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Banerji A, Sleigh JW, Termaat J, Voss LJ. Emergence Electroencephalography in an Unresponsiveness Geriatric Patient in the Postanesthesia Care Unit: A Case Report. A A Pract 2024; 18:e01813. [PMID: 38975674 DOI: 10.1213/xaa.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Incomplete neurological awakening manifested as aberrant patterns of electroencephalography (EEG) at emergence may be responsible for an unresponsive patient in the postanesthesia care unit (PACU). We describe a case of an individual who remained unresponsive but awake in the PACU. Retrospective, intraoperative EEG analysis showed low alpha power and a sudden shift from deep delta to arousal preextubation. We explored parallels with diminished motivation disorders and anesthesia-induced sleep paralysis due to imbalances in anesthetic drug sensitivity between brain regions. Our findings highlight the relevance of end-anesthesia EEG patterns in diagnosing delayed awakening.
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Affiliation(s)
- Antara Banerji
- From the Department of Anesthesiology, Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland, Hamilton, New Zealand
| | - Jamie W Sleigh
- From the Department of Anesthesiology, Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland, Hamilton, New Zealand
| | - Jonathan Termaat
- Department of Anesthesia and Pain Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Logan J Voss
- From the Department of Anesthesiology, Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland, Hamilton, New Zealand
- Department of Anesthesia and Pain Medicine, Waikato Hospital, Hamilton, New Zealand
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2
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Zhou L, Ran Q, Yi R, Tang H, Zhang Y, Yu T. Glutamatergic neurons of piriform cortex delay induction of inhalational general anesthesia. FUNDAMENTAL RESEARCH 2024; 4:829-840. [PMID: 39156577 PMCID: PMC11330113 DOI: 10.1016/j.fmre.2022.12.014] [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: 04/30/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 01/04/2023] Open
Abstract
Since their clinical application in the 1840s, the greatest mystery surrounding general anesthesia (GA) is how different kinds of general anesthetics cause reversible unconsciousness, and the precise neural mechanisms underlying the processes. Over past years, although many studies revealed the roles of cortex, thalamus, brainstem, especially the sleep-wake circuits in GA-induced loss of consciousness (LOC),the full picture of the neural circuit mechanism of GA is still largely unknown. Recent studies have focused on the importance of other brain regions. Here, we report that the activity of glutamatergic (Glu) neurons in the piriform cortex (PC), a critical brain region for odor encoding, began to increase during the LOC of GA and gradually recovered after recovery of consciousness. Chemical lesions of the anterior PC (APC) neurons accelerated the induction time of isoflurane anesthesia. Chemogenetic and optogenetic activation of APCGlu neurons prolonged isoflurane and sevoflurane anesthesia induction, whereas APCGlu neuron inhibition displayed the opposite effects. Moreover, the modification of APCGlu neurons did not affect the induction or emergence time of propofol GA. In addition, odor processing may be partially involved in the induction of isoflurane and sevoflurane GA regulated by APCGlu neurons. In conclusion, our findings reveal a critical role of APCGlu neurons in inhalational GA induction.
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Affiliation(s)
- Liang Zhou
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi 563003, China
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi 563003, China
| | - Qipeng Ran
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi 563003, China
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi 563003, China
| | - Rulan Yi
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi 563003, China
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - Huanyao Tang
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi 563003, China
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi 563003, China
| | - Yu Zhang
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi 563003, China
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi 563003, China
| | - Tian Yu
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi 563003, China
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi 563003, China
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3
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Yi R, Cheng S, Zhong F, Luo D, You Y, Yu T, Wang H, Zhou L, Zhang Y. GABAergic neurons of anterior thalamic reticular nucleus regulate states of consciousness in propofol- and isoflurane-mediated general anesthesia. CNS Neurosci Ther 2024; 30:e14782. [PMID: 38828651 PMCID: PMC11145368 DOI: 10.1111/cns.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The thalamus system plays critical roles in the regulation of reversible unconsciousness induced by general anesthetics, especially the arousal stage of general anesthesia (GA). But the function of thalamus in GA-induced loss of consciousness (LOC) is little known. The thalamic reticular nucleus (TRN) is the only GABAergic neurons-composed nucleus in the thalamus, which is composed of parvalbumin (PV) and somatostatin (SST)-expressing GABAergic neurons. The anterior sector of TRN (aTRN) is indicated to participate in the induction of anesthesia, but the roles remain unclear. This study aimed to reveal the role of the aTRN in propofol and isoflurane anesthesia. METHODS We first set up c-Fos straining to monitor the activity variation of aTRNPV and aTRNSST neurons during propofol and isoflurane anesthesia. Subsequently, optogenetic tools were utilized to activate aTRNPV and aTRNSST neurons to elucidate the roles of aTRNPV and aTRNSST neurons in propofol and isoflurane anesthesia. Electroencephalogram (EEG) recordings and behavioral tests were recorded and analyzed. Lastly, chemogenetic activation of the aTRNPV neurons was applied to confirm the function of the aTRN neurons in propofol and isoflurane anesthesia. RESULTS c-Fos straining showed that both aTRNPV and aTRNSST neurons are activated during the LOC period of propofol and isoflurane anesthesia. Optogenetic activation of aTRNPV and aTRNSST neurons promoted isoflurane induction and delayed the recovery of consciousness (ROC) after propofol and isoflurane anesthesia, meanwhile chemogenetic activation of the aTRNPV neurons displayed the similar effects. Moreover, optogenetic and chemogenetic activation of the aTRN neurons resulted in the accumulated burst suppression ratio (BSR) during propofol and isoflurane GA, although they represented different effects on the power distribution of EEG frequency. CONCLUSION Our findings reveal that the aTRN GABAergic neurons play a critical role in promoting the induction of propofol- and isoflurane-mediated GA.
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Affiliation(s)
- Rulan Yi
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Shiyu Cheng
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Fuwang Zhong
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Dan Luo
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Ying You
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Tian Yu
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Haiying Wang
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Liang Zhou
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
| | - Yu Zhang
- Department of AnesthesiologyAffiliated Hospital of Zunyi Medical UniversityZunyiChina
- Key Laboratory of Anesthesia and Organ Protection (Zunyi Medical University), Ministry of EducationZunyi Medical UniversityZunyiChina
- Key Laboratory of Brain ScienceZunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
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Kikuchi Y, Irifune M, Yoshinaka T, Oue K, Takahashi T, Oda A, Kamio H, Imamura S, Sasaki U, Imado E, Ago Y, Okada Y. A Behavioral and Electroencephalographic Study of Anesthetic State Induced by MK-801 Combined with Haloperidol, Ketamine and Riluzole in Mice. Anesth Analg 2024; 139:00000539-990000000-00753. [PMID: 38377038 PMCID: PMC11465758 DOI: 10.1213/ane.0000000000006900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Ketamine is an intravenous anesthetic that acts as a channel blocker on the N-methyl-d-aspartate (NMDA) receptor, a glutamate receptor subtype. MK-801 is the most potent compound among noncompetitive NMDA receptor antagonists. Ketamine induces loss of the righting reflex (LORR) in rodents, which is one of the indicators of unconsciousness, whereas high doses of MK-801 produce ataxia, but not LORR. In contrast, we previously reported that MK-801 combined with a low dose of the dopamine receptor antagonist haloperidol-induced LORR in mice. To assess a neurophysiologically distinct brain state and demonstrate unconsciousness, electroencephalograms (EEG) need to be examined together with LORR. Therefore, we herein investigated EEG changes after the systemic administration of MK-801 alone or in combination with haloperidol, and compared them with those induced by ketamine, the glutamate release inhibitor riluzole, and the γ-aminobutyric acid type A receptor agonist propofol. METHODS All drugs were intraperitoneally administered to adult male ddY mice (n = 168). General anesthesia was evaluated based on the righting reflex test. Animals who exhibited no righting for more than 30 seconds were considered to have LORR. In a separate group of mice, EEG of the primary visual cortex was recorded before and after the administration of MK-801 (3.0 mg/kg) alone or in combination with haloperidol (0.2 mg/kg), ketamine (150 mg/kg), riluzole (30 mg/kg), or propofol (240 mg/kg). The waveforms recorded were analyzed using EEG power spectra and spectrograms. RESULTS The high dose of MK-801 alone did not induce LORR, whereas MK-801 combined with haloperidol produced LORR in a dose-dependent manner. Ketamine, riluzole, and propofol also dose-dependently induced LORR. In the EEG study, MK-801 alone induced a significant increase in δ power, while MK-801 plus haloperidol exerted similar effects on not only δ, but also θ and α power during LORR, suggesting that increases in δ, θ, and α power were necessary for LORR. The results obtained on MK-801 plus haloperidol were similar to those on ketamine in the behavioral and EEG studies, except for an increase in γ power by ketamine during LORR. Propofol significantly increased δ, θ, α, and β power during LORR. However, the EEG results obtained using riluzole, which produced a unique pattern of lower amplitude activity spanning most frequencies, markedly differed from those with the other drugs. CONCLUSIONS This study revealed differences in EEG changes induced by various sedatives. The results obtained on MK-801 alone and MK-801 plus haloperidol suggest the importance of dopamine transmission in maintaining the righting reflex.
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Affiliation(s)
- Yuka Kikuchi
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Masahiro Irifune
- Department of Dental Anesthesiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taiga Yoshinaka
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Kana Oue
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Tamayo Takahashi
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Aya Oda
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hisanobu Kamio
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Serika Imamura
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Utaka Sasaki
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Eiji Imado
- From the Section of Dental Anesthesiology, Department of Oral & Maxillofacial Surgery and Oral Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Yukio Ago
- Department of Cellular and Molecular Pharmacology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiyuki Okada
- Department of Special Care Dentistry, Hiroshima University Hospital, Hiroshima, Japan
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5
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Ma H, Gu L, Wang Y, Xu Q, Zhang Y, Shao W, Yu Q, Lian X, Liu L, Gu J, Ji N, Liu X, Nagayasu K, Zhang H. The States of Different 5-HT Receptors Located in the Dorsal Raphe Nucleus Are Crucial for Regulating the Awakening During General Anesthesia. Mol Neurobiol 2023; 60:6931-6948. [PMID: 37516665 DOI: 10.1007/s12035-023-03519-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
General anesthesia is widely used in various clinical practices due to its ability to cause loss of consciousness. However, the exact mechanism of anesthesia-induced unconsciousness remains unclear. It is generally thought that arousal-related brain nuclei are involved. 5-Hydroxytryptamine (5-HT) is closely associated with sleep arousal. Here, we explore the role of the 5-HT system in anesthetic awakening through pharmacological interventions and optogenetic techniques. Our data showed that exogenous administration of 5-hydroxytryptophan (5-HTP) and optogenetic activation of 5-HT neurons in the dorsal raphe nucleus (DR) could significantly shorten the emergence time of sevoflurane anesthesia in mice, suggesting that regulation of the 5-HT system using both endogenous and exogenous approaches could mediate delayed emergence. In addition, we first discovered that the different 5-HT receptors located in the DR, known as 5-HT autoreceptors, are essential for the regulation of general anesthetic awakening, with 5-HT1A and 5-HT2A/C receptors playing a regulatory role. These results can provide a reliable theoretical basis as well as potential targets for clinical intervention to prevent delayed emergence and some postoperative risks.
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Affiliation(s)
- HaiXiang Ma
- Department of Anesthesiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
- Medical College of Jining Medical University, Ningji, 272067, Shandong, China
| | - LeYuan Gu
- Department of Anesthesiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - YuLing Wang
- Department of Anesthesiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Qing Xu
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Yuanli Zhang
- Department of Anesthesiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - WeiHui Shao
- Department of Anesthesiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Qian Yu
- Department of Anesthesiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - XiTing Lian
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Lu Liu
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - JiaXuan Gu
- Department of Anesthesiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Na Ji
- Department of Anesthesia, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - XiaoLing Liu
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Kazuki Nagayasu
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, 606-8501, Japan
| | - HongHai Zhang
- Department of Anesthesiology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China.
- Medical College of Jining Medical University, Ningji, 272067, Shandong, China.
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, 310006, China.
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Valli K, Radek L, Kallionpää RE, Scheinin A, Långsjö J, Kaisti K, Kantonen O, Korhonen J, Vahlberg T, Revonsuo A, Scheinin H. Subjective experiences during dexmedetomidine- or propofol-induced unresponsiveness and non-rapid eye movement sleep in healthy male subjects. Br J Anaesth 2023; 131:348-359. [PMID: 37268445 PMCID: PMC10375502 DOI: 10.1016/j.bja.2023.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Anaesthetic-induced unresponsiveness and non-rapid eye movement (NREM) sleep share common neural pathways and neurophysiological features. We hypothesised that these states bear resemblance also at the experiential level. METHODS We compared, in a within-subject design, the prevalence and content of experiences in reports obtained after anaesthetic-induced unresponsiveness and NREM sleep. Healthy males (N=39) received dexmedetomidine (n=20) or propofol (n=19) in stepwise doses to induce unresponsiveness. Those rousable were interviewed and left unstimulated, and the procedure was repeated. Finally, the anaesthetic dose was increased 50%, and the participants were interviewed after recovery. The same participants (N=37) were also later interviewed after NREM sleep awakenings. RESULTS Most subjects were rousable, with no difference between anaesthetic agents (P=0.480). Lower drug plasma concentrations were associated with being rousable for both dexmedetomidine (P=0.007) and propofol (P=0.002) but not with recall of experiences in either drug group (dexmedetomidine: P=0.543; propofol: P=0.460). Of the 76 and 73 interviews performed after anaesthetic-induced unresponsiveness and NREM sleep, 69.7% and 64.4% included experiences, respectively. Recall did not differ between anaesthetic-induced unresponsiveness and NREM sleep (P=0.581), or between dexmedetomidine and propofol in any of the three awakening rounds (P>0.05). Disconnected dream-like experiences (62.3% vs 51.1%; P=0.418) and memory incorporation of the research setting (88.7% vs 78.7%; P=0.204) were equally often present in anaesthesia and sleep interviews, respectively, whereas awareness, signifying connected consciousness, was rarely reported in either state. CONCLUSIONS Anaesthetic-induced unresponsiveness and NREM sleep are characterised by disconnected conscious experiences with corresponding recall frequencies and content. CLINICAL TRIAL REGISTRATION Clinical trial registration. This study was part of a larger study registered at ClinicalTrials.gov (NCT01889004).
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Affiliation(s)
- Katja Valli
- Department of Psychology and Speech-Language Pathology, Turku Brain and Mind Center, University of Turku, Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Skövde, Sweden.
| | - Linda Radek
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Roosa E Kallionpää
- Department of Psychology and Speech-Language Pathology, Turku Brain and Mind Center, University of Turku, Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Annalotta Scheinin
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Jaakko Långsjö
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Kaike Kaisti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Anesthesiology and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Oskari Kantonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Jarno Korhonen
- Department of Psychology and Speech-Language Pathology, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Institute of Clinical Medicine, Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Antti Revonsuo
- Department of Psychology and Speech-Language Pathology, Turku Brain and Mind Center, University of Turku, Turku, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Skövde, Sweden
| | - Harry Scheinin
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Institute of Biomedicine and Unit of Clinical Pharmacology, University of Turku and Turku University Hospital, Turku, Finland
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7
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Liu PC, Yao W, Chen XY, Su WK, Zheng ZH, Yan XB, Deng YL, Shi KG, Liu X, Gao YW, Lin TT, Zhu YX, Lin YX, Zhu ZH, Cai P, Zhang LC, Chen L. Parabrachial nucleus astrocytes regulate wakefulness and isoflurane anesthesia in mice. Front Pharmacol 2023; 13:991238. [PMID: 36712675 PMCID: PMC9880442 DOI: 10.3389/fphar.2022.991238] [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: 07/11/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Background: The parabrachial nucleus (PBN) is an important structure regulating the sleep-wake behavior and general anesthesia. Astrocytes in the central nervous system modulate neuronal activity and consequential behavior. However, the specific role of the parabrachial nucleus astrocytes in regulating the sleep-wake behavior and general anesthesia remains unclear. Methods: We used chemogenetic approach to activate or inhibit the activity of PBN astrocytes by injecting AAV-GFAabc1d-hM3Dq-eGFP or AAV-GFAabc1d-hM4Di-eGFP into the PBN. We investigated the effects of intraperitoneal injection of CNO or vehicle on the amount of wakefulness, NREM sleep and REM sleep in sleep-wake behavior, and on the time of loss of righting reflex, time of recovery of righting reflex, sensitivity to isoflurane, electroencephalogram (EEG) power spectrum and burst suppression ratio (BSR) in isoflurane anesthesia. Results: The activation of PBN astrocytes increased wakefulness amount for 4 h, while the inhibition of PBN astrocytes decreased total amount of wakefulness during the 3-hour post-injection period. Chemogenetic activation of PBN astrocytes decreased isoflurane sensitivity and shortened the emergence time from isoflurane-induced general anesthesia. Cortical EEG recordings revealed that PBN astrocyte activation decreased the EEG delta power and BSR during isoflurane anesthesia. Chemogenetic Inhibition of PBN astrocytes increased the EEG delta power and BSR during isoflurane anesthesia. Conclusion: PBN astrocytes are a key neural substrate regulating wakefulness and emergence from isoflurane anesthesia.
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Affiliation(s)
- Pei-Chang Liu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Wei Yao
- Fujian Province Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Xing-Yu Chen
- Fujian Province Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Wei-Kun Su
- Department of Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
| | - Ze-Hong Zheng
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiong-Bin Yan
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Ya-Ling Deng
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Kai-Ge Shi
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Xin Liu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Yu-Wei Gao
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Tian-Tian Lin
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Yun-Xi Zhu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Ying-Xuan Lin
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhong-Hua Zhu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Ping Cai
- Fujian Province Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China,*Correspondence: Li Chen, ; Liang-Cheng Zhang, ; Ping Cai,
| | - Liang-Cheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China,*Correspondence: Li Chen, ; Liang-Cheng Zhang, ; Ping Cai,
| | - Li Chen
- Department of Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China,*Correspondence: Li Chen, ; Liang-Cheng Zhang, ; Ping Cai,
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8
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Mu B, Xu W, Li H, Suo Z, Wang X, Zheng Y, Tian Y, Zhang B, Yu J, Tian N, Lin N, Zhao D, Zheng Z, Zheng H, Ni C. Determination of the effective dose of dexmedetomidine to achieve loss of consciousness during anesthesia induction. Front Med (Lausanne) 2023; 10:1158085. [PMID: 37153107 PMCID: PMC10159180 DOI: 10.3389/fmed.2023.1158085] [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: 02/03/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Background Dexmedetomidine (DEX) is a sedative with greater preservation of cognitive function, reduced respiratory depression, and improved patient arousability. This study was designed to investigate the performance of DEX during anesthesia induction and to establish an effective DEX induction strategy, which could be valuable for multiple clinical conditions. Methods Patients undergoing abdominal surgery were involved in this dose-finding trial. Dixon's up-and-down sequential method was employed to determine the effective dose of DEX to achieve the state of "loss of consciousness", and an effective induction strategy was established with continuous infusion of DEX and remifentanil. The effects of DEX on hemodynamics, respiratory state, EEG, and anesthetic depth were monitored and analyzed. Results Through the strategy mentioned, the depth of surgical anesthesia was successfully achieved by DEX-led anesthesia induction. The ED50 and ED95 of the initial infusion rate of DEX were 0.115 and 0.200 μg/kg/min, respectively, and the mean induction time was 18.3 min. The ED50 and ED95 of DEX to achieve the state of "loss of consciousness" were 2.899 (95% CI: 2.703-3.115) and 5.001 (95% CI: 4.544-5.700) μg/kg, respectively. The mean PSI on the loss of consciousness was 42.8 among the patients. During anesthesia induction, the hemodynamics including BP and HR were stable, and the EEG monitor showed decreased α and β powers and increased θ and δ in the frontal and pre-frontal cortices of the brain. Conclusion This study indicated that continuous infusion of combined DEX and remifentanil could be an effective strategy for anesthesia induction. The EEG during the induction was similar to the physiological sleep process.
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Affiliation(s)
- Bing Mu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjie Xu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyi Li
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zizheng Suo
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxiao Wang
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Yuxiang Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Tian
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bowen Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Yu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Naiyuan Tian
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Lin
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dan Zhao
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaoxu Zheng
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Hui Zheng
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cheng Ni
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9
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Bu X, Chen Y, Lv P, Fu X, Fu B. Glutamatergic neurons in paraventricular nucleus of the thalamus regulate the recovery from isoflurane anesthesia. BMC Anesthesiol 2022; 22:256. [PMID: 35953781 PMCID: PMC9367068 DOI: 10.1186/s12871-022-01799-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Previous studies have demonstrated that the paraventricular nucleus of the thalamus (PVT) is a key wakefulness-controlling nucleus in the thalamus. Therefore, PVT may also be involved in the process of general anesthesia. This study intends to explore the role of PVT in isoflurane anesthesia. Methods In the present study, we used the expression of c-Fos to observe the neuronal activity of PVT neurons under isoflurane anesthesia. We further recorded the effect of isoflurane anesthesia on the calcium signal of PVT glutamatergic neurons in real time with the help of calcium fiber photometry. We finally used chemogenetic technology to specifically regulate PVT glutamatergic neurons, and observed its effect on isoflurane anesthesia and cortical electroencephalography (EEG) in mice. Results We found that glutamatergic neurons of PVT exhibited high activity during wakefulness and low activity during isoflurane anesthesia. Activation of PVT glutamatergic neuronal caused an acceleration in emergence from isoflurane anesthesia accompanied with a decrease in EEG delta power (1–4 Hz). Whereas suppression of PVT glutamatergic neurons induced a delay recovery of isoflurane anesthesia, without affecting anesthesia induction. Conclusions Assuming a pharmacokinetic explanation for results can be excluded, these results demonstrate that the PVT is involved in regulating anesthesia emergence.
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Affiliation(s)
- Xiaoli Bu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou Province, 563003, Zunyi city, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi city, 563003, Guizhou Province, China
| | - Yiqiu Chen
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou Province, 563003, Zunyi city, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi city, 563003, Guizhou Province, China
| | - Ping Lv
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou Province, 563003, Zunyi city, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi city, 563003, Guizhou Province, China
| | - Xiaoyun Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou Province, 563003, Zunyi city, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi city, 563003, Guizhou Province, China
| | - Bao Fu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Guizhou Province, 563003, Zunyi city, China. .,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi city, 563003, Guizhou Province, China.
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10
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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: 6] [Impact Index Per Article: 3.0] [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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11
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Biophysical Model: A Promising Method in the Study of the Mechanism of Propofol: A Narrative Review. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8202869. [PMID: 35619772 PMCID: PMC9129930 DOI: 10.1155/2022/8202869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 04/02/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022]
Abstract
The physiological and neuroregulatory mechanism of propofol is largely based on very limited knowledge. It is one of the important puzzling issues in anesthesiology and is of great value in both scientific and clinical fields. It is acknowledged that neural networks which are comprised of a number of neural circuits might be involved in the anesthetic mechanism. However, the mechanism of this hypothesis needs to be further elucidated. With the progress of artificial intelligence, it is more likely to solve this problem through using artificial neural networks to perform temporal waveform data analysis and to construct biophysical computational models. This review focuses on current knowledge regarding the anesthetic mechanism of propofol, an intravenous general anesthetic, by constructing biophysical computational models.
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12
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Baron M, Devor M. Might pain be experienced in the brainstem rather than in the cerebral cortex? Behav Brain Res 2022; 427:113861. [DOI: 10.1016/j.bbr.2022.113861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022]
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13
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Zhang J, Li J, Liu C, Gui H, Yuan C, Zhang Y. The role of intracerebral dopamine D1 and D2 receptors in sleep-wake cycles and general anesthesia. IBRAIN 2022; 8:48-54. [PMID: 37786416 PMCID: PMC10528804 DOI: 10.1002/ibra.12024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 10/04/2023]
Abstract
Dopamine (DA), a monoamine neurotransmitter, is synthesized and released mainly by neurons in the ventral tegmental area and the substantia nigra (SN) pars compacta of the midbrain. DA and its receptors are essential for the regulation of arousal, movement, cognition, reward, and other neurobiological behaviors. Arousal, locomotion, cognition, reward, and other neurobiological functions are all regulated by dopamine and its receptors. Dopamine receptors can be divided into D1-like receptors (including D1 and D5) or D2-like receptors (containing D2, D3, and D4), with D1 and D2 receptors (D1Rs, and D2Rs) being the most important. Currently, studies indicated that D1Rs and D2Rs are tightly involved with the process of sleep-wake and general anesthesia, but the specific mechanism remains unclear. In this review, we compiled the most recent findings, mainly focusing on the structure, distribution, and signal pathway of D1Rs and D2Rs in the central nervous system, as well as the involvement of D1Rs and D2Rs in sleep-wake and general anesthesia. Thus, the investigations of the D1Rs and D2Rs will benefit not only better knowledge for how sleep-wake control works but also the mechanism of general anesthesia.
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Affiliation(s)
- Jie Zhang
- The Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
- School of AnesthesiologyZunyi Medical UniversityZunyiChina
| | - Jia Li
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
- School of AnesthesiologyZunyi Medical UniversityZunyiChina
| | - Cheng‐Xi Liu
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
- School of AnesthesiologyZunyi Medical UniversityZunyiChina
| | - Huan Gui
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
- School of AnesthesiologyZunyi Medical UniversityZunyiChina
| | - Cheng‐Dong Yuan
- The Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
- School of AnesthesiologyZunyi Medical UniversityZunyiChina
| | - Yi Zhang
- The Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
- Guizhou Key Laboratory of Anesthesia and Organ ProtectionZunyi Medical UniversityZunyiChina
- School of AnesthesiologyZunyi Medical UniversityZunyiChina
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14
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Tanaka R, Tanaka S, Hayashi K, Iida K, Sawa T, Kawamata M. The histamine H 1 receptor antagonist hydroxyzine enhances sevoflurane and propofol anesthesia: A quantitative EEG study. Clin Neurophysiol 2021; 132:2054-2061. [PMID: 34284240 DOI: 10.1016/j.clinph.2021.05.024] [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: 08/27/2020] [Revised: 04/26/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine the anesthesia-promoting effects of hydroxyzine on electroencephalograms during sevoflurane anesthesia and during propofol anesthesia. METHODS We analyzed 40 patients scheduled for elective surgery under sevoflurane anesthesia (n = 20) or propofol anesthesia (n = 20). Anesthesia was adjusted at a bispectral index value of 50-60, and then 0.5 mg/kg of hydroxyzine was administered intravenously. We analyzed frontal electroencephalograms before and after hydroxyzine injection with power spectral and bicoherence analyses, which are suitable for assessing the anesthetic depth induced by γ-aminobutyric acid (GABA)ergic anesthetics. RESULTS Hydroxyzine increased the α bicoherence peaks in both sevoflurane anesthesia (mean difference, 11.2%; 95% confidence interval (CI), 7.6 to 14.8; P < 0.001) and propofol anesthesia (mean difference, 5.6%; 95% CI, 1.7 to 9.4; P = 0.008). Hydroxyzine increased the averaged δ bicoherence values in both sevoflurane anesthesia (mean difference, 5.5%; 95% CI, 2.1 to 8.8; P = 0.003) and propofol anesthesia (mean difference, 3.9%; 95% CI, 1.0 to 6.8; P = 0.011). CONCLUSIONS Hydroxyzine enhances both sevoflurane anesthesia and propofol anesthesia probably by facilitation of GABAergic neural circuit mechanisms. SIGNIFICANCE The findings provide a new insight into the role of histaminergic neurons during general anesthesia in humans.
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Affiliation(s)
- Ryusuke Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan.
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
| | - Kazuko Hayashi
- Department of Anesthesiology, Kyoto Chubu Medical Center, Japan; Department of Anesthesiology, Kyoto Prefectural University of Medicine, Japan
| | - Keisuke Iida
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
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15
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Zhang Y, Gui H, Duan Z, Yu T, Zhang J, Liang X, Liu C. Dopamine D1 Receptor in the Nucleus Accumbens Modulates the Emergence from Propofol Anesthesia in Rat. Neurochem Res 2021; 46:1435-1446. [PMID: 33683630 DOI: 10.1007/s11064-021-03284-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/26/2021] [Accepted: 02/23/2021] [Indexed: 01/04/2023]
Abstract
It has been reported that systemic activation of D1 receptors promotes emergence from isoflurane-induced unconsciousness, suggesting that the central dopaminergic system is involved in the process of recovering from general anesthesia. The nucleus accumbens (NAc) contains abundant GABAergic medium spiny neurons (MSNs) expressing the D1 receptor (D1R), which plays a key role in sleep-wake behavior. However, the role of NAc D1 receptors in the process of emergence from general anesthesia has not been identified. Here, using real-time in vivo fiber photometry, we found that neuronal activity in the NAc was markedly disinhibited during recovery from propofol anesthesia. Subsequently, microinjection of a D1R selective agonist (chloro-APB hydrobromide) into the NAc notably reduced the time to emerge from propofol anesthesia with a decrease in δ-band power and an increase in β-band power evident in the cortical electroencephalogram. These effects were prevented by pretreatment with a D1R antagonist (SCH-23390). Whole-cell patch clamp recordings were performed to further explore the cellular mechanism underlying the modulation of D1 receptors on MSNs under propofol anesthesia. Our data primarily demonstrated that propofol increased the frequency and prolonged the decay time of spontaneous inhibitory postsynaptic currents (sIPSCs) and miniature IPSCs (mIPSCs) of MSNs expressing D1 receptors. A D1R agonist attenuated the effect of propofol on the frequency of sIPSCs and mIPSCs, and the effects of the agonist were eliminated by preapplication of SCH-23390. Collectively, these results indicate that modulation of the D1 receptor on the activity of NAc MSNs is vital for emergence from propofol-induced unconsciousness.
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Affiliation(s)
- Yi Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Guizhou Key Laboratory of Brain Science, Guizhou Key Laboratory of Anesthesia and Organ Protection, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Huan Gui
- Guizhou Key Laboratory of Brain Science, Guizhou Key Laboratory of Anesthesia and Organ Protection, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zikun Duan
- Guizhou Key Laboratory of Brain Science, Guizhou Key Laboratory of Anesthesia and Organ Protection, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tian Yu
- Guizhou Key Laboratory of Brain Science, Guizhou Key Laboratory of Anesthesia and Organ Protection, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jie Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Guizhou Key Laboratory of Brain Science, Guizhou Key Laboratory of Anesthesia and Organ Protection, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaoli Liang
- Department of Anesthesiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Guizhou Key Laboratory of Brain Science, Guizhou Key Laboratory of Anesthesia and Organ Protection, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chengxi Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.
- Guizhou Key Laboratory of Brain Science, Guizhou Key Laboratory of Anesthesia and Organ Protection, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.
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16
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Dendritic spine remodeling and plasticity under general anesthesia. Brain Struct Funct 2021; 226:2001-2017. [PMID: 34061250 PMCID: PMC8166894 DOI: 10.1007/s00429-021-02308-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Abstract
Ever since its first use in surgery, general anesthesia has been regarded as a medical miracle enabling countless life-saving diagnostic and therapeutic interventions without pain sensation and traumatic memories. Despite several decades of research, there is a lack of understanding of how general anesthetics induce a reversible coma-like state. Emerging evidence suggests that even brief exposure to general anesthesia may have a lasting impact on mature and especially developing brains. Commonly used anesthetics have been shown to destabilize dendritic spines and induce an enhanced plasticity state, with effects on cognition, motor functions, mood, and social behavior. Herein, we review the effects of the most widely used general anesthetics on dendritic spine dynamics and discuss functional and molecular correlates with action mechanisms. We consider the impact of neurodevelopment, anatomical location of neurons, and their neurochemical profile on neuroplasticity induction, and review the putative signaling pathways. It emerges that in addition to possible adverse effects, the stimulation of synaptic remodeling with the formation of new connections by general anesthetics may present tremendous opportunities for translational research and neurorehabilitation.
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17
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Kushikata T, Hirota K, Saito J, Takekawa D. Roles of Neuropeptide S in Anesthesia, Analgesia, and Sleep. Pharmaceuticals (Basel) 2021; 14:ph14050483. [PMID: 34069327 PMCID: PMC8158725 DOI: 10.3390/ph14050483] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023] Open
Abstract
Neuropeptide S (NPS) is an endogenous peptide that regulates various physiological functions, such as immune functions, anxiety-like behaviors, learning and memory, the sleep–wake rhythm, ingestion, energy balance, and drug addiction. These processes include the NPS receptor (NPSR1). The NPS–NPSR1 system is also significantly associated with the onset of disease, as well as these physiologic functions. For example, NPS is involved in bronchial asthma, anxiety and awakening disorders, and rheumatoid arthritis. In this review, among the various functions, we focus on the role of NPS in anesthesia-induced loss of consciousness; analgesia, mainly by anesthesia; and sleep–wakefulness. Progress in the field regarding the functions of endogenous peptides in the brain, including NPS, suggests that these three domains share common mechanisms. Further NPS research will help to elucidate in detail how these three domains interact with each other in their functions, and may contribute to improving the quality of medical care.
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Affiliation(s)
- Tetsuya Kushikata
- Department of Anesthesiology, Graduate School of Medicine, Hirosaki University, Zaifu 5, Hirosaki 0368562, Japan; (K.H.); (J.S.)
- Correspondence:
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Graduate School of Medicine, Hirosaki University, Zaifu 5, Hirosaki 0368562, Japan; (K.H.); (J.S.)
| | - Junichi Saito
- Department of Anesthesiology, Graduate School of Medicine, Hirosaki University, Zaifu 5, Hirosaki 0368562, Japan; (K.H.); (J.S.)
| | - Daiki Takekawa
- Department of Anesthesia, Hirosaki University Hospital, Honcho 53, Hirosaki 0368563, Japan;
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Li A, Li R, Ouyang P, Li H, Wang S, Zhang X, Wang D, Ran M, Zhao G, Yang Q, Zhu Z, Dong H, Zhang H. Dorsal raphe serotonergic neurons promote arousal from isoflurane anesthesia. CNS Neurosci Ther 2021; 27:941-950. [PMID: 33973716 PMCID: PMC8265942 DOI: 10.1111/cns.13656] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/30/2021] [Accepted: 04/17/2021] [Indexed: 12/04/2022] Open
Abstract
Aims General anesthesia has been widely applied in surgical or nonsurgical medical procedures, but the mechanism behind remains elusive. Because of shared neural circuits of sleep and anesthesia, whether serotonergic system, which is highly implicated in modulation of sleep and wakefulness, regulates general anesthesia as well is worth investigating. Methods Immunostaining and fiber photometry were used to assess the neuronal activities. Electroencephalography spectra and burst‐suppression ratio (BSR) were used to measure anesthetic depth and loss or recovery of righting reflex to indicate the induction or emergence time of general anesthesia. Regulation of serotonergic system was achieved through optogenetic, chemogenetic, or pharmacological methods. Results We found that both Fos expression and calcium activity were significantly decreased during general anesthesia. Activation of 5‐HT neurons in the dorsal raphe nucleus (DRN) decreased the depth of anesthesia and facilitated the emergence from anesthesia, and inhibition deepened the anesthesia and prolonged the emergence time. Furthermore, agonism or antagonism of 5‐HT 1A or 2C receptors mimicked the effect of manipulating DRN serotonergic neurons. Conclusion Our results demonstrate that 5‐HT neurons in the DRN play a regulative role of general anesthesia, and activation of serotonergic neurons could facilitate emergence from general anesthesia partly through 5‐HT 1A and 2C receptors.
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Affiliation(s)
- Ao Li
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Rui Li
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Pengrong Ouyang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Huihui Li
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Sa Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xinxin Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dan Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Mingzi Ran
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guangchao Zhao
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qianzi Yang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhenghua Zhu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Haopeng Zhang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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19
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Gui H, Liu C, He H, Zhang J, Chen H, Zhang Y. Dopaminergic Projections From the Ventral Tegmental Area to the Nucleus Accumbens Modulate Sevoflurane Anesthesia in Mice. Front Cell Neurosci 2021; 15:671473. [PMID: 33994950 PMCID: PMC8119636 DOI: 10.3389/fncel.2021.671473] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 01/03/2023] Open
Abstract
The role of the dopaminergic pathway in general anesthesia and its potential mechanisms are still unknown. In this study, we usedc-Fos staining combined with calcium fiber photometry recording to explore the activity of ventral tegmental area (VTA) dopaminergic neurons(VTA-DA) and nucleus accumbens (NAc) neurons during sevoflurane anesthesia. A genetically encoded dopamine (DA) sensor was used to investigate thefunction of the NAc in sevoflurane anesthesia. Chemogenetics and optogenetics were used to explore the role of the VTA-DA in sevofluraneanesthesia. Electroencephalogram (EEG) spectra, time of loss of righting reflex (LORR) and recovery of righting reflex (RORR) were recorded asassessment indicators. We found that VTA-DA and NAc neurons were inhibited during the induction period and were activated during the recoveryperiod of sevoflurane anesthesia. The fluorescence signals of dopamine decreased in the induction of and increased in the emergence from sevoflurane anesthesia.Activation of VTA-DA and the VTADA-NAc pathway delayed the induction and facilitated the emergence accompanying with thereduction of delta band and the augmentation of the gamma band. These data demonstrate that VTA-DA neurons play a critical role in modulating sevofluraneanesthesia via the VTADA-NAc pathway.
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Affiliation(s)
- Huan Gui
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,School of Anesthesiology, Zunyi Medical University, Zunyi, China
| | - Chengxi Liu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,School of Anesthesiology, Zunyi Medical University, Zunyi, China
| | - Haifeng He
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,School of Anesthesiology, Zunyi Medical University, Zunyi, China
| | - Jie Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,School of Anesthesiology, Zunyi Medical University, Zunyi, China
| | - Hong Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,School of Anesthesiology, Zunyi Medical University, Zunyi, China
| | - Yi Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,School of Anesthesiology, Zunyi Medical University, Zunyi, China
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20
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Cai S, Tang AC, Luo TY, Yang SC, Yang H, Liu CX, Shu Y, Pan YC, Zhang Y, Zhou L, Yu T, Yu SY. Effect of basal forebrain somatostatin and parvalbumin neurons in propofol and isoflurane anesthesia. CNS Neurosci Ther 2021; 27:792-804. [PMID: 33764684 PMCID: PMC8193699 DOI: 10.1111/cns.13635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/02/2022] Open
Abstract
Aims The basal forebrain (BF) plays an essential role in wakefulness and cognition. Two subtypes of BF gamma‐aminobutyric acid (GABA) neurons, including somatostatin‐expressing (GABASOM) and parvalbumin‐positive (GABAParv) neurons, function differently in mediating the natural sleep–wake cycle. Since the loss of consciousness induced by general anesthesia and the natural sleep–wake cycle probably share similar mechanisms, it is important to clarify the accurate roles of these neurons in general anesthesia procedure. Methods Based on two transgenic mouse lines expressing SOM‐IRES‐Cre and PV‐IRES‐Cre, we used a combination of genetic activation, inactivation, and chronic ablation approaches to further explore the behavioral and electroencephalography (EEG) roles of BFSOM and BFParv neurons in general anesthesia. After a single intravenous injection of propofol and the induction and recovery times of isoflurane anesthesia, the anesthesia time was compared. The changes in cortical EEG under different conditions were also compared. Results Activation of BF GABASOM neurons facilitates both the propofol and isoflurane anesthesia, manifesting as a longer anesthesia duration time with propofol anesthesia and a fast induction time and longer recovery time with isoflurane anesthesia. Moreover, BF GABASOM‐activated mice displayed a greater suppression of cortical electrical activity during anesthesia, showing an increase in δ power bands or a simultaneous decrease in high‐frequency power bands. However, only a limited and nuanced effect on propofol and isoflurane anesthesia was observed with the manipulated BF GABAParv neurons. Conclusions Our results suggested that BF GABASOM neurons play a critical role in propofol and isoflurane general anesthesia, while BF GABAParv neurons appeared to have little effect.
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Affiliation(s)
- Shuang Cai
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Ai-Chen Tang
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Tian-Yuan Luo
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
| | - Shao-Cheng Yang
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Huanhuan Yang
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Cheng-Xi Liu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
| | - Yue Shu
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Yun-Chao Pan
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yu Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
| | - Liang Zhou
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Tian Yu
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
| | - Shou-Yang Yu
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
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21
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Liu C, Liu J, Zhou L, He H, Zhang Y, Cai S, Yuan C, Luo T, Zheng J, Yu T, Zhang M. Lateral Habenula Glutamatergic Neurons Modulate Isoflurane Anesthesia in Mice. Front Mol Neurosci 2021; 14:628996. [PMID: 33746711 PMCID: PMC7969819 DOI: 10.3389/fnmol.2021.628996] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/09/2021] [Indexed: 01/27/2023] Open
Abstract
Since their introduction in the 1840s, one of the largest mysteries of modern anesthesia are how general anesthetics create the state of reversible loss of consciousness. Increasing researchers have shown that neural pathways that regulate endogenous sleep–wake systems are also involved in general anesthesia. Recently, the Lateral Habenula (LHb) was considered as a hot spot for both natural sleep–wake and propofol-induced sedation; however, the role of the LHb and related pathways in the isoflurane-induced unconsciousness has yet to be identified. Here, using real-time calcium fiber photometry recordings in vivo, we found that isoflurane reversibly increased the activity of LHb glutamatergic neurons. Then, we selectively ablated LHb glutamatergic neurons in Vglut2-cre mice, which caused a longer induction time and less recovery time along with a decrease in delta-band power in mice under isoflurane anesthesia. Furthermore, using a chemogenetic approach to specifically activate LHb glutamatergic neurons shortened the induction time and prolonged the recovery time in mice under isoflurane anesthesia with an increase in delta-band power. In contrast, chemogenetic inhibition of LHb glutamatergic neurons was very similar to the effects of selective lesions of LHb glutamatergic neurons. Finally, optogenetic activation of LHb glutamatergic neurons or the synaptic terminals of LHb glutamatergic neurons in the rostromedial tegmental nucleus (RMTg) produced a hypnosis-promoting effect in isoflurane anesthesia with an increase in slow wave activity. Our results suggest that LHb glutamatergic neurons and pathway are vital in modulating isoflurane anesthesia.
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Affiliation(s)
- Chengxi Liu
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Guizhou Key Laboratory of Anaesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Junxiao Liu
- Guizhou Key Laboratory of Anaesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Liang Zhou
- Guizhou Key Laboratory of Anaesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Haifeng He
- Guizhou Key Laboratory of Anaesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Yu Zhang
- Guizhou Key Laboratory of Anaesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shuang Cai
- Guizhou Key Laboratory of Anaesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Chengdong Yuan
- Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tianyuan Luo
- Guizhou Key Laboratory of Anaesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Yu
- Guizhou Key Laboratory of Anaesthesia and Organ Protection, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Mazhong Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Abstract
The anesthetic state and natural sleep share many neurobiological features and yet are two distinct states. The hallmarks of general anesthesia include hypnosis, analgesia, akinesia and anxiolysis. These are the principal parameters by which the anesthetic state differs from natural sleep. These properties are mediated by systemic administration of a combination of agents producing balanced anesthesia. The exact nature of anesthetic narcosis is dose dependent and agent specific. It exhibits a relative lack of nociceptive response and active suppression of motor and autonomic reflexes. Surgical anesthesia displays a signature electroencephalogram pattern of burst suppression that differs from rapid eye movement sleep, representing more widespread disruption of thalamocortical connectivity, impairing information integration and processing. These differences underpin successful anesthetic action. This review explores the differences between natural sleep and anesthetic-induced unconsciousness as induced by balanced anesthesia.
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Affiliation(s)
- Akshay Date
- Basildon & Thurrock University Hospital, Nethermayne, Basildon, Essex SS16 5NL, UK
| | - Khayam Bashir
- Basildon & Thurrock University Hospital, Nethermayne, Basildon, Essex SS16 5NL, UK
| | - Aaliya Uddin
- Basildon & Thurrock University Hospital, Nethermayne, Basildon, Essex SS16 5NL, UK
| | - Chandni Nigam
- Kings College Hospital, Denmark Hill, Brixton, London SE5 9RS, UK
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23
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Hao L, Hu X, Zhu B, Li W, Huang X, Kang F. Clinical observation of the combined use of propofol and etomidate in painless gastroscopy. Medicine (Baltimore) 2020; 99:e23061. [PMID: 33157963 PMCID: PMC7647540 DOI: 10.1097/md.0000000000023061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study is aims to compare the anesthetic safety of propofol combined with etomidate for painless gastroscopy. METHODS Three hundred patients undergoing painless gastroscopy were randomly assigned to P, PE1, and PE2 groups. Patients were anesthetized with propofol (P group) or propofol combined with etomidate (volume ratio 1: 1, PE1 group; volume ratio 2: 1, PE2 group). The hemodynamics and adverse reactions were observed. The sleep quality satisfaction and nature of dreams were recorded. RESULTS Compared with pre-anesthesia, the mean arterial pressure and heart rate of the 3 groups were significantly slower during the examination and at the end of the examination. PE1 group had a higher incidence of muscle spasm, body moving, choking, and deglutition. The incidence of hypoxemia and injection pain was higher in P group. P and PE2 group had higher sleep quality satisfaction and dream incidence after awaking. However, there was no difference in the nature of dreams among 3 groups. CONCLUSION Our data indicate that the combination of 10 ml 1.0% propofol and 5 ml 0.2% etomidate for painless gastroscopy reduces adverse reactions while not affecting the patients respiratory function. Moreover, it is safe and effective, which is worthy of clinical application and promotion.
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Affiliation(s)
- Lina Hao
- Department of Anesthesiology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, 1st Swan lake road, Shushan District, Hefei, Anhui Province, China
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24
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Luo TY, Cai S, Qin ZX, Yang SC, Shu Y, Liu CX, Zhang Y, Zhang L, Zhou L, Yu T, Yu SY. Basal Forebrain Cholinergic Activity Modulates Isoflurane and Propofol Anesthesia. Front Neurosci 2020; 14:559077. [PMID: 33192246 PMCID: PMC7652994 DOI: 10.3389/fnins.2020.559077] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
Cholinergic neurons in the basal forebrain (BF) have long been considered to be the key neurons in the regulation of cortical and behavioral arousal, and cholinergic activation in the downstream region of the BF can arouse anesthetized rats. However, whether the activation of BF cholinergic neurons can induce behavior and electroencephalogram (EEG) recovery from anesthesia is unclear. In this study, based on a transgenic mouse line expressing ChAT-IRES-Cre, we applied a fiber photometry system combined with GCaMPs expression in the BF and found that both isoflurane and propofol inhibit the activity of BF cholinergic neurons, which is closely related to the consciousness transition. We further revealed that genetic lesion of BF cholinergic neurons was associated with a markedly increased potency of anesthetics, while designer receptor exclusively activated by designer drugs (DREADD)-activated BF cholinergic neurons was responsible for slower induction and faster recovery of anesthesia. We also documented a significant increase in δ power bands (1-4 Hz) and a decrease in β (12-25 Hz) power bands in BF cholinergic lesioned mice, while there was a clearly noticeable decline in EEG δ power of activated BF cholinergic neurons. Moreover, sensitivity to anesthetics was reduced after optical stimulation of BF cholinergic cells, yet it failed to restore wake-like behavior in constantly anesthetized mice. Our results indicate a functional role of BF cholinergic neurons in the regulation of general anesthesia. Inhibition of BF cholinergic neurons mediates the formation of unconsciousness induced by general anesthetics, and their activation promotes recovery from the anesthesia state.
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Affiliation(s)
- Tian-Yuan Luo
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi, China
| | - Shuang Cai
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Zai-Xun Qin
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi, China
| | - Shao-Cheng Yang
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Yue Shu
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Cheng-Xi Liu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi, China
| | - Yu Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi, China
| | - Lin Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi, China
| | - Liang Zhou
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Tian Yu
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi, China.,Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Shou-Yang Yu
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
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25
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Liu C, Zhou X, Zhu Q, Fu B, Cao S, Zhang Y, Zhang L, Zhang Y, Yu T. Dopamine neurons in the ventral periaqueductal gray modulate isoflurane anesthesia in rats. CNS Neurosci Ther 2020; 26:1121-1133. [PMID: 32881314 PMCID: PMC7564192 DOI: 10.1111/cns.13447] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022] Open
Abstract
Aims General anesthesia has been applied in surgery for more than 170 years, and there is little doubt that GABAA receptors have an important role as anesthetic molecular targets, but its neural mechanisms remain unclear. Increasing researchers have shown that dopaminergic pathways in the brain are crucial for sleep and wake. General anesthesia‐induced unconsciousness and natural sleep share some neural correlates. However, the role of GABAA receptors in ventral periaqueductal gray (vPAG) dopamine (DA) neurons in the isoflurane‐induced unconsciousness has yet to be identified. Methods In the present study, we used calcium fiber photometry recording to explore that the activity of ventral periaqueductal gray (vPAG) neurons. Then, rats were unilaterally microinjected with 6‐hydroxydopamine into the vPAG area to determine the role of vPAG‐DA neurons in isoflurane‐induced‐anesthesia. Furthermore, thirty SD rats were divided into three groups: a GABAAR agonist‐muscimol group, a GABAAR antagonist‐gabazine group, and a control group. Finally, whole‐cell patch clamp was used to examine the effects of isoflurane and GABAA receptor agonist/antagonist on vPAG‐DA neurons. Results The vPAG neurons were markedly inhibited during isoflurane anesthesia induction and that these neurons were activated during emergence from isoflurane anesthesia. Lesion to the vPAG‐DA neurons shortened the induction time and prolonged the emergence time while increasing δ power in isoflurane anesthesia. Intracerebral injection of the GABAA receptor agonist (muscimol) into the vPAG accelerated the induction of anesthesia and delayed recovery from isoflurane anesthesia, with a decrease of δ power and an augment of β power. Injection of GABAA receptor antagonist gabazine generated the opposite effects. Isoflurane enhanced GABAergic transmission, and GABAA receptor agonist partly increased isoflurane‐induced inhibition of vPAG‐DA neurons, while GABAA receptor antagonist evidently attenuated GABAergic transmission. Conclusion Our results suggest that vPAG‐DA neurons are involved in isoflurane anesthesia through activation of the GABAA receptor.
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Affiliation(s)
- Chengxi Liu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Xiao Zhou
- Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Qiuyu Zhu
- Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Bao Fu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China.,Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Song Cao
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
| | - Yu Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Lin Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
| | - Yi Zhang
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China.,Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tian Yu
- Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China
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26
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Luo M, Song B, Zhu J. Electroacupuncture: A New Approach for Improved Postoperative Sleep Quality After General Anesthesia. Nat Sci Sleep 2020; 12:583-592. [PMID: 32922103 PMCID: PMC7457783 DOI: 10.2147/nss.s261043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
General anesthesia produces a state of drug-induced unconsciousness that is controlled by the extent and duration of administered agents. Whether inhalation or intravenous in formulation, such agents may interfere with normal sleep-wake cycles, impairing postoperative sleep quality and creating complications. Electroacupuncture is a new approach widely applied in clinical practice during recent years. This particular technology helps regulate neurotransmitter concentrations in the brain, lowering norepinephrine and dopamine levels to improve sleep quality. It also alleviates surgical pain that degrades postoperative sleep quality after general anesthesia by downregulating immune activity (SP, NK-1, and COX-1) and upregulating serotonin receptor (5-HT1AR, 5-HT2AR) and endocannabinoid expression levels. However, large-scale, multicenter studies are still needed to determine the optimal duration, frequency, and timing of electroacupuncture for such use.
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Affiliation(s)
- Man Luo
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
- Department of Anesthesiology, Friendship Hospital of Capital Medical University, Beijing, People’s Republic of China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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27
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Liu D, Li J, Wu J, Dai J, Chen X, Huang Y, Zhang S, Tian B, Mei W. Monochromatic Blue Light Activates Suprachiasmatic Nucleus Neuronal Activity and Promotes Arousal in Mice Under Sevoflurane Anesthesia. Front Neural Circuits 2020; 14:55. [PMID: 32973462 PMCID: PMC7461971 DOI: 10.3389/fncir.2020.00055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/27/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Monochromatic blue light (MBL), with a wavelength between 400–490 nm, can regulate non-image-forming (NIF) functions of light in the central nervous system. The suprachiasmatic nucleus (SCN) in the brain is involved in the arousal-promoting response to blue light in mice. Animal and human studies showed that the responsiveness of the brain to visual stimuli is partly preserved under general anesthesia. Therefore, this study aimed to investigate whether MBL promotes arousal from sevoflurane anesthesia via activation of the SCN in mice. Methods: The induction and emergence time of sevoflurane anesthesia under MBL (460 nm and 800 lux) exposure was measured. Cortical electroencephalograms (EEGs) were recorded and the burst-suppression ratio (BSR) was calculated under MBL during sevoflurane anesthesia. The EEGs and local field potential (LFP) recordings with or without locally electrolytic ablated bilateral SCN were used to further explore the role of SCN in the arousal-promoting effect of MBL under sevoflurane anesthesia. Immunofluorescent staining of c-Fos was conducted to reveal the possible downstream mechanism of SCN activation. Results: Unlike the lack of effect on the induction time, MBL shortened the emergence time and the EEG recordings showed cortical arousal during the recovery period. MBL resulted in a significant decrease in BSR and a marked increase in EEG power at all frequency bands except for the spindle band during 2.5% sevoflurane anesthesia. MBL exposure under sevoflurane anesthesia enhances the neuronal activity of the SCN. These responses to MBL were abolished in SCN lesioned (SCNx) mice. MBL evoked a high level of c-Fos expression in the prefrontal cortex (PFC) and lateral hypothalamus (LH) compared to polychromatic white light (PWL) under sevoflurane anesthesia, while it exerted no effect on c-Fos expression in the ventrolateral preoptic area (VLPO) and locus coeruleus (LC) c-Fos expression. Conclusions: MBL promotes behavioral and electroencephalographic arousal from sevoflurane anesthesia via the activation of the SCN and its associated downstream wake-related nuclei. The clinical implications of this study warrant further study.
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Affiliation(s)
- Daiqiang Liu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayan Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Wu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqi Dai
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Xinfeng Chen
- Chinese Institute for Brain Research (CIBR), ZGC Life Science Park, Beijing, China
| | - Yujie Huang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuang Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Tian
- Department of Neurobiology, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Diseases, Ministry of Education, Wuhan, China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Lendner JD, Helfrich RF, Mander BA, Romundstad L, Lin JJ, Walker MP, Larsson PG, Knight RT. An electrophysiological marker of arousal level in humans. eLife 2020; 9:e55092. [PMID: 32720644 PMCID: PMC7394547 DOI: 10.7554/elife.55092] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
Deep non-rapid eye movement sleep (NREM) and general anesthesia with propofol are prominent states of reduced arousal linked to the occurrence of synchronized oscillations in the electroencephalogram (EEG). Although rapid eye movement (REM) sleep is also associated with diminished arousal levels, it is characterized by a desynchronized, 'wake-like' EEG. This observation implies that reduced arousal states are not necessarily only defined by synchronous oscillatory activity. Using intracranial and surface EEG recordings in four independent data sets, we demonstrate that the 1/f spectral slope of the electrophysiological power spectrum, which reflects the non-oscillatory, scale-free component of neural activity, delineates wakefulness from propofol anesthesia, NREM and REM sleep. Critically, the spectral slope discriminates wakefulness from REM sleep solely based on the neurophysiological brain state. Taken together, our findings describe a common electrophysiological marker that tracks states of reduced arousal, including different sleep stages as well as anesthesia in humans.
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Affiliation(s)
- Janna D Lendner
- Helen Wills Neuroscience Institute, University of California, BerkeleyBerkeleyUnited States
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center TuebingenTuebingenGermany
| | - Randolph F Helfrich
- Hertie-Institute for Clinical Brain ResearchTuebingenGermany
- Department of Neurology and Epileptology, University Medical Center TuebingenTuebingenGermany
| | - Bryce A Mander
- Department of Psychiatry and Human Behavior, University of California, IrvineIrvineUnited States
| | - Luis Romundstad
- Department of Anesthesiology, University of Oslo Medical CenterOsloNorway
| | - Jack J Lin
- Department of Neurology, University of California, IrvineIrvineUnited States
| | - Matthew P Walker
- Helen Wills Neuroscience Institute, University of California, BerkeleyBerkeleyUnited States
- Department of Psychology, University of California, BerkeleyBerkeleyUnited States
| | - Pal G Larsson
- Department of Neurosurgery, University of Oslo Medical CenterOsloNorway
| | - Robert T Knight
- Helen Wills Neuroscience Institute, University of California, BerkeleyBerkeleyUnited States
- Department of Psychology, University of California, BerkeleyBerkeleyUnited States
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Wang S, Li Y, Qiu S, Zhang C, Wang G, Xian J, Li T, He H. Reorganization of rich-clubs in functional brain networks during propofol-induced unconsciousness and natural sleep. NEUROIMAGE-CLINICAL 2020; 25:102188. [PMID: 32018124 PMCID: PMC6997627 DOI: 10.1016/j.nicl.2020.102188] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/31/2019] [Accepted: 01/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND General anesthesia (GA) provides an invaluable experimental tool to understand the essential neural mechanisms underlying consciousness. Previous neuroimaging studies have shown the functional integration and segregation of brain functional networks during anesthetic-induced alteration of consciousness. However, the organization pattern of hubs in functional brain networks remains unclear. Moreover, comparisons with the well-characterized physiological unconsciousness can help us understand the neural mechanisms of anesthetic-induced unconsciousness. METHODS Resting-state functional magnetic resonance imaging was performed during wakefulness, mild propofol-induced sedation (m-PIS), and deep PIS (d-PIS) with clinical unconsciousness on 8 healthy volunteers and wakefulness and natural sleep on 9 age- and sex-matched healthy volunteers. Large-scale functional brain networks of each volunteer were constructed based on 160 regions of interest. Then, rich-club organizations in brain functional networks and nodal properties (nodal strength and efficiency) were assessed and analyzed among the different states and groups. RESULTS Rich-clubs in the functional brain networks were reorganized during alteration of consciousness induced by propofol. Firstly, rich-club nodes were switched from the posterior cingulate cortex (PCC), angular gyrus, and anterior and middle insula to the inferior parietal lobule (IPL), inferior parietal sulcus (IPS), and cerebellum. When sedation was deepened to unconsciousness, the rich-club nodes were switched to the occipital and angular gyrus. These results suggest that the rich-club nodes were switched among the high-order cognitive function networks (default mode network [DMN] and fronto-parietal network [FPN]), sensory networks (occipital network [ON]), and cerebellum network (CN) from consciousness (wakefulness) to propofol-induced unconsciousness. At the same time, compared with wakefulness, local connections were switched to rich-club connections during propofol-induced unconsciousness, suggesting a strengthening of the overall information commutation of networks. Nodal efficiency of the anterior and middle insula and ventral frontal cortex was significantly decreased. Additionally, from wakefulness to natural sleep, a similar pattern of rich-club reorganization with propofol-induced unconsciousness was observed: rich-club nodes were switched from the DMN (including precuneus and PCC) to the sensorimotor network (SMN, including part of the frontal and temporal gyrus). Compared with natural sleep, nodal efficiency of the insula, frontal gyrus, PCC, and cerebellum significantly decreased during propofol-induced unconsciousness. CONCLUSIONS Our study demonstrated that the rich-club reorganization in functional brain networks is characterized by switching of rich-club nodes between the high-order cognitive and sensory and motor networks during propofol-induced alteration of consciousness and natural sleep. These findings will help understand the common neurological mechanism of pharmacological and physiological unconsciousness.
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Affiliation(s)
- Shengpei Wang
- Research Center for Brain-inspired Intelligence and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Yun Li
- Department of Anesthesia, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuang Qiu
- Research Center for Brain-inspired Intelligence and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Chuncheng Zhang
- Research Center for Brain-inspired Intelligence and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Guyan Wang
- Department of Anesthesia, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tianzuo Li
- Department of Anesthesia, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Huiguang He
- Research Center for Brain-inspired Intelligence and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China.
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Hirota K, Kushikata T, Takekawa D, Kudo M. Is neurotransmitter release involved in the mechanism of general anesthesia? J Anesth 2019; 34:153-155. [PMID: 31792666 DOI: 10.1007/s00540-019-02718-1] [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: 10/08/2019] [Accepted: 11/22/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION It is believed that neurotransmitters release modulates general anesthesia via several receptors system which are molecular targets for anesthetic agents in young-adult rats. However, middle-aged rats have rarely been used. Therefore, we studied in this age group. MATERIALS AND METHODS After approval of our protocol by the institutional committee on animal research, 116 middle aged Sprague-Dawley rats were assigned to ketamine (K: n = 74) and propofol (P: n = 42) anesthesia groups. Rats were decapitated 0, 20 60 and 120 min after ip K (100 mg/kg) or P (80 mg/kg), respectively. Melanin-concentrating hormone (MCH), orexin A (OXA) and noradrenaline contents in the pons, hypothalamus, hippocampus and cerebrocortex were measured by a commercial enzyme-linked immunosorbent assay (ELISA) or high-performance liquid chromatography. RESULTS Neurotransmitter content in all brain regions did not significantly change following K or P administration. CONCLUSION Therefore, we question whether neurotransmitter release contributes to general anesthesia.
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Affiliation(s)
- Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan.
| | - Tetsuya Kushikata
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
| | - Daiki Takekawa
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
| | - Mihoko Kudo
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan
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Nir T, Or-Borichev A, Izraitel E, Hendler T, Lerner Y, Matot I. Transient subcortical functional connectivity upon emergence from propofol sedation in human male volunteers: evidence for active emergence. Br J Anaesth 2019; 123:298-308. [DOI: 10.1016/j.bja.2019.05.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022] Open
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Bilandžija H, Abraham L, Ma L, Renner KJ, Jeffery WR. Behavioural changes controlled by catecholaminergic systems explain recurrent loss of pigmentation in cavefish. Proc Biol Sci 2019; 285:rspb.2018.0243. [PMID: 29720416 DOI: 10.1098/rspb.2018.0243] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/10/2018] [Indexed: 12/18/2022] Open
Abstract
Multiple cave populations of the teleost Astyanax mexicanus have repeatedly reduced or lost eye and body pigmentation during adaptation to dark caves. Albinism, the complete absence of melanin pigmentation, is controlled by loss-of-function mutations in the oca2 gene. The mutation is accompanied by an increase in the melanin synthesis precursor l-tyrosine, which is also a precursor for catecholamine synthesis. In this study, we show a relationship between pigmentation loss, enhanced catecholamine synthesis and responsiveness to anaesthesia, determined as a proxy for catecholamine-related behaviours. We demonstrate that anaesthesia resistance (AR) is enhanced in multiple depigmented and albino cavefish (CF), inversely proportional to the degree of pigmentation loss, controlled by the oca2 gene, and can be modulated by experimental manipulations of l-tyrosine or the catecholamine norepinephrine (NE). Moreover, NE is increased in the brains of multiple albino and depigmented CF relative to surface fish. The results provide new insights into the evolution of pigment modification because NE controls a suite of adaptive behaviours similar to AR that may represent a target of natural selection. Thus, understanding the relationship between loss of pigmentation and AR may provide insight into the role of natural selection in the evolution of albinism via a melanin-catecholamine trade-off.
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Affiliation(s)
- Helena Bilandžija
- Department of Biology, University of Maryland, College Park, MD 20742, USA.,Department of Molecular Biology, Rudjer Boskovic Institute, 10000 Zagreb, Croatia
| | - Lindsey Abraham
- Department of Biology, University of Maryland, College Park, MD 20742, USA
| | - Li Ma
- Department of Biology, University of Maryland, College Park, MD 20742, USA
| | - Kenneth J Renner
- Department of Biology, University of South Dakota, Vermillion, SD 57069, USA
| | - William R Jeffery
- Department of Biology, University of Maryland, College Park, MD 20742, USA
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Samuel N, Taub A, Paz R, Raz A. Implicit aversive memory under anaesthesia in animal models: a narrative review. Br J Anaesth 2018; 121:219-232. [DOI: 10.1016/j.bja.2018.05.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022] Open
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LaBarbera V, García PS, Bliwise DL, Trotti LM. Central Disorders of Hypersomnolence, Restless Legs Syndrome, and Surgery With General Anesthesia: Patient Perceptions. Front Hum Neurosci 2018; 12:99. [PMID: 29615884 PMCID: PMC5869929 DOI: 10.3389/fnhum.2018.00099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/05/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: The importance of obstructive sleep apnea in patients undergoing surgery with general anesthesia is well-defined, but the surgical and anesthetic implications of other sleep disorders are less clear. We sought to evaluate response to surgery with general anesthesia in patients with central disorders of hypersomnolence or restless legs syndrome. Methods: We surveyed patients on their most recent surgical procedure with general anesthesia, querying about procedure, recovery, and any changes in sleep disorder symptomatology following the procedure. Results: Forty-five patients with restless legs syndrome and 57 patients with central disorders of hypersomnolence (15 narcolepsy type 2, 1 narcolepsy type 1, 30 idiopathic hypersomnia, 1 Kleine-Levin syndrome, and 10 subjective sleepiness) completed the survey, with response rates of 45.5 and 53.8%, respectively. While patients in both groups were equally likely to report surgical complications and difficulty awakening from anesthesia, hypersomnolent patients were more likely to report worsened sleepiness (40% of the hypersomnolent group vs. 11% of the RLS group, p = 0.001) and worsening of their sleep disorder symptoms (40% of the hypersomnolent group vs. 9% of the RLS group, p = 0.0001). Conclusion: Patients with sleep disorders other than sleep apnea frequently report surgical or anesthetic complications. Patients with hypersomnolence disorders commonly perceive that their sleep disorder worsened following a procedure; whether this might be related to long term effects of general anesthesia in a particularly vulnerable clinical population requires further study.
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Affiliation(s)
- Vincent LaBarbera
- Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Paul S García
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, United States.,Research and Anesthesiology Service Lines, Atlanta VA Medical Center, Atlanta, GA, United States
| | - Donald L Bliwise
- Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Lynn M Trotti
- Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
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Takekawa D, Kushikata T, Kitayama M, Hirota K. Anesthetic management of a patient with narcolepsy by combination of total intravenous and regional anesthesia: a case report. JA Clin Rep 2018; 3:37. [PMID: 29457081 PMCID: PMC5804620 DOI: 10.1186/s40981-017-0107-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/06/2017] [Indexed: 12/21/2022] Open
Abstract
Narcolepsy is a neurological disease characterized by excessive daytime sleepiness, cataplexy, and/or a sudden loss of muscle tone due to malfunction of the orexinergic system, which may cause delayed emergence from general anesthesia. We report a successful anesthetic management of 24-year-old female narcoleptic patient undergoing left anterior cruciate ligament reconstruction. Anesthesia was induced and maintained with total intravenous anesthesia (TIVA) using propofol and remifentanil. Ultrasound-guided left femoral nerve block was also performed with 0.375% ropivacaine 20 ml. Acetaminophen 1000 mg was intravenously administered as part of a multimodal analgesia. After the surgery, the trachea was extubated 9 min after termination of TIVA, and then, the patient correctly responded to verbal commands. The postoperative course was uneventful without any narcoleptic symptoms.
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Affiliation(s)
- Daiki Takekawa
- 1Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Tetsuya Kushikata
- 1Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
| | - Masato Kitayama
- 2Division of Surgical Center, Hirosaki University Hospital, 53 Hon-cho, Hirosaki, 036-8563 Japan
| | - Kazuyoshi Hirota
- 1Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Japan
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36
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Avidan MS, Graetz TJ. Monitoring the brain strikes a discordant note for anesthesiologists. Can J Anaesth 2018; 65:501-506. [DOI: 10.1007/s12630-018-1086-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/30/2022] Open
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Taharabaru S, Satomoto M, Tamura T, Adachi YU. Smaller effect of propofol than sevoflurane anesthesia on dopamine turnover induced by methamphetamine and nomifensine in the rat striatum: an in vivo microdialysis study. Exp Anim 2017; 67:147-153. [PMID: 29176298 PMCID: PMC5955746 DOI: 10.1538/expanim.17-0092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Volatile anesthetics accelerate dopamine turnover in the brain, especially when used in
conjunction with psychotropic agents such as methamphetamine and nomifensine. The effect
of intravenous propofol anesthesia on the extracellular dopamine concentrations is
unclear. The aim of this study was to compare the effect of two anesthetics on the
extracellular concentrations of dopamine and metabolites using an in vivo
microdialysis model. Male Sprague Dawley rats were implanted with a microdialysis probe
into the right striatum. The probe was perfused with modified Ringer’s solution, and the
dialysate was directly injected into a high-performance liquid chromatography system every
20 min. The rats were intraperitoneally administered saline, methamphetamine at 2 mg/kg,
or nomifensine at 10 mg/kg. After treatment, the rats were anesthetized with intravenous
propofol (20 mg/kg followed by 25 or 50 mg/kg/h) or inhalational sevoflurane (2.5%) for 1
h. Propofol showed no effect on the extracellular concentration of dopamine during
anesthesia; however, propofol decreased the dopamine concentration after anesthesia in the
high-dose group. Sevoflurane anesthesia increased the concentration of metabolites.
Systemic administration of methamphetamine and nomifensine increased the extracellular
concentration of dopamine. Sevoflurane anesthesia significantly enhanced the increase in
the dopamine concentration induced by both methamphetamine and nomifensine, whereas
propofol anesthesia showed no effect on the methamphetamine- and nomifensine-induced
dopamine increase during anesthesia. The enhancing effect of psychotropic agent-induced
acceleration of dopamine turnover was smaller for propofol anesthesia than for sevoflurane
anesthesia.
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Affiliation(s)
- Saori Taharabaru
- Department of Anesthesia, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi 466-8550, Japan
| | - Maiko Satomoto
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi 466-8550, Japan
| | - Takahiro Tamura
- Department of Anesthesia, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi 466-8550, Japan
| | - Yushi U Adachi
- Departemnt of Surgical Intensive Care Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showaku, Nagoya-shi, Aichi 466-8550, Japan
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Abstract
Idiopathic hypersomnia (IH) is a chronic neurologic disorder of daytime sleepiness, accompanied by long sleep times, unrefreshing sleep, difficulty in awakening, cognitive dysfunction, and autonomic symptoms. The cause is unknown; a genetic predisposition is suggested. Autonomic, inflammatory, or immune dysfunction has been proposed. Diagnosis involves a clinical history and objective testing. There are no approved treatments for IH, but modafinil is typically considered first-line. A substantial fraction of patients with IH are refractory or intolerant to standard treatments, and different treatment strategies using novel therapeutics are necessary. Even with current treatment options, quality of life and safety may remain impaired.
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Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology, Emory Sleep Center, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA 30329, USA.
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Flores FJ, Hartnack KE, Fath AB, Kim SE, Wilson MA, Brown EN, Purdon PL. Thalamocortical synchronization during induction and emergence from propofol-induced unconsciousness. Proc Natl Acad Sci U S A 2017; 114:E6660-E6668. [PMID: 28743752 PMCID: PMC5558998 DOI: 10.1073/pnas.1700148114] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
General anesthesia (GA) is a reversible drug-induced state of altered arousal required for more than 60,000 surgical procedures each day in the United States alone. Sedation and unconsciousness under GA are associated with stereotyped electrophysiological oscillations that are thought to reflect profound disruptions of activity in neuronal circuits that mediate awareness and cognition. Computational models make specific predictions about the role of the cortex and thalamus in these oscillations. In this paper, we provide in vivo evidence in rats that alpha oscillations (10-15 Hz) induced by the commonly used anesthetic drug propofol are synchronized between the thalamus and the medial prefrontal cortex. We also show that at deep levels of unconsciousness where movement ceases, coherent thalamocortical delta oscillations (1-5 Hz) develop, distinct from concurrent slow oscillations (0.1-1 Hz). The structure of these oscillations in both cortex and thalamus closely parallel those observed in the human electroencephalogram during propofol-induced unconsciousness. During emergence from GA, this synchronized activity dissipates in a sequence different from that observed during loss of consciousness. A possible explanation is that recovery from anesthesia-induced unconsciousness follows a "boot-up" sequence actively driven by ascending arousal centers. The involvement of medial prefrontal cortex suggests that when these oscillations (alpha, delta, slow) are observed in humans, self-awareness and internal consciousness would be impaired if not abolished. These studies advance our understanding of anesthesia-induced unconsciousness and altered arousal and further establish principled neurophysiological markers of these states.
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Affiliation(s)
- Francisco J Flores
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114;
- Harvard Medical School, Boston, MA 02115
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Katharine E Hartnack
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114
| | - Amanda B Fath
- Department of Neuroscience, Wellesley College, Wellesley, MA 02481
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Seong-Eun Kim
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Matthew A Wilson
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Emery N Brown
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114;
- Harvard Medical School, Boston, MA 02115
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139
- Institute of Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Patrick L Purdon
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114;
- Harvard Medical School, Boston, MA 02115
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40
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Background activity and visual responsiveness of caudate nucleus neurons in halothane anesthetized and in awake, behaving cats. Neuroscience 2017; 356:182-192. [PMID: 28546109 DOI: 10.1016/j.neuroscience.2017.05.028] [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: 12/21/2016] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 11/20/2022]
Abstract
This study focuses on the important question whether brain activity recorded from anesthetized, paralyzed animals is comparable to that recorded from awake, behaving ones. We compared neuronal activity recorded from the caudate nucleus (CN) of two halothane-anesthetized, paralyzed and two awake, behaving cats. In both models, extracellular recordings were made from the CN during static and dynamic visual stimulation. The anesthesia was maintained during the recordings by a gaseous mixture of air and halothane (1.0%). The behaving animals were trained to perform a visual fixation task. Based on their electrophysiological properties, the recorded CN neurons were separated into three different classes: phasically active (PANs), high firing (HFNs), and tonically active (TANs) neurons. Halothane anesthesia significantly decreased the background activity of the CN neurons in all three classes. The anesthesia had the most remarkable suppressive effect on PANs, where the background activity was consistently under 1 spike/s. The analysis of these responses was almost impossible due to the extremely low activity. The evoked responses during both static and dynamic visual stimulation were obvious in the behaving cats. On the other hand, only weak visual responses were found in some neurons of halothane anesthetized cats. These results show that halothane gas anesthesia has a marked suppressive effect on the feline CN. We suggest that for the purposes of the visual and related multisensory/sensorimotor electrophysiological exploration of the CN, behaving animal models are preferable over anesthetized ones.
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Abstract
A quest for a systems-level neuroscientific basis of anesthetic-induced loss and return of consciousness has been in the forefront of research for the past 2 decades. Recent advances toward the discovery of underlying mechanisms have been achieved using experimental electrophysiology, multichannel electroencephalography, magnetoencephalography, and functional magnetic resonance imaging. By the careful dosing of various volatile and IV anesthetic agents to the level of behavioral unresponsiveness, both specific and common changes in functional and effective connectivity across large-scale brain networks have been discovered and interpreted in the context of how the synthesis of neural information might be affected during anesthesia. The results of most investigations to date converge toward the conclusion that a common neural correlate of anesthetic-induced unresponsiveness is a consistent depression or functional disconnection of lateral frontoparietal networks, which are thought to be critical for consciousness of the environment. A reduction in the repertoire of brain states may contribute to the anesthetic disruption of large-scale information integration leading to unconsciousness. In future investigations, a systematic delineation of connectivity changes with multiple anesthetics using the same experimental design, and the same analytical method will be desirable. The critical neural events that account for the transition between responsive and unresponsive states should be assessed at similar anesthetic doses just below and above the loss or return of responsiveness. There will also be a need to identify a robust, sensitive, and reliable measure of information transfer. Ultimately, finding a behavior-independent measure of subjective experience that can track covert cognition in unresponsive subjects and a delineation of causal factors versus correlated events will be essential to understand the neuronal basis of human consciousness and unconsciousness.
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De A, Waltuch T, Gonik NJ, Nguyen-Famulare N, Muzumdar H, Bent JP, Isasi CR, Sin S, Arens R. Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:805-811. [PMID: 28454600 DOI: 10.5664/jcsm.6620] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/30/2017] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVES There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. METHODS This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. RESULTS Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentation-arousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). CONCLUSIONS Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. COMMENTARY A commentary on this article appears in this issue on page 775.
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Affiliation(s)
- Aliva De
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Temima Waltuch
- Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Nathan J Gonik
- Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,CS Mott Children's Hospital, University of Michigan, Anne Arbor, Michigan
| | - Ngoc Nguyen-Famulare
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York.,Department of Anesthesiology, Winthrop-University Hospital, Mineola, New York
| | - Hiren Muzumdar
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John P Bent
- Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York
| | - Sanghun Sin
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Raanan Arens
- Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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43
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Akeju O, Brown EN. Neural oscillations demonstrate that general anesthesia and sedative states are neurophysiologically distinct from sleep. Curr Opin Neurobiol 2017; 44:178-185. [PMID: 28544930 PMCID: PMC5520989 DOI: 10.1016/j.conb.2017.04.011] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/17/2017] [Accepted: 04/26/2017] [Indexed: 11/19/2022]
Abstract
General anesthesia is a man-made neurophysiological state comprised of unconsciousness, amnesia, analgesia, and immobility along with maintenance of physiological stability. Growing evidence suggests that anesthetic-induced neural oscillations are a primary mechanism of anesthetic action. Each anesthetic drug class produces distinct oscillatory dynamics that can be related to the circuit mechanisms of drug action. Sleep is a naturally occurring state of decreased arousal that is essential for normal health. Physiological measurements (electrooculogram, electromyogram) and neural oscillatory (electroencephalogram) dynamics are used to empirically characterize sleep into rapid eye movement sleep and the three stages of non-rapid eye movement sleep. In this review, we discuss the differences between anesthesia- and sleep-induced altered states from the perspective of neural oscillations.
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Affiliation(s)
- Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, United States.
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44
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Zhong H, Tong L, Gu N, Gao F, Lu Y, Xie RG, Liu J, Li X, Bergeron R, Pomeranz LE, Mackie K, Wang F, Luo CX, Ren Y, Wu SX, Xie Z, Xu L, Li J, Dong H, Xiong L, Zhang X. Endocannabinoid signaling in hypothalamic circuits regulates arousal from general anesthesia in mice. J Clin Invest 2017; 127:2295-2309. [PMID: 28463228 DOI: 10.1172/jci91038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/02/2017] [Indexed: 11/17/2022] Open
Abstract
Consciousness can be defined by two major attributes: awareness of environment and self, and arousal, which reflects the level of awareness. The return of arousal after general anesthesia presents an experimental tool for probing the neural mechanisms that control consciousness. Here we have identified that systemic or intracerebral injection of the cannabinoid CB1 receptor (CB1R) antagonist AM281 into the dorsomedial nucleus of the hypothalamus (DMH) - but not the adjacent perifornical area (Pef) or the ventrolateral preoptic nucleus of the hypothalamus (VLPO) - accelerates arousal in mice recovering from general anesthesia. Anesthetics selectively activated endocannabinoid (eCB) signaling at DMH glutamatergic but not GABAergic synapses, leading to suppression of both glutamatergic DMH-Pef and GABAergic DMH-VLPO projections. Deletion of CB1R from widespread cerebral cortical or prefrontal cortical (PFC) glutamatergic neurons, including those innervating the DMH, mimicked the arousal-accelerating effects of AM281. In contrast, CB1R deletion from brain GABAergic neurons or hypothalamic glutamatergic neurons did not affect recovery time from anesthesia. Inactivation of PFC-DMH, DMH-VLPO, or DMH-Pef projections blocked AM281-accelerated arousal, whereas activation of these projections mimicked the effects of AM281. We propose that decreased eCB signaling at glutamatergic terminals of the PFC-DMH projection accelerates arousal from general anesthesia through enhancement of the excitatory DMH-Pef projection, the inhibitory DMH-VLPO projection, or both.
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Affiliation(s)
- Haixing Zhong
- Institute of Mental Health Research at the Royal, and.,Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Li Tong
- Institute of Mental Health Research at the Royal, and.,Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Ning Gu
- Institute of Mental Health Research at the Royal, and.,Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fang Gao
- Institute of Mental Health Research at the Royal, and.,Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Neurobiology, and
| | - Yacheng Lu
- Department of Anatomy, Histology, and Embryology, Fourth Military Medical University, Xi'an, China
| | - Rou-Gang Xie
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Department of Neurobiology, and
| | - Jingjing Liu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xin Li
- Institute of Mental Health Research at the Royal, and.,Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Richard Bergeron
- Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa E Pomeranz
- Laboratory of Molecular Genetics, Rockefeller University, New York, New York, USA
| | - Ken Mackie
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - Feng Wang
- Institute of Mental Health Research at the Royal, and.,Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chun-Xia Luo
- Institute of Mental Health Research at the Royal, and
| | - Yan Ren
- Institute of Mental Health Research at the Royal, and
| | | | - Zhongcong Xie
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Lin Xu
- Key Lab of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Science, Kunming, China
| | - Jinlian Li
- Department of Anatomy, Histology, and Embryology, Fourth Military Medical University, Xi'an, China
| | - Hailong Dong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lize Xiong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xia Zhang
- Institute of Mental Health Research at the Royal, and.,Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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45
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Baluška F, Yokawa K, Mancuso S, Baverstock K. Understanding of anesthesia - Why consciousness is essential for life and not based on genes. Commun Integr Biol 2016; 9:e1238118. [PMID: 28042377 PMCID: PMC5193047 DOI: 10.1080/19420889.2016.1238118] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/05/2016] [Accepted: 09/14/2016] [Indexed: 01/14/2023] Open
Abstract
Anesthesia and consciousness represent 2 mysteries not only for biology but also for physics and philosophy. Although anesthesia was introduced to medicine more than 160 y ago, our understanding of how it works still remains a mystery. The most prevalent view is that the human brain and its neurons are necessary to impose the effects of anesthetics. However, the fact is that all life can be anesthesized. Numerous theories have been generated trying to explain the major impact of anesthetics on our human-specific consciousness; switching it off so rapidly, but no single theory resolves this enduring mystery. The speed of anesthetic actions precludes any direct involvement of genes. Lipid bilayers, cellular membranes, and critical proteins emerge as the most probable primary targets of anesthetics. Recent findings suggest, rather surprisingly, that physical forces underlie both the anesthetic actions on living organisms as well as on consciousness in general.
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Affiliation(s)
| | - Ken Yokawa
- IZMB, University of Bonn, Kirschalle, Bonn, Germany
| | - Stefano Mancuso
- Department of Plant, Soil and Environmental Science & LINV, University of Florence, Sesto Fiorentino, Italy
| | - Keith Baverstock
- Department of Environmental Science, University of Eastern Finland, Kuopio, Finland
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46
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Sukhotinsky I, Minert A, Soja P, Devor M. Mesopontine Switch for the Induction of General Anesthesia by Dedicated Neural Pathways. Anesth Analg 2016; 123:1274-1285. [DOI: 10.1213/ane.0000000000001489] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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47
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Bichler EK, Elder CC, García PS. Clarithromycin increases neuronal excitability in CA3 pyramidal neurons through a reduction in GABAergic signaling. J Neurophysiol 2016; 117:93-103. [PMID: 27733592 DOI: 10.1152/jn.00134.2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 10/07/2016] [Indexed: 01/24/2023] Open
Abstract
Antibiotics are used in the treatment and prevention of bacterial infections, but effects on neuron excitability have been documented. A recent study demonstrated that clarithromycin alleviates daytime sleepiness in hypersomnia patients (Trotti LM, Saini P, Freeman AA, Bliwise DL, García PS, Jenkins A, Rye DB. J Psychopharmacol 28: 697-702, 2014). To explore the potential application of clarithromycin as a stimulant, we performed whole cell patch-clamp recordings in rat pyramidal cells from the CA3 region of hippocampus. In the presence of the antibiotic, rheobase current was reduced by 50%, F-I relationship (number of action potentials as a function of injected current) was shifted to the left, and the resting membrane potential was more depolarized. Clarithromycin-induced hyperexcitability was dose dependent; doses of 30 and 300 μM clarithromycin significantly increased the firing frequency and membrane potential compared with controls (P = 0.003, P < 0.0001). We hypothesized that clarithromycin enhanced excitability by reducing GABAA receptor activation. Clarithromycin at 30 μM significantly reduced (P = 0.001) the amplitude of spontaneous miniature inhibitory GABAergic currents and at 300 μM had a minor effect on action potential width. Additionally, we tested the effect of clarithromycin in an ex vivo seizure model by evaluating its effect on spontaneous local field potentials. Bath application of 300 μM clarithromycin enhanced burst frequency twofold compared with controls (P = 0.0006). Taken together, these results suggest that blocking GABAergic signaling with clarithromycin increases cellular excitability and potentially serves as a stimulant, facilitating emergence from anesthesia or normalizing vigilance in hypersomnia and narcolepsy. However, the administration of clarithromycin should be carefully considered in patients with seizure disorders. NEW & NOTEWORTHY Clinical administration of the macrolide antibiotic clarithromycin has been associated with side effects such as mania, agitation, and delirium. Here, we investigated the adverse effects of this antibiotic on CA3 pyramidal cell excitability. Clarithromycin induces hyperexcitability in single neurons and is related to a reduction in GABAergic signaling. Our results support a potentially new application of clarithromycin as a stimulant to facilitate emergence from anesthesia or to normalize vigilance.
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Affiliation(s)
- Edyta K Bichler
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; .,Anesthesiology and Research Divisions, Atlanta VA Medical Center, Decatur, Georgia; and
| | | | - Paul S García
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.,Anesthesiology and Research Divisions, Atlanta VA Medical Center, Decatur, Georgia; and
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48
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Sleep Homeostasis and General Anesthesia: Are Fruit Flies Well Rested after Emergence from Propofol? Anesthesiology 2016; 124:404-16. [PMID: 26556728 DOI: 10.1097/aln.0000000000000939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Shared neurophysiologic features between sleep and anesthetic-induced hypnosis indicate a potential overlap in neuronal circuitry underlying both states. Previous studies in rodents indicate that preexisting sleep debt discharges under propofol anesthesia. The authors explored the hypothesis that propofol anesthesia also dispels sleep pressure in the fruit fly. To the authors' knowledge, this constitutes the first time propofol has been tested in the genetically tractable model, Drosophila melanogaster. METHODS Daily sleep was measured in Drosophila by using a standard locomotor activity assay. Propofol was administered by transferring flies onto food containing various doses of propofol or equivalent concentrations of vehicle. High-performance liquid chromatography was used to measure the tissue concentrations of ingested propofol. To determine whether propofol anesthesia substitutes for natural sleep, the flies were subjected to 10-h sleep deprivation (SD), followed by 6-h propofol exposure, and monitored for subsequent sleep. RESULTS Oral propofol treatment causes anesthesia in flies as indicated by a dose-dependent reduction in locomotor activity (n = 11 to 41 flies from each group) and increased arousal threshold (n = 79 to 137). Recovery sleep in flies fed propofol after SD was delayed until after flies had emerged from anesthesia (n = 30 to 48). SD was also associated with a significant increase in mortality in propofol-fed flies (n = 44 to 46). CONCLUSIONS Together, these data indicate that fruit flies are effectively anesthetized by ingestion of propofol and suggest that homologous molecular and neuronal targets of propofol are conserved in Drosophila. However, behavioral measurements indicate that propofol anesthesia does not satisfy the homeostatic need for sleep and may compromise the restorative properties of sleep.
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49
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Jia M, Liu WX, Yang JJ, Xu N, Xie ZM, Ju LS, Ji MH, Martynyuk AE, Yang JJ. Role of histone acetylation in long-term neurobehavioral effects of neonatal Exposure to sevoflurane in rats. Neurobiol Dis 2016; 91:209-220. [PMID: 27001149 DOI: 10.1016/j.nbd.2016.03.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 01/16/2023] Open
Abstract
Human studies, and especially laboratory studies, provide evidence that early life exposure to general anesthesia may affect neurocognitive development via largely unknown mechanisms. We explored whether hippocampal histone acetylation had a role in neurodevelopmental effects of sevoflurane administered to neonatal rats. Male Sprague-Dawley rats were exposed to 3% sevoflurane or were subjected to maternal separation only for 2h daily at postnatal days 6, 7, and 8. The histone deacetylase inhibitor, sodium butyrate (250mg/kg, intraperitoneally), or saline was administered starting 2h prior to anesthesia or maternal separation and continued daily until the end of behavioral tests, which were performed between postnatal days 33 and 50. Upon completion of the behavioral tests, the brain tissues were harvested for further analysis. Rats neonatally exposed to sevoflurane exhibited decreased freezing time in the fear conditioning contextual test and increased escape latency, decreased time in target quadrant, and number of platform crossings in the Morris water maze test. The sevoflurane-exposed rats had lower hippocampal density of dendritic spines, reduced levels of the brain-derived neurotrophic factor, c-fos protein, microtubule-associated protein 2, synapsin1, postsynaptic density protein 95, pCREB/CREB, CREB binding protein, and acetylated histones H3 and H4, and increased levels of histone deacetylases 3 and 8. These neurobehavioral abnormalities were normalized in the sevoflurane-exposed rats treated with sodium butyrate. Our findings provide evidence that neonatal exposure to sevoflurane induces neurobehavioral abnormalities and long-lasting alterations in histone acetylation; normalization of histone acetylation may alleviate the neurodevelopmental side effects of the anesthetic.
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Affiliation(s)
- Min Jia
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Wen-Xue Liu
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jiao-Jiao Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou, China
| | - Ning Xu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou, China
| | - Ze-Min Xie
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou, China
| | - Ling-Sha Ju
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Mu-Huo Ji
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Anatoly E Martynyuk
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA.,McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Jian-Jun Yang
- Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.,Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou, China
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50
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Postoperative Structural Brain Changes and Cognitive Dysfunction in Patients with Breast Cancer. PLoS One 2015; 10:e0140655. [PMID: 26536672 PMCID: PMC4633203 DOI: 10.1371/journal.pone.0140655] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/29/2015] [Indexed: 12/25/2022] Open
Abstract
Objective The primary purpose of this study was to clarify the influence of the early response to surgery on brain structure and cognitive function in patients with breast cancer. It was hypothesized that the structure of the thalamus would change during the early response after surgery due to the effects of anesthesia and would represent one aspect of an intermediate phenotype of postoperative cognitive dysfunction (POCD). Methods We examined 32 postmenopausal females with breast cancer and 20 age-matched controls. We assessed their cognitive function (attention, memory, and executive function), and performed brain structural MRI 1.5 ± 0.5 days before and 5.6 ± 1.2 days after surgery. Results We found a significant interaction between regional grey matter volume (rGMV) in the thalamus (P < 0.05, familywise error (FWE), small volume correction (SVC)) and one attention domain subtest (P = 0.001, Bonferroni correction) after surgery in the patient group compared with the control group. Furthermore, the changes in attention were significantly associated with sevoflurane anesthetic dose (r2 = 0.247, β = ‒0.471, P = 0.032) and marginally associated with rGMV changes in the thalamus (P = 0.07, FWE, SVC) in the Pt group. Conclusion Our findings suggest that alterations in brain structure, particularly in the thalamus, may occur shortly after surgery and may be associated with attentional dysfunction. This early postoperative response to anesthesia may represent an intermediate phenotype of POCD. It was assumed that patients experiencing other risk factors of POCD, such as the severity of surgery, the occurrence of complications, and pre-existing cognitive impairments, would develop clinical POCD with broad and multiple types of cognitive dysfunction.
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