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Grinde B. Consciousness makes sense in the light of evolution. Neurosci Biobehav Rev 2024; 164:105824. [PMID: 39047928 DOI: 10.1016/j.neubiorev.2024.105824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
I believe consciousness is a property of advanced nervous systems, and as such a product of evolution. Thus, to understand consciousness we need to describe the trajectory leading to its evolution and the selective advantages conferred. A deeper understanding of the neurology would be a significant contribution, but other advanced functions, such as hearing and vision, are explained with a comparable lack of detailed knowledge of the brain processes responsible. In this paper, I try to add details and credence to a previously suggested, evolution-based model of consciousness. According to this model, the feature started to evolve in early amniotes (reptiles, birds, and mammals) some 320 million years ago. The reason was the introduction of feelings as a strategy for making behavioral decisions.
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Affiliation(s)
- Bjørn Grinde
- Professor Emeritus, University of Oslo, Problemveien 11, Oslo 0313, Norway.
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Schoknecht K, Maechler M, Wallach I, Dreier JP, Liotta A, Berndt N. Isoflurane lowers the cerebral metabolic rate of oxygen and prevents hypoxia during cortical spreading depolarization in vitro: An integrative experimental and modeling study. J Cereb Blood Flow Metab 2024; 44:1000-1012. [PMID: 38140913 PMCID: PMC11318408 DOI: 10.1177/0271678x231222306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/23/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Cortical spreading depolarization (SD) imposes a massive increase in energy demand and therefore evolves as a target for treatment following acute brain injuries. Anesthetics are empirically used to reduce energy metabolism in critical brain conditions, yet their effect on metabolism during SD remains largely unknown. We investigated oxidative metabolism during SD in brain slices from Wistar rats. Extracellular potassium ([K+]o), local field potential and partial tissue oxygen pressure (ptiO2) were measured simultaneously. The cerebral metabolic rate of oxygen (CMRO2) was calculated using a reaction-diffusion model. By that, we tested the effect of clinically relevant concentrations of isoflurane on CMRO2 during SD and modeled tissue oxygenation for different capillary pO2 values. During SD, CMRO2 increased 2.7-fold, resulting in transient hypoxia in the slice core. Isoflurane decreased CMRO2, reduced peak [K+]o, and prolonged [K+]o clearance, which indicates reduced synaptic transmission and sodium-potassium ATPase inhibition. Modeling tissue oxygenation during SD illustrates the need for increased capillary pO2 levels to prevent hypoxia. In the absence thereof, isoflurane could improve tissue oxygenation by lowering CMRO2. Therefore, isoflurane is a promising candidate for pre-clinical studies on neuronal survival in conditions involving SD.
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Affiliation(s)
- Karl Schoknecht
- Carl-Ludwig-Institute of Physiology, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Mathilde Maechler
- Department of Anesthesiology and Intensive Care, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Neurophysiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Iwona Wallach
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jens P Dreier
- Centre for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Bernstein Centre for Computational Neuroscience Berlin, Berlin, Germany
- Einstein Centre for Neurosciences Berlin, Berlin, Germany
| | - Agustin Liotta
- Department of Anesthesiology and Intensive Care, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Neurophysiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Department of Experimental Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Health at Charité – Universitätsmedizin Berlin, Berlin
- Neuroscience Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nikolaus Berndt
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Department of Molecular Toxicology, Nuthetal, Germany
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Yuan HX, Zhang LN, Li G, Qiao L. Brain protective effect of dexmedetomidine vs propofol for sedation during prolonged mechanical ventilation in non-brain injured patients. World J Psychiatry 2024; 14:370-379. [PMID: 38617978 PMCID: PMC11008391 DOI: 10.5498/wjp.v14.i3.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation. It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation. AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury. METHODS Patients who underwent mechanical ventilation for > 72 h were randomly assigned to receive sedation with dexmedetomidine or propofol. The Richmond Agitation and Sedation Scale (RASS) was used to evaluate sedation effects, with a target range of -3 to 0. The primary outcomes were serum levels of S100-β and neuron-specific enolase (NSE) every 24 h. The secondary outcomes were remifentanil dosage, the proportion of patients requiring rescue sedation, and the time and frequency of RASS scores within the target range. RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group, respectively. Baseline data were comparable between groups. No significant differences were identified between groups within the median duration of study drug infusion [52.0 (IQR: 36.0-73.5) h vs 53.0 (IQR: 37.0-72.0) h, P = 0.958], the median dose of remifentanil [4.5 (IQR: 4.0-5.0) μg/kg/h vs 4.6 (IQR: 4.0-5.0) μg/kg/h, P = 0.395], the median percentage of time in the target RASS range without rescue sedation [85.6% (IQR: 65.8%-96.6%) vs 86.7% (IQR: 72.3%-95.3), P = 0.592], and the median frequency within the target RASS range without rescue sedation [72.2% (60.8%-91.7%) vs 73.3% (60.0%-100.0%), P = 0.880]. The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance (69.2% vs 50.8%, P = 0.045). Serum S100-β and NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation, respectively (all P < 0.05). CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.
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Affiliation(s)
- Hong-Xun Yuan
- Intensive Care Unit, Peking University International Hospital, Beijing 102206, China
| | - Li-Na Zhang
- Central Operating Room, The Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing 100020, China
| | - Gang Li
- Intensive Care Unit, Peking University International Hospital, Beijing 102206, China
| | - Li Qiao
- Intensive Care Unit, Peking University International Hospital, Beijing 102206, China
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Yan S, Li Q, He K. The effect of esketamine combined with propofol-induced general anesthesia on cerebral blood flow velocity: a randomized clinical trial. BMC Anesthesiol 2024; 24:66. [PMID: 38378447 PMCID: PMC10877857 DOI: 10.1186/s12871-024-02446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Esketamine is increasingly used in clinical anesthesia. The effect of esketamine on the blood flow velocity of the middle cerebral artery has a clinical guiding effect. To investigate the effect of esketamine combined with propofol-induced general anesthesia for endotracheal intubation on the blood flow velocity of middle cerebral artery and hemodynamics during the induction period. METHODS The randomized clinical trial included 80 patients aged 20-65 years who would undergo non-intracranial elective surgery under general anesthesia in our hospital from May 2022 to May 2023. The participants were divided into two groups based on anesthesia drugs: sufentanil 0.5μg/kg (group C) or 1.5mg/kg esketamine (group E). The primary outcome was variation value in average cerebral blood velocity. The secondary outcomes included cerebral blood flow velocities (CBFV), blood pressure (BP) and heart rate (HR) at four different time points: before induction of general anesthesia (T0), 1 min after the induction drug injected (T1), before endotracheal intubation (T2), and 1min after endotracheal intubation (T3). The occurrence of hypotension, hypertension, tearing and choking during induction was also documented. RESULTS The variation of average CBFV from time T0 to T2(ΔVm1) and the variation from time T3 to T0 (ΔVm2) were not obviously different. The median consumption of intraoperative sufentanil in group C was obviously lower than that in group E. At T1, the mean HR of group E was significantly higher than that of group C. At T2 and T3, the BP and HR of group E were obviously higher than that of group C. At T2, the CBFV in the group E were obviously higher than those in the group C. The incidence of hypotension was significantly reduced in the group E compared with the group C. There were no differences in the other outcomes. CONCLUSIONS The induction of esketamine combined with propofol does not increase the blood flow velocity of middle cerebral artery. Esketamine is advantageous in maintaining hemodynamic stability during induction. Furthermore, the administration of esketamine did not result in an increased incidence of adverse effects. TRIAL REGISTRATION 15/06/2023 clinicaltrials.gov ChiCTR2300072518 https://www.chictr.org.cn/bin/project/edit?pid=176675 .
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Affiliation(s)
- Shuang Yan
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, China
| | - Qiying Li
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, China.
| | - Kaihua He
- Department of Anesthesiology, The First Affiliate Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District Chongqing, China
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Wang D, Li H, Xu M, Bo B, Pei M, Liang Z, Thompson GJ. Differential Effect of Global Signal Regression Between Awake and Anesthetized Conditions in Mice. Brain Connect 2024; 14:48-59. [PMID: 38063007 DOI: 10.1089/brain.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Introduction: In resting-state functional magnetic resonance imaging (rs-fMRI) studies, global signal regression (GSR) is a controversial preprocessing strategy. It effectively eliminates global noise driven by motion and respiration but also can introduce artifacts and remove functionally relevant metabolic information. Most preclinical rs-fMRI studies are performed in anesthetized animals, and anesthesia will alter both metabolic and neuronal activity. Methods: In this study, we explored the effect of GSR on rs-fMRI data collected under anesthetized and awake state in mice (n = 12). We measured global signal amplitude, and also functional connectivity (FC), functional connectivity density (FCD) maps, and brain modularity, all commonly used data-driven analysis methods to quantify connectivity patterns. Results: We found that global signal amplitude was similar between the awake and anesthetized states. However, GSR had a different impact on connectivity networks and brain modularity changes between states. We demonstrated that GSR had a more prominent impact on the anesthetized state, with a greater decrease in functional connectivity and increased brain modularity. We classified mice using the change in amplitude of brain modularity coefficient (ΔQ) before and after GSR processing. The results revealed that, when compared with the largest ΔQ group, the smallest ΔQ group had increased FCD in the cortex region in both the awake and anesthetized states. This suggests differences in individual mice may affect how GSR differentially affects awake versus anesthetized functional connectivity. Discussion: This study suggests that, for rs-fMRI studies which compare different physiological states, researchers should use GSR processing with caution.
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Affiliation(s)
- Da Wang
- iHuman Institute, ShanghaiTech University, Shanghai, China
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Hui Li
- iHuman Institute, ShanghaiTech University, Shanghai, China
| | - Mengyang Xu
- iHuman Institute, ShanghaiTech University, Shanghai, China
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
- Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai, China
| | - Binshi Bo
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Mengchao Pei
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Zhifeng Liang
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, 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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Wieser M, Beckmann KM, Kutter APN, Mauri N, Richter H, Zölch N, Bektas RN. Ketamine administration in idiopathic epileptic and healthy control dogs: Can we detect differences in brain metabolite response with spectroscopy? Front Vet Sci 2023; 9:1093267. [PMID: 36686158 PMCID: PMC9853535 DOI: 10.3389/fvets.2022.1093267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction In recent years ketamine has increasingly become the focus of multimodal emergency management for epileptic seizures. However, little is known about the effect of ketamine on brain metabolites in epileptic patients. Magnetic resonance spectroscopy (MRS) is a non-invasive technique to estimate brain metabolites in vivo. Our aim was to measure the effect of ketamine on thalamic metabolites in idiopathic epileptic (IE) dogs using 3 Tesla MRS. We hypothesized that ketamine would increase the glutamine-glutamate (GLX)/creatine ratio in epileptic dogs with and without antiseizure drug treatment, but not in control dogs. Furthermore, we hypothesized that no different responses after ketamine administration in other measured brain metabolite ratios between the different groups would be detected. Methods In this controlled prospective experimental trial IE dogs with or without antiseizure drug treatment and healthy client-owned relatives of the breeds Border Collie and Greater Swiss Mountain Dog, were included. After sedation with butorphanol, induction with propofol and maintenance with sevoflurane in oxygen and air, a single voxel MRS at the level of the thalamus was performed before and 2 min after intravenous administration of 1 mg/kg ketamine. An automated data processing spectral fitting linear combination model algorithm was used to estimate all commonly measured metabolite ratios. A mixed ANOVA with the independent variables ketamine administration and group allocation was performed for all measured metabolites. A p < 0.05 was considered statistically significant. Results Twelve healthy control dogs, 10 untreated IE and 12 treated IE dogs were included. No significant effects for GLX/creatine were found. However, increased glucose/creatine ratios were found (p < 0.001) with no effect of group allocation. Furthermore, increases in the GABA/creatine ratio were found in IEU dogs. Discussion MRS was able to detect changes in metabolite/creatine ratios after intravenous administration of 1 mg/kg ketamine in dogs and no evidence was found that excitatory effects are induced in the thalamus. Although it is beyond the scope of this study to investigate the antiseizure potential of ketamine in dogs, results of this research suggest that the effect of ketamine on the brain metabolites could be dependent on the concentrations of brain metabolites before administration.
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Affiliation(s)
- Manuela Wieser
- Section of Anesthesiology, Department of Clinical Diagnostics and Services, University of Zurich, Zurich, Switzerland,*Correspondence: Manuela Wieser ✉
| | | | - Annette P. N. Kutter
- Section of Anesthesiology, Department of Clinical Diagnostics and Services, University of Zurich, Zurich, Switzerland
| | - Nico Mauri
- Department of Clinical Diagnostics and Services, Clinic for Diagnostic Imaging, University of Zurich, Zurich, Switzerland,Vetimage Diagnostik AG, Oberentfelden, Switzerland
| | - Henning Richter
- Department of Clinical Diagnostics and Services, Clinic for Diagnostic Imaging, University of Zurich, Zurich, Switzerland
| | - Niklaus Zölch
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Rima Nadine Bektas
- Section of Anesthesiology, Department of Clinical Diagnostics and Services, University of Zurich, Zurich, Switzerland
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Tagliabue S, Lindner C, da Prat IC, Sanchez-Guerrero A, Serra I, Kacprzak M, Maruccia F, Silva OM, Weigel UM, de Nadal M, Poca MA, Durduran T. Comparison of cerebral metabolic rate of oxygen, blood flow, and bispectral index under general anesthesia. NEUROPHOTONICS 2023; 10:015006. [PMID: 36911206 PMCID: PMC9993084 DOI: 10.1117/1.nph.10.1.015006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
SIGNIFICANCE The optical measurement of cerebral oxygen metabolism was evaluated. AIM Compare optically derived cerebral signals to the electroencephalographic bispectral index (BIS) sensors to monitor propofol-induced anesthesia during surgery. APPROACH Relative cerebral metabolic rate of oxygen ( rCMRO 2 ) and blood flow (rCBF) were measured by time-resolved and diffuse correlation spectroscopies. Changes were tested against the relative BIS (rBIS) ones. The synchronism in the changes was also assessed by the R-Pearson correlation. RESULTS In 23 measurements, optically derived signals showed significant changes in agreement with rBIS: during propofol induction, rBIS decreased by 67% [interquartile ranges (IQR) 62% to 71%], rCMRO 2 by 33% (IQR 18% to 46%), and rCBF by 28% (IQR 10% to 37%). During recovery, a significant increase was observed for rBIS (48%, IQR 38% to 55%), rCMRO 2 (29%, IQR 17% to 39%), and rCBF (30%, IQR 10% to 44%). The significance and direction of the changes subject-by-subject were tested: the coupling between the rBIS, rCMRO 2 , and rCBF was witnessed in the majority of the cases (14/18 and 12/18 for rCBF and 19/21 and 13/18 for rCMRO 2 in the initial and final part, respectively). These changes were also correlated in time ( R > 0.69 to R = 1 , p - values < 0.05 ). CONCLUSIONS Optics can reliably monitor rCMRO 2 in such conditions.
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Affiliation(s)
- Susanna Tagliabue
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Claus Lindner
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | | | - Angela Sanchez-Guerrero
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
| | - Isabel Serra
- Centre de Recerca Matemàtica, Bellaterra, Spain
- Barcelona Supercomputing Center—Centre Nacional de Supercomputació, Spain
| | - Michał Kacprzak
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, Warsaw, Poland
| | - Federica Maruccia
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
| | - Olga Martinez Silva
- Vall d’Hebron University Hospital, Department of Anesthesiology, Barcelona, Spain
| | - Udo M. Weigel
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- HemoPhotonics S.L., Mediterranean Technology Park, Barcelona, Spain
| | - Miriam de Nadal
- Vall d’Hebron University Hospital, Department of Anesthesiology, Barcelona, Spain
- Universidad Autònoma de Barcelona, Plaça Cívica, Barcelona, Spain
| | - Maria A. Poca
- Vall d’Hebron University Hospital Research Institute, Neurotraumatology and Neurosurgery Research Unit, Barcelona, Spain
- Universidad Autònoma de Barcelona, Plaça Cívica, Barcelona, Spain
- Vall d’Hebron University Hospital, Department of Neurosurgery, Barcelona, Spain
| | - Turgut Durduran
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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Nummela A, Laaksonen L, Scheinin A, Kaisti K, Vahlberg T, Neuvonen M, Valli K, Revonsuo A, Perola M, Niemi M, Scheinin H, Laitio T. Circulating oxylipin and bile acid profiles of dexmedetomidine, propofol, sevoflurane, and S-ketamine: a randomised controlled trial using tandem mass spectrometry. BJA OPEN 2022; 4:100114. [PMID: 37588789 PMCID: PMC10430865 DOI: 10.1016/j.bjao.2022.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 11/11/2022] [Indexed: 08/18/2023]
Abstract
Background This exploratory study aimed to investigate whether dexmedetomidine, propofol, sevoflurane, and S-ketamine affect oxylipins and bile acids, which are functionally diverse molecules with possible connections to cellular bioenergetics, immune modulation, and organ protection. Methods In this randomised, open-label, controlled, parallel group, Phase IV clinical drug trial, healthy male subjects (n=160) received equipotent doses (EC50 for verbal command) of dexmedetomidine (1.5 ng ml-1; n=40), propofol (1.7 μg ml-1; n=40), sevoflurane (0.9% end-tidal; n=40), S-ketamine (0.75 μg ml-1; n=20), or placebo (n=20). Blood samples for tandem mass spectrometry were obtained at baseline, after study drug administration at 60 and 130 min from baseline; 40 metabolites were analysed. Results Statistically significant changes vs placebo were observed in 62.5%, 12.5%, 5.0%, and 2.5% of analytes in dexmedetomidine, propofol, sevoflurane, and S-ketamine groups, respectively. Data are presented as standard deviation score, 95% confidence interval, and P-value. Dexmedetomidine induced wide-ranging decreases in oxylipins and bile acids. Amongst others, 9,10-dihydroxyoctadecenoic acid (DiHOME) -1.19 (-1.6; -0.78), P<0.001 and 12,13-DiHOME -1.22 (-1.66; -0.77), P<0.001 were affected. Propofol elevated 9,10-DiHOME 2.29 (1.62; 2.96), P<0.001 and 12,13-DiHOME 2.13 (1.42; 2.84), P<0.001. Analytes were mostly unaffected by S-ketamine. Sevoflurane decreased tauroursodeoxycholic acid (TUDCA) -2.7 (-3.84; -1.55), P=0.015. Conclusions Dexmedetomidine-induced oxylipin alterations may be connected to pathways associated with organ protection. In contrast to dexmedetomidine, propofol emulsion elevated DiHOMEs, oxylipins associated with acute respiratory distress syndrome, and mitochondrial dysfunction in high concentrations. Further research is needed to establish the behaviour of DIHOMEs during prolonged propofol/dexmedetomidine infusions and to verify the sevoflurane-induced reduction in TUDCA, a suggested neuroprotective agent. Clinical trial registration NCT02624401.
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Affiliation(s)
- Aleksi Nummela
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Internal Medicine, Turku University Hospital, Turku, Finland
| | - Lauri Laaksonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Peri-operative Services, University of Turku and Turku University Hospital, Turku, Finland
| | - Annalotta Scheinin
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Peri-operative Services, University of Turku and Turku University Hospital, Turku, Finland
| | - Kaike Kaisti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Peri-operative Services, University of Turku and Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, Intensive Care and Pain Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Mikko Neuvonen
- Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Katja Valli
- Department of Peri-operative Services, University of Turku and Turku University Hospital, Turku, Finland
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Skövde, Sweden
| | - Antti Revonsuo
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Skövde, Sweden
| | - Markus Perola
- Department of Clinical Pharmacology, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mikko Niemi
- Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Clinical Pharmacology, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Harry Scheinin
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
- Department of Peri-operative Services, University of Turku and Turku University Hospital, Turku, Finland
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Timo Laitio
- Department of Peri-operative Services, University of Turku and Turku University Hospital, Turku, Finland
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Could dexmedetomidine be repurposed as a glymphatic enhancer? Trends Pharmacol Sci 2022; 43:1030-1040. [PMID: 36280451 DOI: 10.1016/j.tips.2022.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
Cerebrospinal fluid (CSF) flows through the central nervous system (CNS) via the glymphatic pathway to clear the interstitium of metabolic waste. In preclinical studies, glymphatic fluid flow rate increases with low central noradrenergic tone and slow-wave activity during natural sleep and general anesthesia. By contrast, sleep deprivation reduces glymphatic clearance and leads to intracerebral accumulation of metabolic waste, suggesting an underlying mechanism linking sleep disturbances with neurodegenerative diseases. The selective α2-adrenergic agonist dexmedetomidine is a sedative drug that induces slow waves in the electroencephalogram, suppresses central noradrenergic tone, and preserves glymphatic outflow. As recently developed dexmedetomidine formulations enable self-administration, we suggest that dexmedetomidine could serve as a sedative-hypnotic drug to enhance clearance of harmful waste from the brain of those vulnerable to neurodegeneration.
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11
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Fujii R, Awaga Y, Nozawa K, Matsushita M, Hama A, Natsume T, Takamatsu H. Regional brain activation during rectal distention and attenuation with alosetron in a nonhuman primate model of irritable bowel syndrome. FASEB Bioadv 2022; 4:694-708. [PMID: 36349296 PMCID: PMC9635009 DOI: 10.1096/fba.2022-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 09/08/2024] Open
Abstract
Greater understanding of the mechanism that mediates visceral pain and hypersensitivity associated with irritable bowel syndrome (IBS) would facilitate the development of effective therapeutics to manage these symptoms. An objective marker associated with the underlying mechanisms of visceral pain and hypersensitivity could be used to guide therapeutic development. The current study examined brain activation evoked by rectal distention with functional magnetic resonance imaging (fMRI) in a cynomolgus macaque model of visceral hypersensitivity. Male, cynomolgus macaques underwent five four-week treatments of dextran sodium sulfate (DSS)-distilled water (DW), which induced mild-moderate colitis with remission during each treatment cycle. Balloon rectal distention (RD) was performed under anesthesia 14 weeks after the final DSS-DW treatment. Colonoscopy confirmed the absence of colitis prior to the start of RD. In naïve, untreated macaques, 10, 20 and 30 ml RD did not evoke brain activation. However, insular cortex/somatosensory II cortex and cerebellum were significantly activated in DSS-treated macaques at 20 and 30 ml rectal distention. Intra-rectal pressure after DSS treatment was not significantly different from that of naïve, untreated macaques, indicating lack of alteration of rectal functioning following DSS-treatment. Treatment with 5-HT3 receptor antagonist alosetron (p.o.) reduced distension-evoked brain activation and decreased intra-rectal pressure. The current findings demonstrated activation of brain regions to RD following DSS treatments which was not present in naïve macaques, suggesting visceral hypersensitivity. Brain activation in turn was reduced by alosetron, which could underlie the analgesic effect alosetron in IBS patients.
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Affiliation(s)
| | - Yuji Awaga
- Hamamatsu Pharma Research, Inc.HamamatsuJapan
| | | | | | - Aldric Hama
- Hamamatsu Pharma Research, Inc.HamamatsuJapan
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12
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Chen Y, Li S, Liang X, Zhang J. Differential Alterations to the Metabolic Connectivity of the Cortical and Subcortical Regions in Rat Brain During Ketamine-Induced Unconsciousness. Anesth Analg 2022; 135:1106-1114. [PMID: 35007212 DOI: 10.1213/ane.0000000000005869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ketamine anesthesia increased glucose metabolism in most brain regions compared to another intravenous anesthetic propofol. However, whether the changes in cerebral metabolic networks induced by ketamine share the same mechanism with propofol remains to be explored. The purpose of the present study was to identify specific features of metabolic network in rat brains during ketamine-induced subanesthesia state and anesthesia state compared to awake state. METHODS We acquired fluorodeoxyglucose positron emission tomography (FDG-PET) images in 20 healthy adult Sprague-Dawley rats that were intravenously administrated saline and ketamine to achieve different conscious states: awake (normal saline), subanesthesia (30 mg kg -1 h -1 ), and anesthesia (160 mg kg -1 h -1 ). Based on the FDG-PET data, the alterations in cerebral glucose metabolism and metabolic topography were investigated by graph-theory analysis. RESULTS The baseline metabolism in rat brains was found significantly increased during ketamine-induced subanesthesia and anesthesia. The graph-theory analysis manifested a reduction in metabolism connectivity and network global/local efficiency across cortical regions and an increase across subcortical regions during ketamine-induced anesthesia (nonparametric permutation test: global efficiency between awake and anesthesia, cortex: P = .016, subcortex: P = .015; global efficiency between subanesthesia and anesthesia, subcortex: P = .012). CONCLUSIONS Ketamine broadly increased brain metabolism alongside decreased metabolic connectivity and network efficiency of cortex network. Modulation of these cortical metabolic networks may be a candidate mechanism underlying general anesthesia-induced loss of consciousness.
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Affiliation(s)
- Yali Chen
- From the Department of Anesthesiology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Siyang Li
- School of Life Science and Technology.,Institute of Space Environment and Materiel Science, Harbin Institute of Technology, Harbin, China
| | - Xia Liang
- School of Life Science and Technology.,Institute of Space Environment and Materiel Science, Harbin Institute of Technology, Harbin, China
| | - Jun Zhang
- From the Department of Anesthesiology, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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13
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Nagaraj C, Joshi RK, Kumar D, R. G, Chakrabarti D, Singh PK, Mangalore S, Venkatapura R. Radiation Safety for Anesthesiologists and Other Personnel on Simultaneous PET/MRI: Possible Radiation Exposure from Patients While Performing Prolonged Duration Scans. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2022. [DOI: 10.1055/s-0042-1750710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AbstractThis observational study was conducted owing to the challenges of the positron emission tomography/magnetic resonance imaging (PET/MRI) that requires longer duration scanning of radiopharmaceutical injected patient and added MRI environment. The aim of this study was to assess radiation dose at different distances from the patient and the radiation burden to anesthesiologist and other personnel in performing PET/MRI under general anesthesia or sedation. First, the pre- and postscan whole body radiation exposure (WBE) from the patient were obtained for 45 minutes (n = 109) after injection of the radiopharmaceutical. The WBE was obtained at specific distances from brain (10, 30, and 100 cm) and abdomen (10 and 30cm) of patients undergoing F18 fluorodeoxyglucose PET/MRI brain or whole body studies. Second, WBE of the anesthesiologist and other staff working was separately measured using pocket dosimeters during the whole procedure. In brain scans, the mean absorbed dose rates (ADR) of prescan (45 minutes) and postscan (45 minutes) were 44.4 and 31.1 μSv at 10 cm, 14.9 and 9.7μSv at 30 cm, and 3.5 and 2.8 μSv at 100 cm, respectively, from surface of head. Similarly, it was 54.8 and 30.3 μSv at 10 cm, 23 and 13.6μSv at 30 cm, respectively, from surface of abdomen. In WB scans, the mean ADR was higher than the brain scans. Anesthesiologist exposure overall was found to be 4.84 µSv/patient/scan (112 patients). The anesthesiologist receives a safe mean effective dose in PET/MRI scanning. With good training and adequate planning, it is possible to decrease the radiation exposure to all the concerned personnel including anesthesiologists.
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Affiliation(s)
- Chandana Nagaraj
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Raman K. Joshi
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dinesh Kumar
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Gopinath R.
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Pardeep K. Singh
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sandhya Mangalore
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Ramesh Venkatapura
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Grigg-Damberger MM, Hussein O, Kulik T. Sleep Spindles and K-Complexes Are Favorable Prognostic Biomarkers in Critically Ill Patients. J Clin Neurophysiol 2022; 39:372-382. [PMID: 35239561 DOI: 10.1097/wnp.0000000000000830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY In this narrative review, we summarize recent research on the prognostic significance of biomarkers of sleep in continuous EEG and polysomnographic recordings in intensive care unit patients. Recent studies show the EEG biosignatures of non-rapid eye movement 2 sleep (sleep spindles and K-complexes) on continuous EEG in critically ill patients better predict functional outcomes and mortality than the ictal-interictal continuum patterns. Emergence of more complex and better organized sleep architecture has been shown to parallel neurocognitive recovery and correlate with functional outcomes in traumatic brain injury and strokes. Particularly interesting are studies which suggest intravenous dexmedetomidine may induce a more biomimetic non-rapid eye movement sleep state than intravenous propofol, potentially providing more restorative sleep and lessening delirium. Protocols to improve intensive care unit sleep and neurophysiological studies evaluating the effect of these on sleep and sleep architecture are here reviewed.
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15
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Robinson EJ, Lyne TC, Blaise BJ. Safety of general anaesthetics on the developing brain: are we there yet? BJA OPEN 2022; 2:100012. [PMID: 37588272 PMCID: PMC10430845 DOI: 10.1016/j.bjao.2022.100012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/11/2022] [Indexed: 08/18/2023]
Abstract
Thirty years ago, neurotoxicity induced by general anaesthetics in the developing brain of rodents was observed. In both laboratory-based and clinical studies, many conflicting results have been published over the years, with initial data confirming both histopathological and neurodevelopmental deleterious effects after exposure to general anaesthetics. In more recent years, animal studies using non-human primates and new human cohorts have identified some specific deleterious effects on neurocognition. A clearer pattern of neurotoxicity seems connected to exposure to repeated general anaesthesia. The biochemistry involved in this neurotoxicity has been explored, showing differential effects of anaesthetic drugs between the developing and developed brains. In this narrative review, we start with a comprehensive description of the initial concerning results that led to recommend that any non-essential surgery should be postponed after the age of 3 yr and that research into this subject should be stepped up. We then focus on the neurophysiology of the developing brain under general anaesthesia, explore the biochemistry of the observed neurotoxicity, before summarising the main scientific and clinical reports investigating this issue. We finally discuss the GAS trial, the importance of its results, and some potential limitations that should not undermine their clinical relevance. We finally suggest some key points that could be shared with parents, and a potential research path to investigate the biochemical effects of general anaesthesia, opening up perspectives to understand the neurocognitive effects of repetitive exposures, especially in at-risk children.
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Affiliation(s)
- Emily J. Robinson
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Tom C. Lyne
- Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Benjamin J. Blaise
- Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
- Department of Paediatric Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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16
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Liu H, Busl KM, Doré S. Role of Dexmedetomidine in Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Scoping Review. J Neurosurg Anesthesiol 2022; 34:176-182. [PMID: 33060552 DOI: 10.1097/ana.0000000000000728] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
Dexmedetomidine (DEX), an α2-adrenergic agonist, has been widely used for anesthesia, pain control, and intensive care unit sedation. Besides sleep-like sedation, DEX has many other beneficial effects, such as anti-inflammation, antioxidation, and anticell death. Subarachnoid hemorrhage (SAH), a severe and potentially fatal form of stroke, is a complex disease that is divided into 2 phases: early brain injury and delayed cerebral ischemia. In each phase, several pathologic changes are involved, including disturbed intracranial homeostasis, metabolic failure, blood-brain barrier damage, vasospasm, microthrombosis, and cortical spreading depolarization. DEX has been shown to have an effect on these SAH-related pathologic processes. Research shows that DEX could serve as a protective therapy for patients with SAH due to its ability to maintain stable intracerebral homeostasis, balance coagulation-fibrinolysis, repair a damaged blood-brain barrier as well as prevent vasospasm and suppress cortical spreading depolarization by anti-inflammatory, antioxidative, antiapoptotic, and vasoconstriction-dilation effects. In this scoping review, we critically assess the existing data on the potential protective effect of DEX after SAH. So far, only 1 retrospective clinical trial assessing the effect of DEX on clinical outcomes after SAH has been performed. Hence, more trials are still needed as well as translational research bringing results from bench to bedside.
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Affiliation(s)
- Hongtao Liu
- Department of Anesthesiology, the Second Affiliated Hospital of Xi'an JiaoTong University, Xi'an, ShaanXi Province, China
- Departments of Anesthesiology, Neurology, Psychiatry, Pharmaceutics, and Neuroscience, McKnight Brain Institute, Center for Translational Research in Neurodegenerative Disease
| | - Katharina M Busl
- Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL
| | - Sylvain Doré
- Departments of Anesthesiology, Neurology, Psychiatry, Pharmaceutics, and Neuroscience, McKnight Brain Institute, Center for Translational Research in Neurodegenerative Disease
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Li YC, Wang R, A JY, Sun RB, Na SJ, Liu T, Ding XS, Ge WH. Cerebrospinal fluid metabolic profiling reveals divergent modulation of pentose phosphate pathway by midazolam, propofol and dexmedetomidine in patients with subarachnoid hemorrhage: a cohort study. BMC Anesthesiol 2022; 22:34. [PMID: 35086470 PMCID: PMC8793156 DOI: 10.1186/s12871-022-01574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Agitation is common in subarachnoid hemorrhage (SAH), and sedation with midazolam, propofol and dexmedetomidine is essential in agitation management. Previous research shows the tendency of dexmedetomidine and propofol in improving long-term outcome of SAH patients, whereas midazolam might be detrimental. Brain metabolism derangement after SAH might be interfered by sedatives. However, how sedatives work and whether the drugs interfere with patient outcome by altering cerebral metabolism is unclear, and the comprehensive view of how sedatives regulate brain metabolism remains to be elucidated. METHODS For cerebrospinal fluid (CSF) and extracellular space of the brain exchange instantly, we performed a cohort study, applying CSF of SAH patients utilizing different sedatives or no sedation to metabolomics. Baseline CSF metabolome was corrected by selecting patients of the same SAH and agitation severity. CSF components were analyzed to identify the most affected metabolic pathways and sensitive biomarkers of each sedative. Markers might represent the outcome of the patients were also investigated. RESULTS Pentose phosphate pathway was the most significantly interfered (upregulated) pathway in midazolam (p = 0.0000107, impact = 0.35348) and propofol (p = 0.00000000000746, impact = 0.41604) groups. On the contrary, dexmedetomidine decreased levels of sedoheptulose 7-phosphate (p = 0.002) and NADP (p = 0.024), and NADP is the key metabolite and regulator in pentose phosphate pathway. Midazolam additionally augmented purine synthesis (p = 0.00175, impact = 0.13481) and propofol enhanced pyrimidine synthesis (p = 0.000203, impact = 0.20046), whereas dexmedetomidine weakened pyrimidine synthesis (p = 0.000000000594, impact = 0.24922). Reduced guanosine diphosphate (AUC of ROC 0.857, 95%CI 0.617-1, p = 0.00506) was the significant CSF biomarker for midazolam, and uridine diphosphate glucose (AUC of ROC 0.877, 95%CI 0.631-1, p = 0.00980) for propofol, and succinyl-CoA (AUC of ROC 0.923, 95%CI 0.785-1, p = 0.000810) plus adenosine triphosphate (AUC of ROC 0.908, 95%CI 0.6921, p = 0.00315) for dexmedetomidine. Down-regulated CSF succinyl-CoA was also associated with favorable outcome (AUC of ROC 0.708, 95% CI: 0.524-0.865, p = 0.029333). CONCLUSION Pentose phosphate pathway was a crucial target for sedatives which alter brain metabolism. Midazolam and propofol enhanced the pentose phosphate pathway and nucleotide synthesis in poor-grade SAH patients, as presented in the CSF. The situation of dexmedetomidine was the opposite. The divergent modulation of cerebral metabolism might further explain sedative pharmacology and how sedatives affect the outcome of SAH patients.
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Affiliation(s)
- Yi-Chen Li
- Department of Pharmacy, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210008, China
- Department of Neurosurgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210008, China
- Nanjing Medical Center of Clinical Pharmacy, Nanjing, 210008, China
| | - Rong Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210008, China.
| | - Ji-Ye A
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, 210009, China
| | - Run-Bin Sun
- Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, 210009, China
| | - Shi-Jie Na
- Department of Neurosurgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210008, China
| | - Tao Liu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210008, China
| | - Xuan-Sheng Ding
- Department of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Wei-Hong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210008, China
- Nanjing Medical Center of Clinical Pharmacy, Nanjing, 210008, China
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Radek L, Koskinen L, Sandman N, Laaksonen L, Kallionpää RE, Scheinin A, Rajala V, Maksimow A, Laitio T, Revonsuo A, Scheinin H, Valli K. On no man's land: Subjective experiences during unresponsive and responsive sedative states induced by four different anesthetic agents. Conscious Cogn 2021; 96:103239. [PMID: 34801782 DOI: 10.1016/j.concog.2021.103239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
To understand how anesthetics with different molecular mechanisms affect consciousness, we explored subjective experiences recalled after responsive and unresponsive sedation induced with equisedative doses of dexmedetomidine, propofol, sevoflurane, and S-ketamine in healthy male participants (N = 140). The anesthetics were administered in experimental setting using target-controlled infusion or vapouriser for one hour. Interviews conducted after anesthetic administration revealed that 46.9% (n = 46) of arousable participants (n = 98) reported experiences, most frequently dreaming or memory incorporation of the setting. Participants receiving dexmedetomidine reported experiences most often while S-ketamine induced the most multimodal experiences. Responsiveness at the end of anesthetic administration did not affect the prevalence or content of reported experiences. These results demonstrate that subjective experiences during responsive and unresponsive sedation are common and anesthetic agents with different molecular mechanisms of action may have different effects on the prevalence and complexity of the experiences, albeit in the present sample the differences between drugs were minute.
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Affiliation(s)
- Linda Radek
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland.
| | - Lauri Koskinen
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Nils Sandman
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Lauri Laaksonen
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Roosa E Kallionpää
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland
| | - Annalotta Scheinin
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Ville Rajala
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Anu Maksimow
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Timo Laitio
- Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland
| | - Antti Revonsuo
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, PO Box 408, 541 28 Skövde, Sweden
| | - Harry Scheinin
- Turku PET Centre, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Institute of Biomedicine and Unit of Clinical Pharmacology, University of Turku and Turku University Hospital, FI-20014 Turun yliopisto, Finland
| | - Katja Valli
- Department of Psychology and Speech-Language Pathology, and Turku Brain and Mind Center, University of Turku, FI-20014 Turun yliopisto, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital and University of Turku, PO Box 52, FI-20521 Turku, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, PO Box 408, 541 28 Skövde, Sweden
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Effects of dexmedetomidine, propofol, sevoflurane and S-ketamine on the human metabolome: A randomised trial using nuclear magnetic resonance spectroscopy. Eur J Anaesthesiol 2021; 39:521-532. [PMID: 34534172 DOI: 10.1097/eja.0000000000001591] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pharmacometabolomics uses large-scale data capturing methods to uncover drug-induced shifts in the metabolic profile. The specific effects of anaesthetics on the human metabolome are largely unknown. OBJECTIVE We aimed to discover whether exposure to routinely used anaesthetics have an acute effect on the human metabolic profile. DESIGN Randomised, open-label, controlled, parallel group, phase IV clinical drug trial. SETTING The study was conducted at Turku PET Centre, University of Turku, Finland, 2016 to 2017. PARTICIPANTS One hundred and sixty healthy male volunteers were recruited. The metabolomic data of 159 were evaluable. INTERVENTIONS Volunteers were randomised to receive a 1-h exposure to equipotent doses (EC50 for verbal command) of dexmedetomidine (1.5 ng ml-1; n = 40), propofol (1.7 μg ml-1; n = 40), sevoflurane (0.9% end-tidal; n = 39), S-ketamine (0.75 μg ml-1; n = 20) or placebo (n = 20). MAIN OUTCOME MEASURES Metabolite subgroups of apolipoproteins and lipoproteins, cholesterol, glycerides and phospholipids, fatty acids, glycolysis, amino acids, ketone bodies, creatinine and albumin and the inflammatory marker GlycA, were analysed with nuclear magnetic resonance spectroscopy from arterial blood samples collected at baseline, after anaesthetic administration and 70 min postanaesthesia. RESULTS All metabolite subgroups were affected. Statistically significant changes vs. placebo were observed in 11.0, 41.3, 0.65 and 3.9% of the 155 analytes in the dexmedetomidine, propofol, sevoflurane and S-ketamine groups, respectively. Dexmedetomidine increased glucose, decreased ketone bodies and affected lipoproteins and apolipoproteins. Propofol altered lipoproteins, fatty acids, glycerides and phospholipids and slightly increased inflammatory marker glycoprotein acetylation. Sevoflurane was relatively inert. S-ketamine increased glucose and lactate, whereas branched chain amino acids and tyrosine decreased. CONCLUSION A 1-h exposure to moderate doses of routinely used anaesthetics led to significant and characteristic alterations in the metabolic profile. Dexmedetomidine-induced alterations mirror α2-adrenoceptor agonism. Propofol emulsion altered the lipid profile. The inertness of sevoflurane might prove useful in vulnerable patients. S-ketamine induced amino acid alterations might be linked to its suggested antidepressive properties. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02624401. URL: https://clinicaltrials.gov/ct2/show/NCT02624401.
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Chen Y, Zhang J. How Energy Supports Our Brain to Yield Consciousness: Insights From Neuroimaging Based on the Neuroenergetics Hypothesis. Front Syst Neurosci 2021; 15:648860. [PMID: 34295226 PMCID: PMC8291083 DOI: 10.3389/fnsys.2021.648860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
Consciousness is considered a result of specific neuronal processes and mechanisms in the brain. Various suggested neuronal mechanisms, including the information integration theory (IIT), global neuronal workspace theory (GNWS), and neuronal construction of time and space as in the context of the temporospatial theory of consciousness (TTC), have been laid forth. However, despite their focus on different neuronal mechanisms, these theories neglect the energetic-metabolic basis of the neuronal mechanisms that are supposed to yield consciousness. Based on the findings of physiology-induced (sleep), pharmacology-induced (general anesthesia), and pathology-induced [vegetative state/unresponsive wakeful syndrome (VS/UWS)] loss of consciousness in both human subjects and animals, we, in this study, suggest that the energetic-metabolic processes focusing on ATP, glucose, and γ-aminobutyrate/glutamate are indispensable for functional connectivity (FC) of normal brain networks that renders consciousness possible. Therefore, we describe the energetic-metabolic predispositions of consciousness (EPC) that complement the current theories focused on the neural correlates of consciousness (NCC).
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Affiliation(s)
- Yali Chen
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical college, Fudan University, Shanghai, China
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Mamelak M. Sleep, Narcolepsy, and Sodium Oxybate. Curr Neuropharmacol 2021; 20:272-291. [PMID: 33827411 PMCID: PMC9413790 DOI: 10.2174/1570159x19666210407151227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
Sodium oxybate (SO) has been in use for many decades to treat narcolepsy with cataplexy. It functions as a weak GABAB agonist but also as an energy source for the brain as a result of its metabolism to succinate and as a powerful antioxidant because of its capacity to induce the formation of NADPH. Its actions at thalamic GABAB receptors can induce slow-wave activity, while its actions at GABAB receptors on monoaminergic neurons can induce or delay REM sleep. By altering the balance between monoaminergic and cholinergic neuronal activity, SO uniquely can induce and prevent cataplexy. The formation of NADPH may enhance sleep’s restorative process by accelerating the removal of the reactive oxygen species (ROS), which accumulate during wakefulness. SO improves alertness in normal subjects and in patients with narcolepsy. SO may allay severe psychological stress - an inflammatory state triggered by increased levels of ROS and characterized by cholinergic supersensitivity and monoaminergic deficiency. SO may be able to eliminate the inflammatory state and correct the cholinergic/ monoaminergic imbalance.
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Affiliation(s)
- Mortimer Mamelak
- Department of Psychiatry, Baycrest Hospital, University of Toronto, Toronto, Ontario. Canada
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22
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Geng W, Chen C, Sun X, Huang S. Effects of sevoflurane and propofol on the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery: a randomized controlled clinical studies. BMC Anesthesiol 2021; 21:30. [PMID: 33504329 PMCID: PMC7839298 DOI: 10.1186/s12871-021-01243-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background The results of studies on changes in intracranial pressure in patients undergoing laparoscopic surgery are inconsistent. Meanwhile, previous neurosurgery studies have suggested that propofol and sevoflurane have inconsistent effects on cerebral blood flow and cerebrovascular self-regulation. The purpose of this study is to compare changes in the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery under anesthetic maintenance with propofol versus sevoflurane. Methods This study included 110 patients undergoing laparoscopic gynecological surgery with an estimated operative time of more than 2 h under general anesthesia. The study was a randomized controlled study. The optic nerve sheath diameter (ONSD) at various time points was measured by ultrasound, including when the patients entered the operating room (Tawake), after successful anesthesia induction and endotracheal intubation (Tinduction), when the body position was adjusted to the Trendelenburg position and the CO2 pneumoperitoneum pressure reached 14 mmHg, which was recorded as T0. Then, measurements were conducted every 15 min for the first 1 h and then once every hour until the end of the surgery (T15, T30, T45, T1h, T2h …), after the end of surgery and the tracheal tube was removed (Tend), and before the patients were transferred to the ward (Tpacu). Results A significant difference in optic nerve sheath diameter was found between two groups at T15, T30, T45 (4.64 ± 0.48 mm and 4.50 ± 0.29 mm, respectively, p = 0.031;4.77 ± 0.45 mm and 4.62 ± 0.28 mm, respectively, p = 0.036;4.84 ± 0.46 mm and 4.65 ± 0.30 mm, respectively, p = 0.012), while there was no significant difference at Tawake and other time points. Conclusion During laparoscopic gynecological surgery lasting more than 2 h, the optic nerve sheath diameter was slightly larger in the propofol group than that in the sevoflurane group in the first 45 min. No significant difference was observed between the two groups 1 h after surgery. Trial registration clinicaltrials.gov, NCT03498235. Retrospectively registered 1 March 2018. The manuscript adheres to CONSORT guidelines.
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Affiliation(s)
- Weilian Geng
- Department of Anesthesia, Obstetrics and Gynecology Hospital of Fudan University, No.128, Shenyang RD, Yangpu district, Shanghai, 200090, China
| | - Changxing Chen
- Department of Emergency and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingfeng Sun
- Department of Anesthesia, Obstetrics and Gynecology Hospital of Fudan University, No.128, Shenyang RD, Yangpu district, Shanghai, 200090, China
| | - Shaoqiang Huang
- Department of Anesthesia, Obstetrics and Gynecology Hospital of Fudan University, No.128, Shenyang RD, Yangpu district, Shanghai, 200090, China.
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Li CX, Kempf D, Howell L, Zhang X. Effects of alfaxalone on cerebral blood flow and intrinsic neural activity of rhesus monkeys: A comparison study with ketamine. Magn Reson Imaging 2020; 75:134-140. [PMID: 33127411 DOI: 10.1016/j.mri.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Alfaxalone has been used increasingly in biomedical research and veterinary medicine of large animals in recent years. However, its effects on the cerebral blood flow (CBF) physiology and intrinsic neuronal activity of anesthetized brains remain poorly understood. METHODS Four healthy adult rhesus monkeys were anesthetized initially with alfaxalone (0.125 mg/kg/min) or ketamine (1.6 mg/kg/min) for 50 min, then administrated with 0.8% isoflurane for 60 min. Heart rates, breathing beats, and blood pressures were continuously monitored. CBF data were collected using pseudo-continuous arterial spin-labeling (pCASL) MRI technique and rsfMRI data were collected using single-shot EPI sequence for each anesthetic. RESULTS Both the heart rates and mean arterial pressure (MAP) remained more stable during alfaxalone infusion than those during ketamine administration. Alfaxalone reduced CBF substantially compared to ketamine anesthesia (grey matter, 65 ± 22 vs. 179 ± 38 ml/100g/min, p<0.001; white matter, 14 ± 7 vs. 26 ± 6 ml/100g/min, p < 0.05); In addition, CBF increase was seen in all selected cortical and subcortical regions of alfaxalone-pretreated monkey brains during isoflurane exposure, very different from the findings in isoflurane-exposed monkeys pretreated with ketamine. Also, alfaxalone showed suppression effects on functional connectivity of the monkey brain similar to ketamine. CONCLUSION Alfaxalone showed strong suppression effects on CBF of the monkey brain.The residual effect of alfaxalone on CBF of isoflurane-exposed brains was evident and monotonous in all the examined brain regions when used as induction agent for inhalational anesthesia. In particular, alfaxalone showed similar suppression effect on intrinsic neuronal activity of the brain in comparison with ketamine. These findings suggest alfaxalone can be a good alternative to veterinary anesthesia in neuroimaging examination of large animal models. However, its effects on CBF and functional connectivity should be considered.
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Affiliation(s)
- Chun-Xia Li
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States
| | - Doty Kempf
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States
| | - Leonard Howell
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States; Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States
| | - Xiaodong Zhang
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States; Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, United States.
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Goutal S, Tournier N, Guillermier M, Van Camp N, Barret O, Gaudin M, Bottlaender M, Hantraye P, Lavisse S. Comparative test-retest variability of outcome parameters derived from brain [18F]FDG PET studies in non-human primates. PLoS One 2020; 15:e0240228. [PMID: 33017429 PMCID: PMC7535063 DOI: 10.1371/journal.pone.0240228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Knowledge of the repeatability of quantitative parameters derived from [18F]FDG PET images is essential to define the group size and allow correct interpretation. Here we tested repeatability and accuracy of different [18F]FDG absolute and relative quantification parameters in a standardized preclinical setup in nonhuman primates (NHP). MATERIAL AND METHODS Repeated brain [18F]FDG scans were performed in 6 healthy NHP under controlled experimental factors likely to account for variability. Regional cerebral metabolic rate of glucose (CMRglu) was calculated using a Patlak plot with blood input function Semi-quantitative approaches measuring standard uptake values (SUV, SUV×glycemia and SUVR (SUV Ratio) using the pons or cerebellum as a reference region) were considered. Test-retest variability of all quantification parameters were compared in different brain regions in terms of absolute variability and intra-and-inter-subject variabilities. In an independent [18F]FDG PET experiment, robustness of these parameters was evaluated in 4 naive NHP. RESULTS Experimental conditions (injected dose, body weight, animal temperature) were the same at both imaging sessions (p >0.4). No significant difference in the [18F]FDG quantification parameters was found between test and retest sessions. Absolute variability of CMRglu, SUV, SUV×glycemia and normalized SUV ranged from 25 to 43%, 16 to 21%, 23 to 28%, and 7 to 14%, respectively. Intra-subject variability largely explained the absolute variability of all quantitative parameters. They were all significantly correlated to each other and they were all robust. Arterial and venous glycemia were highly correlated (r = 0.9691; p<0.0001). CONCLUSION [18F]FDG test-retest studies in NHP protocols need to be conducted under well-standardized experimental conditions to assess and select the most reliable and reproducible quantification approach. Furthermore, the choice of the quantification parameter has to account for the transversal or follow-up study design. If pons and cerebellum regions are not affected, non-invasive SUVR is the most favorable approach for both designs.
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Affiliation(s)
- Sébastien Goutal
- Laboratoire des Maladies Neurodégénératives, CEA, CNRS, MIRCen, Université Paris-Saclay, Fontenay-aux-Roses, France
| | - Nicolas Tournier
- Laboratoire d'Imagerie Biomédicale Multimodale (BioMaps), CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Université Paris-Saclay, Orsay, France
| | - Martine Guillermier
- Laboratoire des Maladies Neurodégénératives, CEA, CNRS, MIRCen, Université Paris-Saclay, Fontenay-aux-Roses, France
| | - Nadja Van Camp
- Laboratoire des Maladies Neurodégénératives, CEA, CNRS, MIRCen, Université Paris-Saclay, Fontenay-aux-Roses, France
| | - Olivier Barret
- Laboratoire des Maladies Neurodégénératives, CEA, CNRS, MIRCen, Université Paris-Saclay, Fontenay-aux-Roses, France
| | - Mylène Gaudin
- Laboratoire des Maladies Neurodégénératives, CEA, CNRS, MIRCen, Université Paris-Saclay, Fontenay-aux-Roses, France
| | - Michel Bottlaender
- Laboratoire d'Imagerie Biomédicale Multimodale (BioMaps), CEA, CNRS, Inserm, Service Hospitalier Frédéric Joliot, Université Paris-Saclay, Orsay, France
- UNIACT, Neurospin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Philippe Hantraye
- Laboratoire des Maladies Neurodégénératives, CEA, CNRS, MIRCen, Université Paris-Saclay, Fontenay-aux-Roses, France
| | - Sonia Lavisse
- Laboratoire des Maladies Neurodégénératives, CEA, CNRS, MIRCen, Université Paris-Saclay, Fontenay-aux-Roses, France
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Zhao E, Bai L, Li S, Li L, Dou Z, Huang Y, Li Y, Lv Y. Dexmedetomidine Alleviates CCI-Induced Neuropathic Pain via Inhibiting HMGB1-Mediated Astrocyte Activation and the TLR4/NF-κB Signaling Pathway in Rats. Neurotox Res 2020; 38:723-732. [PMID: 32607919 DOI: 10.1007/s12640-020-00245-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/21/2020] [Accepted: 06/17/2020] [Indexed: 01/16/2023]
Abstract
To investigate the effects of dexmedetomidine on chronic constriction injury (CCI)-induced neuropathic pain and to further explore its mechanism. A CCI rat model was established and treatment with dexmedetomidine. The paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were monitored at different time points, and the effects of hematoxylin-eosin staining on the sciatic nerve morphology of rats were observed. Immunohistochemical and immunofluorescence analyses were used to detect the expression of high mobility group box-1 (HMGB1) protein and glial fibrillary acidic protein (GFAP), and protein fluorescence intensity of GFAP in spinal cord tissue, respectively. Moreover, the expression of HMGB1 and Toll-like receptor-4/nuclear factor kappa-B (TLR4/NF-κB) pathway-related proteins were detected by western blot assay. To verify whether dexmedetomidine alleviates CCI-induced neuropathic pain by inhibiting HMGB1-mediated astrocyte activation and the TLR4/NF-κB signaling pathway, the rats were further treated with an HMGB1 activator or antagonist. Dexmedetomidine was found to improve the pathological changes of the sciatic nerve and alleviate pain in the CCI rats. The expression of HMGB1, GFAP, TLR4, TRAF6, MyD88, and p-P65 were greatly downregulated in the spinal cord tissues of the CCI rats. In addition, a further study showed that an HMGB1 activator can reverse the inhibition of neuropathic pain behaviors of dexmedetomidine. Overexpression of HMGB1 downregulated the PWMT and PWTL and enhanced the astrocyte activity and the TLR4/NF-κB signaling pathway in CCI rats. These results indicated that dexmedetomidine can alleviate neuropathic pain in CCI rats by inhibiting HMGB1-mediated astrocyte activation and the TLR4/NF-κB signaling pathway.
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Affiliation(s)
- Erxian Zhao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Liying Bai
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Shurong Li
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100000, China
| | - Li Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Zhongci Dou
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Yunli Huang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Yan Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Yunqi Lv
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China.
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Effects of spinal anesthesia and sedation with dexmedetomidine or propofol on cerebral regional oxygen saturation and systemic oxygenation a period after spinal injection. J Anesth 2020; 34:806-813. [PMID: 32556601 DOI: 10.1007/s00540-020-02816-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate changes in cerebral regional oxygen saturation (rSO2) after spinal anesthesia and compare the changes in rSO2 and systemic oxygenation between dexmedetomidine sedation and propofol sedation. METHODS Thirty-six patients scheduled to undergo transurethral surgery under spinal anesthesia were randomly assigned to the dexmedetomidine (n = 18) and propofol groups (n = 18). We used near-infrared spectroscopy sensors to measure rSO2, and obtained data from each side were averaged. After oxygen insufflation, baseline measurements of mean arterial blood pressure (MAP), heart rate, rSO2, pulse oximetry saturation (SpO2), bispectral index, and body temperature were made. After spinal anesthesia, we measured these parameters every 5 min. Twenty minutes after spinal injection, dexmedetomidine or propofol administration was started. We measured each parameter at 10, 25, and 40 min after the administration of dexmedetomidine or propofol. RESULTS The baseline rSO2 in the dexmedetomidine group was 71.3 ± 7.3%, and that in the propofol group was 71.8 ± 5.6%. After spinal anesthesia, rSO2 in both groups decreased significantly (dexmedetomidine group: 65.4 ± 6.9%; propofol group: 64.3 ± 7.4%). After administering sedatives, rSO2 was equivalent after spinal anesthesia. rSO2 was comparable between the two groups. MAP and SpO2 were significantly higher in the dexmedetomidine group than in the propofol group. CONCLUSION Spinal anesthesia decreased rSO2; however, the decline was not severe. Dexmedetomidine and propofol did not compromise cerebral oxygenation under spinal anesthesia. Nevertheless, MAP and SpO2 were more stable in dexmedetomidine sedation than in propofol sedation. Dexmedetomidine may be suitable for spinal anesthesia.
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Minhas JS, Rook W, Panerai RB, Hoiland RL, Ainslie PN, Thompson JP, Mistri AK, Robinson TG. Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review. Br J Anaesth 2020; 124:183-196. [PMID: 31813569 PMCID: PMC7034810 DOI: 10.1016/j.bja.2019.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
With an ageing population and increasing incidence of cerebrovascular disease, an increasing number of patients presenting for routine and emergency surgery have a prior history of stroke. This presents a challenge for pre-, intra-, and postoperative management as the neurological risk is considerably higher. Evidence is lacking around anaesthetic practice for patients with vascular neurological vulnerability. Through understanding the pathophysiological changes that occur after stroke, insight into the susceptibilities of the cerebral vasculature to intrinsic and extrinsic factors can be developed. Increasing understanding of post-stroke systemic and cerebral haemodynamics has provided improved outcomes from stroke and more robust secondary prevention, although this knowledge has yet to be applied to our delivery of anaesthesia in those with prior stroke. This review describes the key pathophysiological and clinical considerations that inform clinicians providing perioperative care for patients with a prior diagnosis of stroke.
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Affiliation(s)
- Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
| | - William Rook
- Academic Department of Anaesthesia, Critical Care, Pain, and Resuscitation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ryan L Hoiland
- Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Phil N Ainslie
- Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Jonathan P Thompson
- Anaesthesia and Critical Care, Department of Cardiovascular Sciences, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Amit K Mistri
- University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Thompson G Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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Sharma HS, Muresanu DF, Nozari A, Castellani RJ, Dey PK, Wiklund L, Sharma A. Anesthetics influence concussive head injury induced blood-brain barrier breakdown, brain edema formation, cerebral blood flow, serotonin levels, brain pathology and functional outcome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 146:45-81. [PMID: 31349932 DOI: 10.1016/bs.irn.2019.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Several lines of evidences show that anesthetics influence neurotoxicity and neuroprotection. The possibility that different anesthetic agents potentially influence the pathophysiological and functional outcome following neurotrauma was examined in a rat model of concussive head injury (CHI). The CHI was produced by an impact of 0.224N on the right parietal bone by dropping a weight of 114.6g from a 20cm height under different anesthetic agents, e.g., inhaled ether anesthesia or intraperitoneally administered ketamine, pentobarbital, equithesin or urethane anesthesia. Five hour CHI resulted in profound volume swelling and brain edema formation in both hemispheres showing disruption of the blood-brain barrier (BBB) to Evans blue and radioiodine. A marked decrease in the cortical CBF and a profound increase in plasma or brain serotonin levels were seen at this time. Neuronal damages were present in several parts of the brain. These pathological changes were most marked in CHI under ether anesthesia followed by ketamine (35mg/kg, i.p.), pentobarbital (50mg/kg, i.p.), equithesin (3mL/kg, i.p.) and urethane (1g/kg, i.p.). The functional outcome on Rota Rod performances or grid walking tests was also most adversely affected after CHI under ether anesthesia followed by pentobarbital, equithesin and ketamine. Interestingly, the plasma and brain serotonin levels strongly correlated with the development of brain edema in head injured animals in relation to different anesthetic agents used. These observations suggest that anesthetic agents are detrimental to functional and pathological outcomes in CHI probably through influencing the circulating plasma and brain serotonin levels, not reported earlier. Whether anesthetics could also affect the efficacy of different neuroprotective agents in CNS injuries is a new subject that is currently being examined in our laboratory.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin Fior Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Ala Nozari
- Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, United States
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Prasanta Kumar Dey
- Neurophysiology Research Unit, Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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29
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Wenzel M, Han S, Smith EH, Hoel E, Greger B, House PA, Yuste R. Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness. Cell Syst 2019; 8:467-474.e4. [PMID: 31054810 DOI: 10.1016/j.cels.2019.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/20/2018] [Accepted: 03/14/2019] [Indexed: 12/14/2022]
Abstract
Medically induced loss of consciousness (mLOC) during anesthesia is associated with a macroscale breakdown of brain connectivity, yet the neural microcircuit correlates of mLOC remain unknown. To explore this, we applied different analytical approaches (t-SNE/watershed segmentation, affinity propagation clustering, PCA, and LZW complexity) to two-photon calcium imaging of neocortical and hippocampal microcircuit activity and local field potential (LFP) measurements across different anesthetic depths in mice, and to micro-electrode array recordings in human subjects. We find that in both cases, mLOC disrupts population activity patterns by generating (1) fewer discriminable network microstates and (2) fewer neuronal ensembles. Our results indicate that local neuronal ensemble dynamics could causally contribute to the emergence of conscious states.
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Affiliation(s)
- Michael Wenzel
- Department of Biological Sciences, Columbia University, New York, NY 10027, USA; NeuroTechnology Center, Columbia University, New York, NY 10027, USA.
| | - Shuting Han
- Department of Biological Sciences, Columbia University, New York, NY 10027, USA; NeuroTechnology Center, Columbia University, New York, NY 10027, USA
| | - Elliot H Smith
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Erik Hoel
- Department of Biological Sciences, Columbia University, New York, NY 10027, USA; NeuroTechnology Center, Columbia University, New York, NY 10027, USA
| | - Bradley Greger
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Paul A House
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - Rafael Yuste
- Department of Biological Sciences, Columbia University, New York, NY 10027, USA; NeuroTechnology Center, Columbia University, New York, NY 10027, USA
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30
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18F-Flurodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) findings in children with encephalitis and comparison to conventional imaging. Eur J Nucl Med Mol Imaging 2019; 46:1309-1324. [DOI: 10.1007/s00259-019-04302-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/28/2019] [Indexed: 12/24/2022]
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31
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Farag E. Dexmedetomidine: A multifaceted drug in perioperative medicine. J Clin Anesth 2018; 55:1-2. [PMID: 30562591 DOI: 10.1016/j.jclinane.2018.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Ehab Farag
- Professor of Anesthesiology CCLCM, Case Western University, Department of General Anesthesia and Outcomes Research, Anesthesia Institute, Cleveland Clinic.
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