Single-trial classification of awareness state during anesthesia by measuring critical dynamics of global brain activity

Time-resolved correlation of distributed brain activity tracks E-I balance and accounts for diverse scale-free phenomena

Much of systems neuroscience posits the functional importance of brain activity patterns that lack natural scales of sizes, durations, or frequencies. The field has developed prominent, and sometimes competing, explanations for the nature of this scale-free activity. Here, we reconcile these explanations across species and modalities. First, we link estimates of excitation-inhibition (E-I) balance with time-resolved correlation of distributed brain activity. Second, we develop an unbiased method for sampling time series constrained by this time-resolved correlation. Third, we use this method to show that estimates of E-I balance account for diverse scale-free phenomena without need to attribute additional function or importance to these phenomena. Collectively, our results simplify existing explanations of scale-free brain activity and provide stringent tests on future theories that seek to transcend these explanations.

Intraoperative Awareness in Patients Undergoing Cardiac Surgery in an Academic Center in the North of Iran

Background

Coronary artery bypass grafting (CABG) has distinctive characteristics that may increase the risk of awareness during general anesthesia (AGA).

Objectives

This study was conducted to assess the incidence of AGA in cardiac surgery in an academic hospital in Guilan, Iran.

Methods

This descriptive cross-sectional study was performed in Dr. Heshmat Hospital in Rasht, Iran. Eligible patients candidates for CABG were enrolled in the survey in 2022. After surgery, when the patient was cooperative enough, a questionnaire including demographic data and specialized questions related to different stages of anesthesia was completed via face-to-face interviews. The data were analyzed using IBM SPSS Statistics 21 with chi-square, Fisher's exact, and t-test.

Results

The data from 322 patients were analyzed, of whom 14 (4.3%) experienced AGA. Among them, the "feeling of fear and anxiety" reported by 9 (39.1%) cases was the most common awareness state. "Dreaming during surgery and anesthesia" and "feeling unable to move during anesthesia,", each reported by 6 (26.1%) cases, were the other common types of awareness state. None of the demographic data had a significant association with the occurrence of AGA.

Conclusions

The incidence of AGA during CABG was almost acceptable according to the credible evidence.

May the 4C's be with you: an overview of complexity-inspired frameworks for analysing resting-state neuroimaging data

Competing and complementary models of resting-state brain dynamics contribute to our phenomenological and mechanistic understanding of whole-brain coordination and communication, and provide potential evidence for differential brain functioning associated with normal and pathological behaviour. These neuroscientific theories stem from the perspectives of physics, engineering, mathematics and psychology and create a complicated landscape of domain-specific terminology and meaning, which, when used outside of that domain, may lead to incorrect assumptions and conclusions within the neuroscience community. Here, we review and clarify the key concepts of connectivity, computation, criticality and coherence-the 4C's-and outline a potential role for metastability as a common denominator across these propositions. We analyse and synthesize whole-brain neuroimaging research, examined through functional magnetic imaging, to demonstrate that complexity science offers a principled and integrated approach to describe, and potentially understand, macroscale spontaneous brain functioning.

Robustness and Flexibility of Neural Function through Dynamical Criticality

In theoretical biology, robustness refers to the ability of a biological system to function properly even under perturbation of basic parameters (e.g., temperature or pH), which in mathematical models is reflected in not needing to fine-tune basic parameter constants; flexibility refers to the ability of a system to switch functions or behaviors easily and effortlessly. While there are extensive explorations of the concept of robustness and what it requires mathematically, understanding flexibility has proven more elusive, as well as also elucidating the apparent opposition between what is required mathematically for models to implement either. In this paper we address a number of arguments in theoretical neuroscience showing that both robustness and flexibility can be attained by systems that poise themselves at the onset of a large number of dynamical bifurcations, or dynamical criticality, and how such poising can have a profound influence on integration of information processing and function. Finally, we examine critical map lattices, which are coupled map lattices where the coupling is dynamically critical in the sense of having purely imaginary eigenvalues. We show that these map lattices provide an explicit connection between dynamical criticality in the sense we have used and "edge of chaos" criticality.

How general anesthetics work: from the perspective of reorganized connections within the brain

General anesthesia is critical for various procedures and surgeries. Despite the widespread use of anesthetics, their precise mechanisms remain poorly understood. Anesthetics inevitably act on the brain, primarily through the modulation of target receptors. Even if the action is specific to an individual neuron, however, long-range effects can occur due to the tremendous interconnectedness of neuronal activity. The strength of this connectivity can be understood using mathematical models that allow for the study of neuronal connectivity dynamics. These models also allow researchers to develop hypotheses on the candidate mechanisms of action of different types of anesthesia. This review highlights the theoretical background associated with the study of the mechanisms of action of anesthetics. We propose a candidate framework that describes how anesthetics act on the brain and consciousness in general.

Propofol-induced Unresponsiveness Is Associated with a Brain Network Phase Transition

Background:

The wakeful brain can easily access and coordinate a large repertoire of different states—dynamics suggestive of “criticality.” Anesthesia causes loss of criticality at the level of electroencephalogram waveforms, but the criticality of brain network connectivity is less well studied. The authors hypothesized that propofol anesthesia is associated with abrupt and divergent changes in brain network connectivity for different frequencies and time scales—characteristic of a phase transition, a signature of loss of criticality.

Methods:

As part of a previously reported study, 16 volunteers were given propofol in slowly increasing brain concentrations, and their behavioral responsiveness was assessed. The network dynamics from 31-channel electroencephalogram data were calculated from 1 to 20 Hz using four phase and envelope amplitude–based functional connectivity metrics that covered a wide range of time scales from milliseconds to minutes. The authors calculated network global efficiency, clustering coefficient, and statistical complexity (using the Jensen–Shannon divergence) for each functional connectivity metric and compared their findings with those from an in silico Kuramoto network model.

Results:

The transition to anesthesia was associated with critical slowing and then abrupt profound decreases in global network efficiency of 2 Hz power envelope metrics (from mean ± SD of 0.64 ± 0.15 to 0.29 ± 0.28 absolute value, P < 0.001, for medium; and from 0.47 ± 0.13 to 0.24 ± 0.21, P < 0.001, for long time scales) but with an increase in global network efficiency for 10 Hz weighted phase lag index (from 0.30 ± 0.20 to 0.72 ± 0.06, P < 0.001). Network complexity decreased for both the 10 Hz hypersynchronous (0.44 ± 0.13 to 0.23 ± 0.08, P < 0.001), and the 2 Hz asynchronous (0.73 ± 0.08 to 0.40 ± 0.13, P < 0.001) network states. These patterns of network coupling were consistent with those of the Kuramoto model of an order–disorder phase transition.

Conclusions:

Around loss of behavioral responsiveness, a small increase in propofol concentrations caused a collapse of long time scale power envelope connectivity and an increase in 10 Hz phase-based connectivity—suggestive of a brain network phase transition.

Temporospatial electroencephalographic analysis of brain network dynamics over a wide range of frequencies and time scales in 16 volunteers receiving slowly increasing concentrations of propofol revealed that transition to unresponsiveness was associated with a sudden rise in alpha frequency network phase synchrony anteriorly, but also a transient surge and then loss of network coupling over long (tens of seconds) time scales. Deep anesthesia was characterized by alpha waveform hypersynchrony and slow-wave power envelope dissynchrony across the whole cortex. These observations suggest that propofol anesthesia is associated with a constellation of changes in network connectivity across frequencies and time scales that are signatures of sharp and sudden transitions in the behavior of networks.

Topological analysis of differential effects of ketamine and propofol anaesthesia on brain dynamics

Research has found that the vividness of conscious experience is related to brain dynamics. Despite both being anaesthetics, propofol and ketamine produce different subjective states: we explore the different effects of these two anaesthetics on the structure of dynamic attractors reconstructed from electrophysiological activity recorded from cerebral cortex of two macaques. We used two methods: the first embeds the recordings in a continuous high-dimensional manifold on which we use topological data analysis to infer the presence of higher-order dynamics. The second reconstruction, an ordinal partition network embedding, allows us to create a discrete state-transition network, which is amenable to information-theoretic analysis and contains rich information about state-transition dynamics. We find that the awake condition generally had the 'richest' structure, visiting the most states, the presence of pronounced higher-order structures, and the least deterministic dynamics. By contrast, the propofol condition had the most dissimilar dynamics, transitioning to a more impoverished, constrained, low-structure regime. The ketamine condition, interestingly, seemed to combine aspects of both: while it was generally less complex than the awake condition, it remained well above propofol in almost all measures. These results provide deeper and more comprehensive insights than what is typically gained by using point-measures of complexity.

Explaining anaesthetic hysteresis with effect-site equilibration

BACKGROUND

Anaesthetic induction occurs at higher plasma drug concentrations than emergence in animal studies. Some studies find evidence for such anaesthetic hysteresis in humans, whereas others do not. Traditional thinking attributes hysteresis to drug equilibration between plasma and the effect site. Indeed, a key difference between human studies showing anaesthetic hysteresis and those that do not is in how effect-site equilibration was modelled. However, the effect-site is a theoretical compartment in which drug concentration cannot be measured experimentally. Thus, it is not clear whether drug equilibration models with experimentally intractable compartments are sufficiently constrained to unequivocally establish evidence for the presence or absence of anaesthetic hysteresis.

METHODS

We constructed several models. One lacked hysteresis beyond effect-site equilibration. In another, neuronal dynamics contributed to hysteresis. We attempted to distinguish between these two systems using drug equilibration models.

RESULTS

Our modelling studies showed that one can always construct an effect-site equilibration model such that hysteresis collapses. So long as the concentration in the effect-site cannot be measured directly, the correct effect-site equilibration model and the one that erroneously collapses hysteresis are experimentally indistinguishable. We also found that hysteresis can naturally arise even in a simple network of neurones independently of drug equilibration.

CONCLUSIONS

Effect-site equilibration models can readily collapse hysteresis. However, this does not imply that hysteresis is solely attributable to the kinetics of drug equilibration.

Resistance to state transitions in responsiveness is differentially modulated by different volatile anaesthetics in male mice

BACKGROUND

Recent studies point to a fundamental distinction between population-based and individual-based anaesthetic pharmacology. At the population level, anaesthetic potency is defined as the relationship between drug concentration and the likelihood of response to a stimulus. At the individual level, even when the anaesthetic concentration is held constant, fluctuations between the responsive and unresponsive states are observed. Notably, these spontaneous fluctuations exhibit resistance to state transitions R_st. Therefore, the response probability in each individual depends not just upon the drug concentration, but also upon responses to previous stimuli. Here, we hypothesise that R_st is distinct from drug potency and is differentially modulated by different anaesthetics.

METHODS

Adult (14-24 weeks old) C57BL/6J male mice (n=60) were subjected to repeated righting reflex (RR) assays at equipotent steady-state concentrations of isoflurane (0.6 vol%), sevoflurane (1.0 vol%), and halothane (0.4 vol%).

RESULTS

Fluctuations in RR were observed for all tested anaesthetics. Analysis of these fluctuations revealed that R_st was differentially modulated by different anaesthetics (F[2, 56.01]=49.59; P<0.0001). Fluctuations in RR were modelled using a stochastic dynamical system. This analysis confirmed that the amount of noise that drives behavioural state transitions depends on the anaesthetic agent (F[2, 42.86]=16.72; P<0.0001).

CONCLUSIONS

Whilst equipotent doses of distinct anaesthetics produce comparable population response probabilities, they engage dramatically different dynamics in each individual animal. This manifests as a differential aggregate propensity to exhibit state transitions. Thus, resistance to state transitions is a fundamentally distinct, novel measure of individualised anaesthetic pharmacology.

Analysis of stochastic fluctuations in responsiveness is a critical step toward personalized anesthesia

Traditionally, drug dosing is based on a concentration-response relationship estimated in a population. Yet, in specific individuals, decisions based on the population-level effects frequently result in over or under-dosing. Here, we interrogate the relationship between population-based and individual-based responses to anesthetics in mice and zebrafish. The anesthetic state was assessed by quantifying responses to simple stimuli. Individual responses dynamically fluctuated at a fixed drug concentration. These fluctuations exhibited resistance to state transitions. Drug sensitivity varied dramatically across individuals in both species. The amount of noise driving transitions between states, in contrast, was highly conserved in vertebrates separated by 400 million years of evolution. Individual differences in anesthetic sensitivity and stochastic fluctuations in responsiveness complicate the ability to appropriately dose anesthetics to each individual. Identifying the biological substrate of noise, however, may spur novel therapies, assure consistent drug responses, and encourage the shift from population-based to personalized medicine.

Every year, millions of patients undergo general anesthesia for complex or life-saving surgeries. In the vast majority of cases, the drugs work as intended. But a minority of patients take longer than expected to regain consciousness after anesthetic, and a few wake up during the surgery itself. It is unclear what causes these unintended events.

When choosing an anesthetic dose for each patient, physicians rely on data from large clinical studies. These studies expose many patients to different doses of an anesthetic drug. At higher doses, fewer and fewer patients remain conscious. This enables physicians to identify the dose at which an average person will lose consciousness. But this approach ignores the difference between the response of an individual and that of the population as a whole. At the population level, the likelihood of a patient being awake decreases smoothly as the concentration of anesthetic increases. But within that population, each individual patient can only ever show a binary response: awake or not awake.

To compare anesthetic effects on individuals versus populations, McKinstry-Wu, Wasilczuk et al. exposed mice to a commonly used anesthetic called isoflurane. During prolonged exposure to a constant dose of the drug, each mouse was sometimes unconscious and sometimes awake. These fluctuations in responsiveness seemed to occur at random. Exposing zebrafish to propofol, an anesthetic that works via a different mechanism, had a similar effect.

Notably, the responses of both species to anesthesia showed a phenomenon known as inertia. If an individual was unresponsive at one point in time, they were likely to still be unresponsive when assessed again after three minutes. The amount of inertia was similar in mice and zebrafish. This suggests that the mechanism responsible for inertia has remained unchanged over more than 400 million years of evolution.

The results reveal similarities between how individuals respond to anesthetics and how individual anesthetic molecules act on cells. When a molecule binds to its receptor protein on a cell, the receptor fluctuates spontaneously between active and inactive states. Studying how individuals respond to drugs could thus provide clues to how the drugs themselves work. Future studies should explore the biological basis of fluctuations in anesthetic responses. Understanding how these arise will help us tailor anesthetics to individual patients.

General Anesthesia: A Probe to Explore Consciousness

General anesthesia reversibly alters consciousness, without shutting down the brain globally. Depending on the anesthetic agent and dose, it may produce different consciousness states including a complete absence of subjective experience (unconsciousness), a conscious experience without perception of the environment (disconnected consciousness, like during dreaming), or episodes of oriented consciousness with awareness of the environment (connected consciousness). Each consciousness state may potentially be followed by explicit or implicit memories after the procedure. In this respect, anesthesia can be considered as a proxy to explore consciousness. During the recent years, progress in the exploration of brain function has allowed a better understanding of the neural correlates of consciousness, and of their alterations during anesthesia. Several changes in functional and effective between-region brain connectivity, consciousness network topology, and spatio-temporal dynamics of between-region interactions have been evidenced during anesthesia. Despite a set of effects that are common to many anesthetic agents, it is still uneasy to draw a comprehensive picture of the precise cascades during general anesthesia. Several questions remain unsolved, including the exact identification of the neural substrate of consciousness and its components, the detection of specific consciousness states in unresponsive patients and their associated memory processes, the processing of sensory information during anesthesia, the pharmacodynamic interactions between anesthetic agents, the direction-dependent hysteresis phenomenon during the transitions between consciousness states, the mechanisms of cognitive alterations that follow an anesthetic procedure, the identification of an eventual unitary mechanism of anesthesia-induced alteration of consciousness, the relationship between network effects and the biochemical or sleep-wake cycle targets of anesthetic agents, as well as the vast between-studies variations in dose and administration mode, leading to difficulties in between-studies comparisons. In this narrative review, we draw the picture of the current state of knowledge in anesthesia-induced unconsciousness, from insights gathered on propofol, halogenated vapors, ketamine, dexmedetomidine, benzodiazepines and xenon. We also describe how anesthesia can help understanding consciousness, we develop the above-mentioned unresolved questions, and propose tracks for future research.