Primary Somatosensory Cortex Compared to Propofol and Ketamine. Brain Sci 2022; 12:brainsci12121720. [PMID: 36552179 PMCID: PMC9775739 DOI: 10.3390/brainsci12121720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
General anesthesia has been shown to induce significant changes in the functional connectivity of the cerebral cortex. However, traditional methods such as electroencephalography (EEG) or functional magnetic resonance imaging (fMRI) lack the spatial resolution to study the effects of general anesthesia on individual cortical neurons. This study aimed to use high-resolution two-photon imaging, which can provide single-neuron resolution, to investigate the characteristics of consciousness under general anesthesia. We used C57BL/6J and Thy1-GCamp6s mice and found that at similar levels of sedation, as measured by EEG, dexmedetomidine did not significantly inhibit the spontaneous activity of neuronal somata in the S1 cortex, but preserved the frequency of calcium events in neuronal spines. In contrast, propofol and ketamine dramatically inhibited the spontaneous activity of both neuronal somata and spines. The S1 cortex still responded to whisker stimulation under dexmedetomidine anesthesia, but not under propofol or ketamine anesthesia. Our results suggest that dexmedetomidine anesthesia has unique neuronal properties associated with its ability to facilitate easy awakening in the clinic. These findings provide insights into the development of more effective strategies for monitoring consciousness during general anesthesia.
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Affiliation(s)
- Mu-Chao Xia
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai 200032, China
| | - Juan Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yan Ding
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai 200032, China
| | - Zi-Qi Shi
- Institute of Neurology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Fang Du
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Kai Wang
- Institute of Neurology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Chang-Hong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai 200032, China
- Correspondence: (C.-H.M.); (C.L.); Tel./Fax: +86-021-64041990 (C.-H.M. & C.L.)
| | - Chao Liang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Correspondence: (C.-H.M.); (C.L.); Tel./Fax: +86-021-64041990 (C.-H.M. & C.L.)
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Imantalab V, Mohammadzadeh Jouryabi A, Sedighinejad A, Gholipour M, Kanafi Vahed L, Zargar-Nattaj SS, Biazar G, Shadkam N. Intraoperative Awareness in Patients Undergoing Cardiac Surgery in an Academic Center in the North of Iran. Anesth Pain Med 2022; 12:e131795. [PMID: 36938110 PMCID: PMC10016114 DOI: 10.5812/aapm-131795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background Coronary artery bypass grafting (CABG) has distinctive characteristics that may increase the risk of awareness during general anesthesia (AGA). Objectives This study was conducted to assess the incidence of AGA in cardiac surgery in an academic hospital in Guilan, Iran. Methods This descriptive cross-sectional study was performed in Dr. Heshmat Hospital in Rasht, Iran. Eligible patients candidates for CABG were enrolled in the survey in 2022. After surgery, when the patient was cooperative enough, a questionnaire including demographic data and specialized questions related to different stages of anesthesia was completed via face-to-face interviews. The data were analyzed using IBM SPSS Statistics 21 with chi-square, Fisher's exact, and t-test. Results The data from 322 patients were analyzed, of whom 14 (4.3%) experienced AGA. Among them, the "feeling of fear and anxiety" reported by 9 (39.1%) cases was the most common awareness state. "Dreaming during surgery and anesthesia" and "feeling unable to move during anesthesia,", each reported by 6 (26.1%) cases, were the other common types of awareness state. None of the demographic data had a significant association with the occurrence of AGA. Conclusions The incidence of AGA during CABG was almost acceptable according to the credible evidence.
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Affiliation(s)
- Vali Imantalab
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mohammadzadeh Jouryabi
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Sedighinejad
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahboobeh Gholipour
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Leila Kanafi Vahed
- Department of Community Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Gelareh Biazar
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Department of Anesthesiology, Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, Namjoo Street, P. O. Box: 4144654839, Rasht, Iran.
| | - Neda Shadkam
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Hwang IC. Current Status and Future Directions of Research on Palliative Sedation. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2022; 25:193-197. [PMID: 37674671 PMCID: PMC10179994 DOI: 10.14475/jhpc.2022.25.4.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 09/08/2023]
Abstract
Patients with terminal cancer experience very severe symptoms during the end of life, and palliative sedation (PS) may be considered if those symptoms are refractory to any other treatment. This brief report presents ethical considerations, practices, and recent concerns on PS. PS is quite different from euthanasia. There is a lack of consensus and standards on protocols, but its notable effects have been reported in hospice care settings. Most studies to date have reported no difference in survival between patients receiving PS and those not, and PS must be conducted proportionally with the lightest level of sedation. The most common indication for PS is delirium, and midazolam is the main sedative used. It is recommended that information regarding PS should be provided to patients and their caregivers repeatedly as early as possible. Existential suffering alone is not an indication for PS, and there is a lack of evidence on bispectral analysis. Additional research on PS is needed in Korea.
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Affiliation(s)
- In Cheol Hwang
- Department of Family Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Weakly Correlated Local Cortical State Switches under Anesthesia Lead to Strongly Correlated Global States. J Neurosci 2022; 42:8980-8996. [PMID: 36288946 PMCID: PMC9732829 DOI: 10.1523/jneurosci.0123-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/30/2022] [Accepted: 07/15/2022] [Indexed: 01/05/2023] Open
Abstract
During recovery from anesthesia, brain activity switches abruptly between a small set of discrete states. Surprisingly, this switching also occurs under constant doses of anesthesia, even in the absence of stimuli. These metastable states and the transitions between them are thought to form a "scaffold" that ultimately guides the brain back to wakefulness. The processes that constrain cortical activity patterns to these states and govern how states are coordinated between different cortical regions are unknown. If state transitions were driven by subcortical modulation, different cortical sites should exhibit near-synchronous state transitions. Conversely, spatiotemporal heterogeneity would suggest that state transitions are coordinated through corticocortical interactions. To differentiate between these hypotheses, we quantified synchrony of brain states in male rats exposed to a fixed isoflurane concentration. States were defined from spectra of local field potentials recorded across layers of visual and motor cortices. A transition synchrony measure shows that most state transitions are highly localized. Furthermore, while most pairs of cortical sites exhibit statistically significant coupling of both states and state transition times, coupling strength is typically weak. States and state transitions in the thalamic input layer (L4) are particularly decoupled from those in supragranular and infragranular layers. This suggests that state transitions are not imposed on the cortex by broadly projecting modulatory systems. Although each pairwise interaction is typically weak, we show that the multitude of such weak interactions is sufficient to confine global activity to a small number of discrete states.SIGNIFICANCE STATEMENT The brain consistently recovers to wakefulness after anesthesia, but this process is poorly understood. Previous work revealed that, during recovery from anesthesia, corticothalamic activity falls into one of several discrete patterns. The neuronal mechanisms constraining the cortex to just a few discrete states remain unknown. Global states could be coordinated by fluctuations in subcortical nuclei that project broadly to the cortex. Alternatively, these states may emerge from interactions within the cortex itself. Here, we provide evidence for the latter possibility by demonstrating that most pairs of cortical sites exhibit weak coupling. We thereby lay groundwork for future investigations of the specific cellular and network mechanisms of corticocortical activity state coupling.
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Martial C, Gosseries O, Cassol H, Kondziella D. Studying death and near-death experiences requires neuroscientific expertise. Ann N Y Acad Sci 2022; 1517:11-14. [PMID: 36017883 DOI: 10.1111/nyas.14888] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Parnia et al. recently published suggestions for the study of death and experiences recalled in a near-death context. We have serious reservations about the authors' statements. In this commentary, we discuss the omissions and knowledge gaps inherent to the authors' paper, which among others include incorrect neurological claims about brain death and misunderstandings regarding the terminology of consciousness. Although we believe that (near-)death research deserves a framework guideline, the paper by Parnia and colleagues is misleading and, contrary to the authors' intention, hinders the scientific understanding of near-death experiences and the neural mechanisms occurring in the dying brain.
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Affiliation(s)
- Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Héléna Cassol
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Rabuffo G, Sorrentino P, Bernard C, Jirsa V. Spontaneous neuronal avalanches as a correlate of access consciousness. Front Psychol 2022; 13:1008407. [PMID: 36337573 PMCID: PMC9634647 DOI: 10.3389/fpsyg.2022.1008407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/04/2022] [Indexed: 09/03/2023] Open
Abstract
Decades of research have advanced our understanding of the biophysical mechanisms underlying consciousness. However, an overarching framework bridging between models of consciousness and the large-scale organization of spontaneous brain activity is still missing. Based on the observation that spontaneous brain activity dynamically switches between epochs of segregation and large-scale integration of information, we hypothesize a brain-state dependence of conscious access, whereby the presence of either segregated or integrated states marks distinct modes of information processing. We first review influential works on the neuronal correlates of consciousness, spontaneous resting-state brain activity and dynamical system theory. Then, we propose a test experiment to validate our hypothesis that conscious access occurs in aperiodic cycles, alternating windows where new incoming information is collected but not experienced, to punctuated short-lived integration events, where conscious access to previously collected content occurs. In particular, we suggest that the integration events correspond to neuronal avalanches, which are collective bursts of neuronal activity ubiquitously observed in electrophysiological recordings. If confirmed, the proposed framework would link the physics of spontaneous cortical dynamics, to the concept of ignition within the global neuronal workspace theory, whereby conscious access manifest itself as a burst of neuronal activity.
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Affiliation(s)
- Giovanni Rabuffo
- Institut de Neurosciences des Systemes, Aix-Marseille University, Marseille, France
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Nævra MCJ, Romundstad L, Aasheim A, Larsson PG. Monitoring the Awake and Anesthetized Unconscious States Using Bispectral Index and Electroencephalographic Connectivity Measures. Clin EEG Neurosci 2022; 54:273-280. [PMID: 36226378 PMCID: PMC10084521 DOI: 10.1177/15500594221131680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Our objective was to compare three electroencephalography (EEG)-based methods with anesthesiologist clinical judgment of the awake and anesthetized unconscious states. Methods. EEG recorded from 25 channels and from four channel bilateral Bispectral index (BIS) electrodes were collected from 20 patients undergoing surgery with general anesthesia. To measure connectivity we applied Directed Transfer Function (DTF) in eight channels of the EEG, and extracted data from BIS over the same time segments. Shannon's entropy was applied to assess the complexity of the EEG signal. Discriminant analysis was used to evaluate the data in relation to clinical judgment. Results. Assessing anesthetic state relative clinical judgment, the bilateral BIS gave the highest accuracy (ACC) (95.4%) and lowest false positive discovery rate (FDR) (0.5%) . Equivalent DTF gave 94.5% for ACC and 2.6% for FDR. Combining all methods gave ACC = 94.9% and FDR = 1%. Generally, entropy scored lower on ACC and higher on FDR than the other methods (ACC 90.87% and FDR 4.6%). BIS showed at least a one minute delay in 18 of the 20 patients. Conclusions. Our results show that BIS and DTF both have a high ACC and low FDR. Because of time delays in BIS values, we recommend combining the two methods.
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Affiliation(s)
- Marianne Cecilie Johansen Nævra
- Section of Clinical Neurophysiology, Department of Neurosurgery, Division of Clinical Neuroscience, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Luis Romundstad
- Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anders Aasheim
- Department of Anesthesia Nursing, Division of Emergencies and Critical Care, Rikshospitalet, Oslo Univeristy Hospital, Oslo, Norway
| | - Pål Gunnar Larsson
- Section of Clinical Neurophysiology, Department of Neurosurgery, Division of Clinical Neuroscience, Rikshospitalet, Oslo University Hospital, Oslo, Norway
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Casey CP, Tanabe S, Farahbakhsh Z, Parker M, Bo A, White M, Ballweg T, Mcintosh A, Filbey W, Banks MI, Saalmann YB, Pearce RA, Sanders RD. Dynamic causal modelling of auditory surprise during disconnected consciousness: The role of feedback connectivity. Neuroimage 2022; 263:119657. [PMID: 36209793 PMCID: PMC10076444 DOI: 10.1016/j.neuroimage.2022.119657] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/08/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
The neural mechanisms through which individuals lose sensory awareness of their environment during anesthesia remains poorly understood despite being of vital importance to the field. Prior research has not distinguished between sensory awareness of the environment (connectedness) and consciousness itself. In the current study, we investigated the neural correlates of sensory awareness by contrasting neural responses to an auditory roving oddball paradigm during consciousness with sensory awareness (connected consciousness) and consciousness without sensory awareness (disconnected consciousness). These states were captured using a serial awakening paradigm with the sedative alpha2 adrenergic agonist dexmedetomidine, chosen based on our published hypothesis that suppression of noradrenaline signaling is key to induce a state of sensory disconnection. High-density electroencephalography was recorded from 18 human subjects before and after administration of dexmedetomidine. By investigating event-related potentials and taking advantage of advances in Dynamic Causal Modeling (DCM), we assessed alterations in effective connectivity between nodes of a previously established auditory processing network. We found that during disconnected consciousness, the scalp-level response to standard tones produced a P3 response that was absent during connected consciousness. This P3 response resembled the response to oddball tones seen in connected consciousness. DCM showed that disconnection produced increases in standard tone feedback signaling throughout the auditory network. Simulation analyses showed that these changes in connectivity, most notably the increase in feedback from right superior temporal gyrus to right A1, can explain the new P3 response. Together these findings show that during disconnected consciousness there is a disruption of normal predictive coding processes, so that all incoming auditory stimuli become similarly surprising.
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Affiliation(s)
- Cameron P Casey
- Department of Anesthesiology, University of Wisconsin, Madison, USA.
| | - Sean Tanabe
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | | | - Margaret Parker
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - Amber Bo
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - Marissa White
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - Tyler Ballweg
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - Andrew Mcintosh
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - William Filbey
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - Matthew I Banks
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - Yuri B Saalmann
- Department of Psychology, University of Wisconsin, Madison, USA
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Camperdown, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia.
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81
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Sevenius Nilsen A, Juel BE, Thürer B, Aamodt A, Storm JF. Are we really unconscious in "unconscious" states? Common assumptions revisited. Front Hum Neurosci 2022; 16:987051. [PMID: 36277049 PMCID: PMC9581328 DOI: 10.3389/fnhum.2022.987051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/08/2022] [Indexed: 12/05/2022] Open
Abstract
In the field of consciousness science, there is a tradition to categorize certain states such as slow-wave non-REM sleep and deep general anesthesia as "unconscious". While this categorization seems reasonable at first glance, careful investigations have revealed that it is not so simple. Given that (1) behavioral signs of (un-)consciousness can be unreliable, (2) subjective reports of (un-)consciousness can be unreliable, and, (3) states presumed to be unconscious are not always devoid of reported experience, there are reasons to reexamine our traditional assumptions about "states of unconsciousness". While these issues are not novel, and may be partly semantic, they have implications both for scientific progress and clinical practice. We suggest that focusing on approaches that provide a more pragmatic and nuanced characterization of different experimental conditions may promote clarity in the field going forward, and help us build stronger foundations for future studies.
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Affiliation(s)
- Andre Sevenius Nilsen
- Department of Physiology, Institute of Basic Medicine, University of Oslo, Oslo, Norway
| | - Bjørn E. Juel
- Department of Physiology, Institute of Basic Medicine, University of Oslo, Oslo, Norway
- School of Medicine and Public Health, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, United States
| | - Benjamin Thürer
- Department of Physiology, Institute of Basic Medicine, University of Oslo, Oslo, Norway
| | - Arnfinn Aamodt
- Department of Physiology, Institute of Basic Medicine, University of Oslo, Oslo, Norway
| | - Johan F. Storm
- Department of Physiology, Institute of Basic Medicine, University of Oslo, Oslo, Norway
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82
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Wang H, Zhang Y, Cheng H, Yan F, Song D, Wang Q, Cai S, Wang Y, Huang L. Selective corticocortical connectivity suppression during propofol-induced anesthesia in healthy volunteers. Cogn Neurodyn 2022; 16:1029-1043. [PMID: 36237410 PMCID: PMC9508318 DOI: 10.1007/s11571-021-09775-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022] Open
Abstract
We comprehensively studied directional feedback and feedforward connectivity to explore potential connectivity changes that underlie propofol-induced deep sedation. We further investigated the corticocortical connectivity patterns within and between hemispheres. Sixty-channel electroencephalographic data were collected from 19 healthy volunteers in a resting wakefulness state and propofol-induced deep unconsciousness state defined by a bispectral index value of 40. A source analysis was employed to locate cortical activity. The Desikan-Killiany atlas was used to partition cortices, and directional functional connectivity was assessed by normalized symbolic transfer entropy between higher-order (prefrontal and frontal) and lower-order (auditory, sensorimotor and visual) cortices and between hot-spot frontal and parietal cortices. We found that propofol significantly suppressed feedforward connectivity from the left parietal to right frontal cortex and bidirectional connectivity between the left frontal and left parietal cortex, between the frontal and auditory cortex, and between the frontal and sensorimotor cortex. However, there were no significant changes in either feedforward or feedback connectivity between the prefrontal and all the lower-order cortices and between the frontal and visual cortices or in feedback connectivity from the frontal to parietal cortex. Propofol anesthetic selectively decreased the unidirectional interaction between higher-order frontoparietal cortices and bidirectional interactions between the higher-order frontal cortex and lower-order auditory and sensorimotor cortices, which indicated that both feedback and feedforward connectivity were suppressed under propofol-induced deep sedation. Our findings provide critical insights into the connectivity changes underlying the top-down mechanism of propofol anesthesia at deep sedation. Supplementary Information The online version contains supplementary material available at 10.1007/s11571-021-09775-x.
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Affiliation(s)
- Haidong Wang
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Yun Zhang
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Huanhuan Cheng
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Fei Yan
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Dawei Song
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Qiang Wang
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061 China
| | - Suping Cai
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi’an, 710071 China
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83
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Mashour GA, Pal D, Brown EN. Prefrontal cortex as a key node in arousal circuitry. Trends Neurosci 2022; 45:722-732. [PMID: 35995629 PMCID: PMC9492635 DOI: 10.1016/j.tins.2022.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/02/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
The role of the prefrontal cortex (PFC) in the mechanism of consciousness is a matter of active debate. Most theoretical and empirical investigations have focused on whether the PFC is critical for the content of consciousness (i.e., the qualitative aspects of conscious experience). However, there is emerging evidence that, in addition to its well-established roles in cognition, the PFC is a key regulator of the level of consciousness (i.e., the global state of arousal). In this opinion article we review recent data supporting the hypothesis that the medial PFC is a critical node in arousal-promoting networks.
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Affiliation(s)
- George A Mashour
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA; Center for Consciousness Science, University of Michigan, Ann Arbor, MI, USA; Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA.
| | - Dinesh Pal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Center for Consciousness Science, University of Michigan, Ann Arbor, MI, USA; Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Emery N Brown
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA; Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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84
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Provencio JJ. Neurocritical Care Research. Crit Care Clin 2022; 39:47-54. [DOI: 10.1016/j.ccc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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85
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Kim KM, Bang JY, Lee JM, Yang HS, Choi BM, Noh GJ. Effect-site concentration of remimazolam at loss and recovery of responsiveness during general anesthesia: a simulation study. Anesth Pain Med (Seoul) 2022; 17:262-270. [PMID: 35918858 PMCID: PMC9346207 DOI: 10.17085/apm.21121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background The objective of this study was to investigate the effect-site concentration (Ce) of remimazolam at loss of response (LOR) and recovery of response (ROR) in patients underwent general anesthesia using simulation. In addition, the relationships between patient’s factors and simulated Ce at LOR and ROR were examined. Methods The medical records of 81 patients who underwent elective surgery under general anesthesia using remimazolam with simulation of Ce between August 4, 2021 and October 12, 2021, were retrospectively reviewed. Remimazolam was administered as an induction dose of 6 or 12 mg/kg/h until the patient became unresponsive, followed by 0.3–2 mg/kg/h to maintain BIS values below 60. Simultaneously, simulations of manual infusion mode were performed using Asan Pump software and the Ce of remimazolam was simulated using the Schüttler model. Whenever infusion rate of remimazolam was manually changed, the simulated Ce was confirmed almost simultaneously. LOR and ROR, defined as unresponsive and eye-opening to verbal commands, respectively, were recorded in the Asan Pump program. Results The median (1Q, 3Q) simulated Ce at LOR and ROR were 0.7 (0.5, 0.9) and 0.3 (0.2, 0.4) μg/ml, respectively. LOR was achieved in 1.9 min after remimazolam infusion with cumulative doses of 0.3 mg/kg. There was a significant relationship between age and simulated Ce at ROR (Ce at ROR = –0.0043 × age + 0.57, r = 0.30, P = 0.014). Conclusions For optimal dosage adjustment, simulating Ce while administering remimazolam with a weight-based dose during anesthesia is helpful. Elderly patients may recover from anesthesia at lower Ce of remimazolam.
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Affiliation(s)
- Kyung Mi Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Yeon Bang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Min Lee
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Hong Seuk Yang
- Department of Anesthesiology and Pain Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Byung-Moon Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Corresponding author: Byung-Moon Choi, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-1704, Fax: 82-2-3010-6790, E-mail:
| | - Gyu-Jeong Noh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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86
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Rasulo FA, Hopkins P, Lobo FA, Pandin P, Matta B, Carozzi C, Romagnoli S, Absalom A, Badenes R, Bleck T, Caricato A, Claassen J, Denault A, Honorato C, Motta S, Meyfroidt G, Radtke FM, Ricci Z, Robba C, Taccone FS, Vespa P, Nardiello I, Lamperti M. Processed Electroencephalogram-Based Monitoring to Guide Sedation in Critically Ill Adult Patients: Recommendations from an International Expert Panel-Based Consensus. Neurocrit Care 2022; 38:296-311. [PMID: 35896766 PMCID: PMC10090014 DOI: 10.1007/s12028-022-01565-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The use of processed electroencephalography (pEEG) for depth of sedation (DOS) monitoring is increasing in anesthesia; however, how to use of this type of monitoring for critical care adult patients within the intensive care unit (ICU) remains unclear. METHODS A multidisciplinary panel of international experts consisting of 21 clinicians involved in monitoring DOS in ICU patients was carefully selected on the basis of their expertise in neurocritical care and neuroanesthesiology. Panelists were assigned four domains (techniques for electroencephalography [EEG] monitoring, patient selection, use of the EEG monitors, competency, and training the principles of pEEG monitoring) from which a list of questions and statements was created to be addressed. A Delphi method based on iterative approach was used to produce the final statements. Statements were classified as highly appropriate or highly inappropriate (median rating ≥ 8), appropriate (median rating ≥ 7 but < 8), or uncertain (median rating < 7) and with a strong disagreement index (DI) (DI < 0.5) or weak DI (DI ≥ 0.5 but < 1) consensus. RESULTS According to the statements evaluated by the panel, frontal pEEG (which includes a continuous colored density spectrogram) has been considered adequate to monitor the level of sedation (strong consensus), and it is recommended by the panel that all sedated patients (paralyzed or nonparalyzed) unfit for clinical evaluation would benefit from DOS monitoring (strong consensus) after a specific training program has been performed by the ICU staff. To cover the gap between knowledge/rational and routine application, some barriers must be broken, including lack of knowledge, validation for prolonged sedation, standardization between monitors based on different EEG analysis algorithms, and economic issues. CONCLUSIONS Evidence on using DOS monitors in ICU is still scarce, and further research is required to better define the benefits of using pEEG. This consensus highlights that some critically ill patients may benefit from this type of neuromonitoring.
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Affiliation(s)
- Frank A Rasulo
- Department of Anesthesiology and Intensive Care, Spedali Civili Hospital, Brescia, Italy. .,Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Philip Hopkins
- Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Francisco A Lobo
- Institute of Anesthesiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Pierre Pandin
- Department of Anesthesia and Intensive Care, Erasme Hospital, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Basil Matta
- Department of Anaesthesia and Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Carla Carozzi
- Department of Anesthesia and Intensive Care, Istituto Neurologico C. Besta, Milan, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Anthony Absalom
- Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands
| | - Rafael Badenes
- Department of Anesthesia and Intensive Care, University of Valencia, Valencia, Spain
| | - Thomas Bleck
- Division of Stroke and Neurocritical Care, Department of Neurology, Northwestern University, Evanston, IL, USA
| | - Anselmo Caricato
- Department of Anesthesia and Intensive Care, Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jan Claassen
- Department of Neurocritical Care, Columbia University Irving Medical Center, New York, NY, USA
| | - André Denault
- Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Cristina Honorato
- Department of Anesthesiology and Critical Care, Universidad de Navarra, Pamplona, Spain
| | - Saba Motta
- Scientific Library, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Geert Meyfroidt
- Department of Intensive Care, University Hospitals Leuven and Laboratory of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Finn Michael Radtke
- Department of Anesthesiology IRS, Nykøbing F. Hospital, Nykøbing Falster, Denmark
| | - Zaccaria Ricci
- Department of Pediatric Anesthesia, Meyer University Hospital of Florence, University of Florence, Florence, Italy
| | - Chiara Robba
- Department of Anesthesia and Intensive Care, Policlinico San Martino and University of Genoa, Genoa, Italy
| | - Fabio S Taccone
- Department of Anesthesia and Intensive Care, Erasme Hospital, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Paul Vespa
- Department of Neurosurgery and Neurocritical Care, Los Angeles Medical Center, Ronald Reagan University of California, Los Angeles, CA, USA
| | - Ida Nardiello
- Department of Anesthesiology and Intensive Care, Spedali Civili Hospital, Brescia, Italy
| | - Massimo Lamperti
- Institute of Anesthesiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
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87
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Nowak H, Wolf A, Rahmel T, Oprea G, Grause L, Moeller M, Gyarmati K, Mittler C, Zagler A, Lutz K, Loeser J, Saller T, Tryba M, Adamzik M, Hansen E, Zech N. Therapeutic Suggestions During General Anesthesia Reduce Postoperative Nausea and Vomiting in High-Risk Patients – A Post hoc Analysis of a Randomized Controlled Trial. Front Psychol 2022; 13:898326. [PMID: 35910976 PMCID: PMC9337244 DOI: 10.3389/fpsyg.2022.898326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022] Open
Abstract
Postoperative nausea and vomiting (PONV) are one of the most adverse events after general anesthesia, a distressing experience, and pose a risk to the patient. Despite advances in drug prophylaxis and PONV treatment, the incidence remains high and additional non-pharmacological treatments are needed. In this post hoc analysis of a recently published double-blind multicenter randomized controlled trial on the efficacy of intraoperative therapeutic suggestions on postoperative opioid dosage, we analyzed the effects of intraoperative therapeutic suggestions on PONV. We focus on patients with a high risk of PONV (Apfel risk score of 3–4) and distinguished early (first two postoperative hours) and delayed PONV (2–24 h). A total of 385 patients with a moderate or high risk for PONV were included. The incidence of early and delayed PONV was reduced (22.7–18.3 and 29.9–24.1%, respectively), without statistical significance, whereas in high-risk patients (n = 180) their incidence was nearly halved, 17.2 vs. 31.2% (p = 0.030) and 20.7 vs. 34.4% (p = 0.040), corresponding to a number needed to treat of 7 to avoid PONV. In addition, there was a significant reduction in PONV severity. In a multivariate logistic regression model, assignment to the control group (OR 2.2; 95% CI: 1.1–4.8) was identified as an independent predictor of the occurrence of early PONV. Our results indicate that intraoperative therapeutic suggestions can significantly reduce the incidence of PONV in high-risk patients. This encourages the expansion of therapeutic suggestions under general anesthesia, which are inexpensive and virtually free of side effects. Clinical Trial Registration: German Clinical Trials Register, https://drks.de, registration number: DRKS00013800.
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Affiliation(s)
- Hartmuth Nowak
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
- *Correspondence: Hartmuth Nowak,
| | - Alexander Wolf
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Guenther Oprea
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Lisa Grause
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | | | - Katharina Gyarmati
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany
| | - Corinna Mittler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany
| | - Alexandra Zagler
- Department of Anesthesiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Katrin Lutz
- Department of Anesthesiology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Johannes Loeser
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, University of Cologne, Cologne, Germany
| | - Thomas Saller
- Department of Anesthesiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Michael Tryba
- Kassel School of Medicine, Kassel, Germany
- Clinic for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Kassel Hospital, Kassel, Germany
| | - Michael Adamzik
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Ernil Hansen
- Department of Anesthesiology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Nina Zech
- Department of Anesthesiology, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
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Dong K, Zhang D, Wei Q, Wang G, Huang F, Chen X, Muhammad KG, Sun Y, Liu J. Intrinsic phase-amplitude coupling on multiple spatial scales during the loss and recovery of consciousness. Comput Biol Med 2022; 147:105687. [PMID: 35687924 DOI: 10.1016/j.compbiomed.2022.105687] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent studies have demonstrated that changes in brain information processing during anesthetic-induced loss of consciousness (LOC) might be influenced by phase-amplitude coupling (PAC) in electroencephalogram (EEG). However, most anesthesia research on PAC typically focuses on delta and alpha oscillations. Studies of spatial-frequency characteristics by PAC for EEG may yield additional insights into understanding the impaired information processing under anesthesia unconsciousness and provide potential improvements in anesthesia monitoring. OBJECTIVE Considering different frequency bands of EEG represent neural activities on different spatial scales, we hypothesized that functional coupling simultaneously appears in multiple frequency bands and specific brain regions during anesthesia unconsciousness. In this paper, PAC analysis on whole-brain EEG besides delta and alpha oscillations was investigated to understand the influence of multiple cross-frequency coordination coupling on information processing during the loss and recovery of consciousness. METHOD EEG data from fifteen patients without cognitive diseases (7 males/8 females, aged 43.8 ± 13.4 years, weighing 63.3 ± 14.9 kilograms) undergoing lower limb surgery and sevoflurane anesthesia was recorded. To investigate the spatial-frequency characteristics of EEG source signals during loss and recovery of consciousness, the time-resolved PAC (tPAC) was calculated to reflect cross-frequency coordination in different frequency bands (delta, theta, alpha, beta, gamma) and different functional regions (Visual, Limbic, Dorsal attention, Ventral attention, Default, Somatomotor, Control, Salience networks). Furthermore, different patterns (peak-max and trough-max) of PAC were examined by constructing phase-amplitude histograms using phase bins to investigate the different information processing during LOC. The multivariate analysis of variance (MANOVA) and trend analysis were used for statistical analysis. RESULTS Theta-alpha and alpha-beta PAC were observed during sevoflurane-induced LOC, which significantly changed during loss and recovery of consciousness (F4,70 = 16.553, p < 0.001 for theta-alpha PAC and F4,70 = 12.446, p < 0.001 for alpha-beta PAC, MANOVA test). Simultaneously, PAC was distributed in specific functional regions, i.e., Visual, Limbic, Default, Somatomotor, etc. Furthermore, peak-max patterns of theta-alpha PAC were observed while alpha-beta PAC showed trough-max patterns and vice versa. CONCLUSION Theta-alpha and alpha-beta PAC observed in specific brain regions represent information processing on multiple spatial scales, and the opposite patterns of PAC indicate opposite information processing on multiple spatial scales during LOC. Our study demonstrates the regulation of local-global information processing during sevoflurane-induced LOC. It suggests the utility of evaluating the balance of functional integration and segregation in monitoring anesthetized states.
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Affiliation(s)
- Kangli Dong
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Delin Zhang
- The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310027, China
| | - Qishun Wei
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Guozheng Wang
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Fan Huang
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Xing Chen
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Kanhar G Muhammad
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Yu Sun
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Jun Liu
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China.
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89
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Affiliation(s)
- George A. Mashour
- From the Departments of Anesthesiology and Pharmacology, Center for Consciousness Science, Michigan Neuroscience Institute, Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan
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Krooupa AM, Stone P, McKeever S, Seddon K, Davis S, Sampson EL, Tookman A, Martin J, Nambisan V, Vivat B. Do palliative care patients and relatives think it would be acceptable to use Bispectral index (BIS) technology to monitor palliative care patients' levels of consciousness? A qualitative exploration with interviews and focus groups for the I-CAN-CARE research programme. BMC Palliat Care 2022; 21:86. [PMID: 35610644 PMCID: PMC9131519 DOI: 10.1186/s12904-022-00949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS Participants considered BIS technology might be of benefit to palliative care as a non-intrusive means of assisting clinical assessment and decision-making at the end of life, and concluded that it would therefore be acceptable to trial the technology with patients.
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Affiliation(s)
- Anna-Maria Krooupa
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
| | - Patrick Stone
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Stephen McKeever
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kathy Seddon
- grid.419428.20000 0000 9768 8171Marie Curie Palliative Care Research Voices, London, UK
| | - Sarah Davis
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Elizabeth L. Sampson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- grid.419428.20000 0000 9768 8171Marie Curie Hospice Hampstead, London, UK ,Field Editor Cochrane; Palliative and Supportive Care, Oxford, UK
| | - Jonathan Martin
- grid.450578.b0000 0001 1550 1922Central & North West London NHS Foundation Trust, London, UK ,grid.52996.310000 0000 8937 2257National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Bella Vivat
- grid.83440.3b0000000121901201Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
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91
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Málek J. Awareness during surgery and anesthesia. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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92
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End-tidal Anesthetic Concentration: Monitoring, Interpretation, and Clinical Application. Anesthesiology 2022; 136:985-996. [PMID: 35483048 DOI: 10.1097/aln.0000000000004218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Age-adjusted fraction of minimum alveolar concentration derived from end-tidal anesthetic partial pressure measurement remains a useful drug advisory display to help prevent awareness if interpreted with proper understanding of the quantal and probabilistic nature of minimum alveolar concentration, semantics, drug interactions, and hysteresis.
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93
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Chen X, Li L, Yang L, Li A, Wu M, Yu D. A randomized trial: bispectral-guided anesthesia decreases incidence of delayed neurocognitive recovery and postoperative neurocognitive disorder but not postoperative delirium. Am J Transl Res 2022; 14:2081-2091. [PMID: 35422948 PMCID: PMC8991109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD), also known as delayed neurocognitive recovery (up to 30 days) and postoperative neurocognitive disorder (up to 12 months), is a frequent complication of the neurological system associated with poor outcome. This randomized controlled trial aimed to determine whether bispectral (BIS) monitoring is correlated with delayed neurocognitive recovery, postoperative neurocognitive disorder, or postoperative delirium (POD). METHODS Among 197 patients included in the study, 100 were assigned to the BIS group and 97 to the control group. The BIS index was kept at 40-60 in the BIS group, and the depth of anesthesia in the control group was maintained according to anesthetists' clinical experience. Cognitive function was evaluated from the 1st-7th day after the operation and the time of discharge, and at 1st month, 6th months, and 1 year after the operation. RESULTS The incidence of delayed neurocognitive recovery (3% vs. 21.6%, P<0.001, at 7th day) (3% vs. 21.1%, P<0.001, at 1st month) and postoperative neurocognitive disorder (6.2% vs. 21.3%, P=0.002, at 6th month) (4.4% vs. 16.3%, P=0.009, at 1 year) were lower in the BIS group, while there was no significant difference in POD between the two groups (12% vs. 19.6%, P=0.144). The average value of intraoperative BIS was lower in the BIS group (43.75 vs. 50.69, P<0.001). The postoperative hospitalization time (9.99 vs. 12.41, P<0.001) and the mortality (5.4% vs. 14.4%, P=0.042) were significantly decreased, while satisfaction was higher in the BIS group (39% vs. 24.7%, P=0.009). CONCLUSION BIS decreases delayed neurocognitive recovery and postoperative neurocognitive disorder; however, it is not associated with POD. BIS monitoring could effectively lessen postoperative hospitalization and mortality and increase patient satisfaction.
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Affiliation(s)
- Xingqu Chen
- Department of Anesthesiology, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| | - Linji Li
- Department of Anesthesiology, The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital97 Renmin South Road, Nanchong 637000, Sichuan, China
| | - Li Yang
- Department of Anesthesiology, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| | - Aijiao Li
- Department of Anesthesiology, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| | - Miao Wu
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
| | - Deshui Yu
- Department of Anesthesiology, The Second People’s Hospital of Yibin96 North Street, Yibin 644000, Sichuan, China
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Arena A, Juel BE, Comolatti R, Thon S, Storm JF. Capacity for consciousness under ketamine anaesthesia is selectively associated with activity in posteromedial cortex in rats. Neurosci Conscious 2022; 2022:niac004. [PMID: 35261778 PMCID: PMC8896332 DOI: 10.1093/nc/niac004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 12/04/2022] Open
Abstract
It remains unclear how specific cortical regions contribute to the brain's overall capacity for consciousness. Clarifying this could help distinguish between theories of consciousness. Here, we investigate the association between markers of regionally specific (de)activation and the brain's overall capacity for consciousness. We recorded electroencephalographic responses to cortical electrical stimulation in six rats and computed Perturbational Complexity Index state-transition (PCIST), which has been extensively validated as an index of the capacity for consciousness in humans. We also estimated the balance between activation and inhibition of specific cortical areas with the ratio between high and low frequency power from spontaneous electroencephalographic activity at each electrode. We repeated these measurements during wakefulness, and during two levels of ketamine anaesthesia: with the minimal dose needed to induce behavioural unresponsiveness and twice this dose. We found that PCIST was only slightly reduced from wakefulness to light ketamine anaesthesia, but dropped significantly with deeper anaesthesia. The high-dose effect was selectively associated with reduced high frequency/low frequency ratio in the posteromedial cortex, which strongly correlated with PCIST. Conversely, behavioural unresponsiveness induced by light ketamine anaesthesia was associated with similar spectral changes in frontal, but not posterior cortical regions. Thus, activity in the posteromedial cortex correlates with the capacity for consciousness, as assessed by PCIST, during different depths of ketamine anaesthesia, in rats, independently of behaviour. These results are discussed in relation to different theories of consciousness.
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Affiliation(s)
- A Arena
- Brain Signalling Group, Department of Molecular Medicine, University of Oslo, Sognsvannsveien 9, Oslo 0372, Norway
| | - B E Juel
- Brain Signalling Group, Department of Molecular Medicine, University of Oslo, Sognsvannsveien 9, Oslo 0372, Norway
- Center for Sleep and Consciousness, University of Wisconsin, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - R Comolatti
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Via Giovanni Battista Grassi 74, Milano 20157, Italy
| | - S Thon
- Brain Signalling Group, Department of Molecular Medicine, University of Oslo, Sognsvannsveien 9, Oslo 0372, Norway
| | - J F Storm
- Brain Signalling Group, Department of Molecular Medicine, University of Oslo, Sognsvannsveien 9, Oslo 0372, Norway
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Lee M, Sanz LRD, Barra A, Wolff A, Nieminen JO, Boly M, Rosanova M, Casarotto S, Bodart O, Annen J, Thibaut A, Panda R, Bonhomme V, Massimini M, Tononi G, Laureys S, Gosseries O, Lee SW. Quantifying arousal and awareness in altered states of consciousness using interpretable deep learning. Nat Commun 2022; 13:1064. [PMID: 35217645 PMCID: PMC8881479 DOI: 10.1038/s41467-022-28451-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/25/2022] [Indexed: 12/16/2022] Open
Abstract
Consciousness can be defined by two components: arousal (wakefulness) and awareness (subjective experience). However, neurophysiological consciousness metrics able to disentangle between these components have not been reported. Here, we propose an explainable consciousness indicator (ECI) using deep learning to disentangle the components of consciousness. We employ electroencephalographic (EEG) responses to transcranial magnetic stimulation under various conditions, including sleep (n = 6), general anesthesia (n = 16), and severe brain injury (n = 34). We also test our framework using resting-state EEG under general anesthesia (n = 15) and severe brain injury (n = 34). ECI simultaneously quantifies arousal and awareness under physiological, pharmacological, and pathological conditions. Particularly, ketamine-induced anesthesia and rapid eye movement sleep with low arousal and high awareness are clearly distinguished from other states. In addition, parietal regions appear most relevant for quantifying arousal and awareness. This indicator provides insights into the neural correlates of altered states of consciousness.
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Affiliation(s)
- Minji Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Leandro R D Sanz
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Alice Barra
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Audrey Wolff
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Jaakko O Nieminen
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Melanie Boly
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
- Department of Neurology, University of Wisconsin, Madison, WI, USA
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
- Fondazione Europea di Ricerca Biomedica, FERB Onlus, Milan, Italy
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Rajanikant Panda
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Liège, Liège, Belgium
- University Department of Anesthesia and Intensive Care Medicine, CHR Citadelle, Liège, Belgium
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Giulio Tononi
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium.
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA.
- Department of Psychology, University of Wisconsin, Madison, WI, USA.
| | - Seong-Whan Lee
- Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea.
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Casey CP, Tanabe S, Farahbakhsh Z, Parker M, Bo A, White M, Ballweg T, Mcintosh A, Filbey W, Saalmann Y, Pearce RA, Sanders RD. Distinct EEG signatures differentiate unconsciousness and disconnection during anaesthesia and sleep. Br J Anaesth 2022; 128:1006-1018. [PMID: 35148892 DOI: 10.1016/j.bja.2022.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND How conscious experience becomes disconnected from the environment, or disappears, across arousal states is unknown. We sought to identify the neural correlates of sensory disconnection and unconsciousness using a novel serial awakening paradigm. METHODS Volunteers were recruited for sedation with dexmedetomidine i.v., propofol i.v., or natural sleep with high-density EEG monitoring and serial awakenings to establish whether subjects were in states of disconnected consciousness or unconsciousness in the preceding 20 s. The primary outcome was classification of conscious states by occipital delta power (0.5-4 Hz). Secondary analyses included derivation (dexmedetomidine) and validation (sleep/propofol) studies of EEG signatures of conscious states. RESULTS Occipital delta power differentiated disconnected and unconscious states for dexmedetomidine (area under the curve [AUC] for receiver operating characteristic 0.605 [95% confidence interval {CI}: 0.516; 0.694]) but not for sleep/propofol (AUC 0.512 [95% CI: 0.380; 0.645]). Distinct source localised signatures of sensory disconnection (AUC 0.999 [95% CI: 0.9954; 1.0000]) and unconsciousness (AUC 0.972 [95% CI: 0.9507; 0.9879]) were identified using support vector machine classification of dexmedetomidine data. These findings generalised to sleep/propofol (validation data set: sensory disconnection [AUC 0.743 {95% CI: 0.6784; 0.8050}]) and unconsciousness (AUC 0.622 [95% CI: 0.5176; 0.7238]). We identified that sensory disconnection was associated with broad spatial and spectral changes. In contrast, unconsciousness was associated with focal decreases in activity in anterior and posterior cingulate cortices. CONCLUSIONS These findings may enable novel monitors of the anaesthetic state that can distinguish sensory disconnection and unconsciousness, and these may provide novel insights into the biology of arousal. CLINICAL TRIAL REGISTRATION NCT03284307.
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Affiliation(s)
- Cameron P Casey
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Sean Tanabe
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Zahra Farahbakhsh
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Margaret Parker
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Amber Bo
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Marissa White
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Tyler Ballweg
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Andrew Mcintosh
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - William Filbey
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Yuri Saalmann
- Department of Psychology, University of Wisconsin, Madison, WI, USA
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Camperdown, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
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97
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Propofol Anesthesia: A Leap into the Void? Anesthesiology 2022; 136:405-407. [PMID: 35120194 DOI: 10.1097/aln.0000000000004110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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98
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Pujol J, Blanco-Hinojo L, Ortiz H, Gallart L, Moltó L, Martínez-Vilavella G, Vilà E, Pacreu S, Adalid I, Deus J, Pérez-Sola V, Fernández-Candil J. Mapping the neural systems driving breathing at the transition to unconsciousness. Neuroimage 2021; 246:118779. [PMID: 34875384 DOI: 10.1016/j.neuroimage.2021.118779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/04/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
After falling asleep, the brain needs to detach from waking activity and reorganize into a functionally distinct state. A functional MRI (fMRI) study has recently revealed that the transition to unconsciousness induced by propofol involves a global decline of brain activity followed by a transient reduction in cortico-subcortical coupling. We have analyzed the relationships between transitional brain activity and breathing changes as one example of a vital function that needs the brain to readapt. Thirty healthy participants were originally examined. The analysis involved the correlation between breathing and fMRI signal upon loss of consciousness. We proposed that a decrease in ventilation would be coupled to the initial decline in fMRI signal in brain areas relevant for modulating breathing in the awake state, and that the subsequent recovery would be coupled to fMRI signal in structures relevant for controlling breathing during the unconscious state. Results showed that a slight reduction in breathing from wakefulness to unconsciousness was distinctively associated with decreased activity in brain systems underlying different aspects of consciousness including the prefrontal cortex, the default mode network and somatosensory areas. Breathing recovery was distinctively coupled to activity in deep brain structures controlling basic behaviors such as the hypothalamus and amygdala. Activity in the brainstem, cerebellum and hippocampus was associated with breathing variations in both states. Therefore, our brain maps illustrate potential drives to breathe, unique to wakefulness, in the form of brain systems underlying cognitive awareness, self-awareness and sensory awareness, and to unconsciousness involving structures controlling instinctive and homeostatic behaviors.
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Affiliation(s)
- Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain.
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain; Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | - Héctor Ortiz
- Department of Project and Construction Engineering, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Lluís Gallart
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luís Moltó
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Gerard Martínez-Vilavella
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain
| | - Esther Vilà
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Susana Pacreu
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Irina Adalid
- Department of Anesthesiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain; Department of Psychobiology and Methodology in Health Sciences, Autonomous University of Barcelona, Barcelona, Spain
| | - Víctor Pérez-Sola
- Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain; Hospital del Mar- IMIM and Department of Psychiatry, Institute of Neuropsychiatry and Addictions, Autonomous University of Barcelona, Barcelona, Spain
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Radek L, Koskinen L, Sandman N, Laaksonen L, Kallionpää RE, Scheinin A, Rajala V, Maksimow A, Laitio T, Revonsuo A, Scheinin H, Valli K. On no man's land: Subjective experiences during unresponsive and responsive sedative states induced by four different anesthetic agents. Conscious Cogn 2021; 96:103239. [PMID: 34801782 DOI: 10.1016/j.concog.2021.103239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
To understand how anesthetics with different molecular mechanisms affect consciousness, we explored subjective experiences recalled after responsive and unresponsive sedation induced with equisedative doses of dexmedetomidine, propofol, sevoflurane, and S-ketamine in healthy male participants (N = 140). The anesthetics were administered in experimental setting using target-controlled infusion or vapouriser for one hour. Interviews conducted after anesthetic administration revealed that 46.9% (n = 46) of arousable participants (n = 98) reported experiences, most frequently dreaming or memory incorporation of the setting. Participants receiving dexmedetomidine reported experiences most often while S-ketamine induced the most multimodal experiences. Responsiveness at the end of anesthetic administration did not affect the prevalence or content of reported experiences. These results demonstrate that subjective experiences during responsive and unresponsive sedation are common and anesthetic agents with different molecular mechanisms of action may have different effects on the prevalence and complexity of the experiences, albeit in the present sample the differences between drugs were minute.
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Affiliation(s)
- Linda Radek
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland.
| | - Lauri Koskinen
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Nils Sandman
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Lauri Laaksonen
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Roosa E Kallionpää
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Annalotta Scheinin
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Ville Rajala
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Anu Maksimow
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Timo Laitio
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Antti Revonsuo
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, PO Box 408, 541 28 Skövde, Sweden
| | - Harry Scheinin
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Institute of Biomedicine and Unit of Clinical Pharmacology, University of Turku and Turku University Hospital, FI-20014 Turun yliopisto, Finland
| | - Katja Valli
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, PO Box 408, 541 28 Skövde, Sweden
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Ellia F, Hendren J, Grasso M, Kozma C, Mindt G, P. Lang J, M. Haun A, Albantakis L, Boly M, Tononi G. Consciousness and the fallacy of misplaced objectivity. Neurosci Conscious 2021; 2021:niab032. [PMID: 34667639 PMCID: PMC8519344 DOI: 10.1093/nc/niab032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/22/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022] Open
Abstract
Objective correlates-behavioral, functional, and neural-provide essential tools for the scientific study of consciousness. But reliance on these correlates should not lead to the 'fallacy of misplaced objectivity': the assumption that only objective properties should and can be accounted for objectively through science. Instead, what needs to be explained scientifically is what experience is intrinsically-its subjective properties-not just what we can do with it extrinsically. And it must be explained; otherwise the way experience feels would turn out to be magical rather than physical. We argue that it is possible to account for subjective properties objectively once we move beyond cognitive functions and realize what experience is and how it is structured. Drawing on integrated information theory, we show how an objective science of the subjective can account, in strictly physical terms, for both the essential properties of every experience and the specific properties that make particular experiences feel the way they do.
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Affiliation(s)
- Francesco Ellia
- Department of Philosophy and Communication Studies, University of Bologna, Via Zamboni, 38, 40126 Bologna, Italy
| | - Jeremiah Hendren
- Graduate School Language & Literature, Ludwig Maximilian University of Munich, Geschwister-Scholl-Platz 1, 80539 Munich, Germany
| | - Matteo Grasso
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - Csaba Kozma
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - Garrett Mindt
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - Jonathan P. Lang
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - Andrew M. Haun
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - Larissa Albantakis
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
| | - Melanie Boly
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA
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