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Zhao Y, Ou M, Liu J, Jiang J, Zhang D, Ke B, Wu Y, Chen Y, Jiang R, Hemmings HC, Zhu T, Zhou C. Astrocytes Modulate a Specific Paraventricular Thalamus→Prefrontal Cortex Projection to Enhance Consciousness Recovery from Anesthesia. J Neurosci 2024; 44:e1808232024. [PMID: 38926088 PMCID: PMC11340278 DOI: 10.1523/jneurosci.1808-23.2024] [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: 09/23/2023] [Revised: 03/30/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
Current anesthetic theory is mostly based on neurons and/or neuronal circuits. A role for astrocytes also has been shown in promoting recovery from volatile anesthesia, while the exact modulatory mechanism and/or the molecular target in astrocytes is still unknown. In this study by animal models in male mice and electrophysiological recordings in vivo and in vitro, we found that activating astrocytes of the paraventricular thalamus (PVT) and/or knocking down PVT astrocytic Kir4.1 promoted the consciousness recovery from sevoflurane anesthesia. Single-cell RNA sequencing of the PVT reveals two distinct cellular subtypes of glutamatergic neurons: PVT GRM and PVT ChAT neurons. Patch-clamp recording results proved astrocytic Kir4.1-mediated modulation of sevoflurane on the PVT mainly worked on PVT ChAT neurons, which projected mainly to the mPFC. In summary, our findings support the novel conception that there is a specific PVT→prefrontal cortex projection involved in consciousness recovery from sevoflurane anesthesia, which is mediated by the inhibition of sevoflurane on PVT astrocytic Kir4.1 conductance.
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Affiliation(s)
- Yi Zhao
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Mengchan Ou
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jingyao Jiang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Donghang Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Bowen Ke
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yujie Wu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yali Chen
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ruotian Jiang
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Hugh C Hemmings
- Departments of Anesthesiology and Pharmacology, Weill Cornell Medicine, New York, New York 10065
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Cheng Zhou
- Research Institution of Anesthesiology, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China
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Li Z, Wang P, Han L, Hao X, Mi W, Tong L, Liang Z. Age-dependent coupling characteristics of bilateral frontal EEG during desflurane anesthesia. Physiol Meas 2024; 45:055012. [PMID: 38697205 DOI: 10.1088/1361-6579/ad46e0] [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: 01/10/2023] [Accepted: 05/01/2024] [Indexed: 05/04/2024]
Abstract
Objectives.The purpose of this study is to investigate the age dependence of bilateral frontal electroencephalogram (EEG) coupling characteristics, and find potential age-independent depth of anesthesia monitoring indicators for the elderlies.Approach.We recorded bilateral forehead EEG data from 41 patients (ranged in 19-82 years old), and separated into three age groups: 18-40 years (n= 12); 40-65 years (n= 14), >65 years (n= 15). All these patients underwent desflurane maintained general anesthesia (GA). We analyzed the age-related EEG spectra, phase amplitude coupling (PAC), coherence and phase lag index (PLI) of EEG data in the states of awake, GA, and recovery.Main results.The frontal alpha power shows age dependence in the state of GA maintained by desflurane. Modulation index in slow oscillation-alpha and delta-alpha bands showed age dependence and state dependence in varying degrees, the PAC pattern also became less pronounced with increasing age. In the awake state, the coherence in delta, theta and alpha frequency bands were all significantly higher in the >65 years age group than in the 18-40 years age group (p< 0.05 for three frequency bands). The coherence in alpha-band was significantly enhanced in all age groups in GA (p< 0.01) and then decreased in recovery state. Notably, the PLI in the alpha band was able to significantly distinguish the three states of awake, GA and recovery (p< 0.01) and the results of PLI in delta and theta frequency bands had similar changes to those of coherence.Significance.We found the EEG coupling and synchronization between bilateral forehead are age-dependent. The PAC, coherence and PLI portray this age-dependence. The PLI and coherence based on bilateral frontal EEG functional connectivity measures and PAC based on frontal single-channel are closely associated with anesthesia-induced unconsciousness.
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Affiliation(s)
- Ziyang Li
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, People's Republic of China
| | - Peiqi Wang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Licheng Han
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, People's Republic of China
| | - Xinyu Hao
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Li Tong
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Zhenhu Liang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, People's Republic of China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, People's Republic of China
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Mashour GA. Anesthesia and the neurobiology of consciousness. Neuron 2024; 112:1553-1567. [PMID: 38579714 PMCID: PMC11098701 DOI: 10.1016/j.neuron.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 04/07/2024]
Abstract
In the 19th century, the discovery of general anesthesia revolutionized medical care. In the 21st century, anesthetics have become indispensable tools to study consciousness. Here, I review key aspects of the relationship between anesthesia and the neurobiology of consciousness, including interfaces of sleep and anesthetic mechanisms, anesthesia and primary sensory processing, the effects of anesthetics on large-scale functional brain networks, and mechanisms of arousal from anesthesia. I discuss the implications of the data derived from the anesthetized state for the science of consciousness and then conclude with outstanding questions, reflections, and future directions.
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Affiliation(s)
- George A Mashour
- Center for Consciousness Science, Department of Anesthesiology, Department of Pharmacology, Neuroscience Graduate Program, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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Obert DP, Killing D, Happe T, Tamas P, Altunkaya A, Dragovic SZ, Kreuzer M, Schneider G, Fenzl T. Substance specific EEG patterns in mice undergoing slow anesthesia induction. BMC Anesthesiol 2024; 24:167. [PMID: 38702608 PMCID: PMC11067159 DOI: 10.1186/s12871-024-02552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
The exact mechanisms and the neural circuits involved in anesthesia induced unconsciousness are still not fully understood. To elucidate them valid animal models are necessary. Since the most commonly used species in neuroscience are mice, we established a murine model for commonly used anesthetics/sedatives and evaluated the epidural electroencephalographic (EEG) patterns during slow anesthesia induction and emergence. Forty-four mice underwent surgery in which we inserted a central venous catheter and implanted nine intracranial electrodes above the prefrontal, motor, sensory, and visual cortex. After at least one week of recovery, mice were anesthetized either by inhalational sevoflurane or intravenous propofol, ketamine, or dexmedetomidine. We evaluated the loss and return of righting reflex (LORR/RORR) and recorded the electrocorticogram. For spectral analysis we focused on the prefrontal and visual cortex. In addition to analyzing the power spectral density at specific time points we evaluated the changes in the spectral power distribution longitudinally. The median time to LORR after start anesthesia ranged from 1080 [1st quartile: 960; 3rd quartile: 1080]s under sevoflurane anesthesia to 1541 [1455; 1890]s with ketamine. Around LORR sevoflurane as well as propofol induced a decrease in the theta/alpha band and an increase in the beta/gamma band. Dexmedetomidine infusion resulted in a shift towards lower frequencies with an increase in the delta range. Ketamine induced stronger activity in the higher frequencies. Our results showed substance-specific changes in EEG patterns during slow anesthesia induction. These patterns were partially identical to previous observations in humans, but also included significant differences, especially in the low frequencies. Our study emphasizes strengths and limitations of murine models in neuroscience and provides an important basis for future studies investigating complex neurophysiological mechanisms.
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Affiliation(s)
- David P Obert
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts's General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - David Killing
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany
| | - Tom Happe
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany
| | - Philipp Tamas
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany
| | - Alp Altunkaya
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany
| | - Srdjan Z Dragovic
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany
| | - Matthias Kreuzer
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany
| | - Gerhard Schneider
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany
| | - Thomas Fenzl
- School of Medicine and Health, Department of Anesthesiology and Intensive Care, Technical University of Munich, 81675, Munich, Germany.
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Liang Z, Tang B, Chang Y, Wang J, Li D, Li X, Wei C. State-related Electroencephalography Microstate Complexity during Propofol- and Esketamine-induced Unconsciousness. Anesthesiology 2024; 140:935-949. [PMID: 38157438 DOI: 10.1097/aln.0000000000004896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Identifying the state-related "neural correlates of consciousness" for anesthetics-induced unconsciousness is challenging. Spatiotemporal complexity is a promising tool for investigating consciousness. The authors hypothesized that spatiotemporal complexity may serve as a state-related but not drug-related electroencephalography (EEG) indicator during an unconscious state induced by different anesthetic drugs (e.g., propofol and esketamine). METHODS The authors recorded EEG from patients with unconsciousness induced by propofol (n = 10) and esketamine (n = 10). Both conventional microstate parameters and microstate complexity were analyzed. Spatiotemporal complexity was constructed by microstate sequences and complexity measures. Two different EEG microstate complexities were proposed to quantify the randomness (type I) and complexity (type II) of the EEG microstate series during the time course of the general anesthesia. RESULTS The coverage and occurrence of microstate E (prefrontal pattern) and the duration of microstate B (right frontal pattern) could distinguish the states of preinduction wakefulness, unconsciousness, and recovery under both anesthetics. Type I EEG microstate complexity based on mean information gain significantly increased from awake to unconsciousness state (propofol: from mean ± SD, 1.562 ± 0.059 to 1.672 ± 0.023, P < 0.001; esketamine: 1.599 ± 0.051 to 1.687 ± 0.013, P < 0.001), and significantly decreased from unconsciousness to recovery state (propofol: 1.672 ± 0.023 to 1.537 ± 0.058, P < 0.001; esketamine: 1.687 ± 0.013 to 1.608 ± 0.028, P < 0.001) under both anesthetics. In contrast, type II EEG microstate fluctuation complexity significantly decreased in the unconscious state under both drugs (propofol: from 2.291 ± 0.771 to 0.782 ± 0.163, P < 0.001; esketamine: from 1.645 ± 0.417 to 0.647 ± 0.252, P < 0.001), and then increased in the recovery state (propofol: 0.782 ± 0.163 to 2.446 ± 0.723, P < 0.001; esketamine: 0.647 ± 0.252 to 1.459 ± 0.264, P < 0.001). CONCLUSIONS Both type I and type II EEG microstate complexities are drug independent. Thus, the EEG microstate complexity measures that the authors proposed are promising tools for building state-related neural correlates of consciousness to quantify anesthetic-induced unconsciousness. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Zhenhu Liang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao, China
| | - Bo Tang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao, China
| | - Yu Chang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao, China
| | - Jing Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Duan Li
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern, Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Changwei Wei
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Martin JC, Liley DTJ, Beer CFLA, Davidson AJ. Topographical Features of Pediatric Electroencephalography during High Initial Concentration Sevoflurane for Inhalational Induction of Anesthesia. Anesthesiology 2024; 140:890-905. [PMID: 38207324 DOI: 10.1097/aln.0000000000004902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND High-density electroencephalographic (EEG) monitoring remains underutilized in clinical anesthesia, despite its obvious utility in unraveling the profound physiologic impact of these agents on central nervous system functioning. In school-aged children, the routine practice of rapid induction with high concentrations of inspiratory sevoflurane is commonplace, given its favorable efficacy and tolerance profile. However, few studies investigate topographic EEG during the critical timepoint coinciding with loss of responsiveness-a key moment for anesthesiologists in their everyday practice. The authors hypothesized that high initial sevoflurane inhalation would better precipitate changes in brain regions due to inhomogeneities in maturation across three different age groups compared with gradual stepwise paradigms utilized by other investigators. Knowledge of these changes may inform strategies for agent titration in everyday clinical settings. METHODS A total of 37 healthy children aged 5 to 10 yr underwent induction with 4% or greater sevoflurane in high-flow oxygen. Perturbations in anesthetic state were investigated in 23 of these children using 64-channel EEG with the Hjorth Laplacian referencing scheme. Topographical maps illustrated absolute, relative, and total band power across three age groups: 5 to 6 yr (n = 7), 7 to 8 yr (n = 8), and 9 to 10 yr (n = 8). RESULTS Spectral analysis revealed a large shift in total power driven by increased delta oscillations. Well-described topographic patterns of anesthesia, e.g., frontal predominance, paradoxical beta excitation, and increased slow activity, were evident in the topographic maps. However, there were no statistically significant age-related changes in spectral power observed in a midline electrode subset between the groups when responsiveness was lost compared to the resting state. CONCLUSIONS High initial concentration sevoflurane induction causes large-scale topographic effects on the pediatric EEG. Within the minute after unresponsiveness, this dosage may perturb EEG activity in children to an extent where age-related differences are not discernible. EDITOR’S PERSPECTIVE
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Affiliation(s)
| | - David T J Liley
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher F L A Beer
- Swinburne University of Technology, Faculty of Science, Engineering, and Technology, Australia
| | - Andrew J Davidson
- Department of Anaesthetics, Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Liu J, Zhang W, Hu S, Wu C, Dong K, Wei Q, Wang G, Fang J, Zhang D, Lan M, Zhang F, Sun H. Analysis of Amplitude Modulation of EEG Based on Holo-Hilbert Spectrum Analysis During General Anesthesia. IEEE Trans Biomed Eng 2024; 71:1607-1616. [PMID: 38285584 DOI: 10.1109/tbme.2023.3345942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVE The study aims to investigate the relationship between amplitude modulation (AM) of EEG and anesthesia depth during general anesthesia. METHODS In this study, Holo-Hilbert spectrum analysis (HHSA) was used to decompose the multichannel EEG signals of 15 patients to obtain the spatial distribution of AM in the brain. Subsequently, HHSA was applied to the prefrontal EEG (Fp1) obtained during general anesthesia surgery in 15 and 34 patients, and the α-θ and α-δ regions of feature (ROFs) were defined in Holo-Hilbert spectrum (HHS) and three features were derived to quantify AM in ROFs. RESULTS During anesthetized phase, an anteriorization of the spatial distribution of AMs of α-carrier in brain was observed, as well as AMs of α-θ and α-δ in the EEG of Fp1. The total power ([Formula: see text]), mean carrier frequency ([Formula: see text]) and mean amplitude frequency ([Formula: see text]) of AMs changed during different anesthesia states. CONCLUSION HHSA can effectively analyze the cross-frequency coupling of EEG during anesthesia and the AM features may be applied to anesthesia monitoring. SIGNIFICANCE The study provides a new perspective for the characterization of brain states during general anesthesia, which is of great significance for exploring new features of anesthesia monitoring.
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Cui Y, Li Y, Li Q, Huang J, Tan X, Zhan CA. Alpha anteriorization and theta posteriorization during deep sleep. J Neurosci Res 2024; 102:e25325. [PMID: 38562056 DOI: 10.1002/jnr.25325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Brain states (wake, sleep, general anesthesia, etc.) are profoundly associated with the spatiotemporal dynamics of brain oscillations. Previous studies showed that the EEG alpha power shifted from the occipital cortex to the frontal cortex (alpha anteriorization) after being induced into a state of general anesthesia via propofol. The sleep research literature suggests that slow waves and sleep spindles are generated locally and propagated gradually to different brain regions. Since sleep and general anesthesia are conceptualized under the same framework of consciousness, the present study examines whether alpha anteriorization similarly occurs during sleep and how the EEG power in other frequency bands changes during different sleep stages. The results from the analysis of three polysomnography datasets of 234 participants show consistent alpha anteriorization during the sleep stages N2 and N3, beta anteriorization during stage REM, and theta posteriorization during stages N2 and N3. Although it is known that the neural circuits responsible for sleep are not exactly the same for general anesthesia, the findings of alpha anteriorization in this study suggest that, at macro level, the circuits for alpha oscillations are organized in the similar cortical areas. The spatial shifts of EEG power in different frequency bands during sleep may offer meaningful neurophysiological markers for the level of consciousness.
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Affiliation(s)
- Yue Cui
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yu Li
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Qiqi Li
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Jing Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Xiaodan Tan
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Chang'an A Zhan
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Casey CP, Tanabe S, Farahbakhsh ZZ, Parker M, Bo A, White M, Ballweg T, Mcintosh A, Filbey W, Banks MI, Saalmann YB, Pearce RA, Sanders RD. Evaluation of putative signatures of consciousness using specific definitions of responsiveness, connectedness, and consciousness. Br J Anaesth 2024; 132:300-311. [PMID: 37914581 PMCID: PMC10808836 DOI: 10.1016/j.bja.2023.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Understanding the neural correlates of consciousness has important ramifications for the theoretical understanding of consciousness and for clinical anaesthesia. A major limitation of prior studies is the use of responsiveness as an index of consciousness. We identified a collection of measures derived from unresponsive subjects and more specifically their association with consciousness (any subjective experience) or connectedness (specific experience of environmental stimuli). METHODS Using published data generated through the UNderstanding Consciousness Connectedness and Intra-Operative Unresponsiveness Study (NCT03284307), we evaluated 10 previously published resting-state EEG-based measures that were derived using unresponsiveness as a proxy for unconsciousness. Measures were tested across dexmedetomidine and propofol sedation and natural sleep. These markers represent the complexity, connectivity, cross-frequency coupling, graph theory, and power spectrum measures. RESULTS Although many of the proposed markers were associated with consciousness per se (reported subjective experience), none were specific to consciousness alone; rather, each was also associated with connectedness (i.e. awareness of the environment). In addition, multiple markers showed no association with consciousness and were associated only with connectedness. Of the markers tested, loss of normalised-symbolic transfer entropy (front to back) was associated with connectedness across all three experimental conditions, whereas the transition from disconnected consciousness to unconsciousness was associated with significant decreases in permutation entropy and spectral exponent (P<0.05 for all conditions). CONCLUSIONS None of the proposed EEG-based neural correlates of unresponsiveness corresponded solely to consciousness, highlighting the need for a more conservative use of the term (un)consciousness when assessing unresponsive participants. CLINICAL TRIAL REGISTRATION NCT03284307.
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Affiliation(s)
- Cameron P Casey
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA.
| | - Sean Tanabe
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Zahra Z Farahbakhsh
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Margaret Parker
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Amber Bo
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Marissa White
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Tyler Ballweg
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew Mcintosh
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - William Filbey
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew I Banks
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuri B Saalmann
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert D Sanders
- Specialty of Anaesthetics & NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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10
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Gao Z, Zhang J, Zhang X, Wang L, Huang Y, Yu J. A Retrospective Study of the Patient State Index During General Anesthesia in Infants and Young Children. Clin Pediatr (Phila) 2024; 63:249-256. [PMID: 37042054 DOI: 10.1177/00099228231168475] [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] [Indexed: 04/13/2023]
Abstract
This study described electroencephalogram (EEG) parameters in children under general anesthesia, which could monitor patient-specific brain responses to anesthetics and assess the effects of anesthesia. The objective was to detect the patient state index (PSI) and associated factors. We analyzed EEG parameters in patients in the age range 1 to 36 months. Patients were stratified into 2 groups as those aged 1 to 12 months and 13 to 36 months. Sixty-two patients were involved. Spectral edge frequency (SEF), PSI, and blood pressure were lower, and burst suppression rate (BSR) and heart rate were higher in the 1 to 12 months group. The SEF was associated with PSI in both groups. Age and blood pressure were positively associated with PSI, and BSR was negatively related to PSI in children under 1 year of age. Blood pressure was not associated with PSI in the 13 to 36 months age group. We found that the PSI levels did not accurately assess the depth of anesthesia in children under 1 year of age.
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Affiliation(s)
- Zhengzheng Gao
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jianmin Zhang
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuemei Zhang
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Liya Wang
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yao Huang
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Yu
- Department of Anaesthesiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Jiang X, Wen X, Ou G, Li S, Chen Y, Zhang J, Liang Z. Propofol modulates neural dynamics of thalamo-cortical system associated with anesthetic levels in rats. Cogn Neurodyn 2023; 17:1541-1559. [PMID: 37974577 PMCID: PMC10640503 DOI: 10.1007/s11571-022-09912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/14/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
The thalamocortical system plays an important role in consciousness. How anesthesia modulates the thalamocortical interactions is not completely known. We simultaneously recorded local field potentials(LFPs) in thalamic reticular nucleus(TRN) and ventroposteromedial thalamic nucleus(VPM), and electrocorticographic(ECoG) activities in frontal and occipital cortices in freely moving rats (n = 11). We analyzed the changes in thalamic and cortical local spectral power and connectivities, which were measured with phase-amplitude coupling (PAC), coherence and multivariate Granger causality, at the states of baseline, intravenous infusion of propofol 20, 40, 80 mg/kg/h and after recovery of righting reflex. We found that propofol-induced burst-suppression results in a synchronous decrease of spectral power in thalamus and cortex (p < 0.001 for all frequency bands). The cross-frequency PAC increased by propofol, characterized by gradually stronger 'trough-max' pattern in TRN and stronger 'peak-max' pattern in cortex. The cross-region PAC increased in the phase of TRN modulating the amplitude of cortex. The functional connectivity (FC) between TRN and cortex for α/β bands also significantly increased (p < 0.040), with increased directional connectivity from TRN to cortex under propofol anesthesia. In contrast, the corticocortical FC significantly decreased (p < 0.047), with decreased directional connectivity from frontal cortex to occipital cortex. However, the thalamothalamic functional and directional connectivities remained largely unchanged by propofol anesthesia. The spectral powers and connectivities are differentially modulated with the changes of propofol doses, suggesting the changes in neural dynamics in thalamocortical system could be used for distinguishing different vigilance levels caused by propofol. Supplementary Information The online version contains supplementary material available at 10.1007/s11571-022-09912-0.
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Affiliation(s)
- Xuliang Jiang
- Department of Anesthesiology, Shanghai Cancer Center, Fudan University, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Xin Wen
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, 066004 People’s Republic of China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao, 066004 People’s Republic of China
| | - Guoyao Ou
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, 200040 People’s Republic of China
| | - Shitong Li
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, 200040 People’s Republic of China
| | - Yali Chen
- Department of Anesthesiology, Shanghai Cancer Center, Fudan University, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Jun Zhang
- Department of Anesthesiology, Shanghai Cancer Center, Fudan University, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Zhenhu Liang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, 066004 People’s Republic of China
- Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao, 066004 People’s Republic of China
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12
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Zakaria L, Desowska A, Berde CB, Cornelissen L. Electroencephalographic delta and alpha oscillations reveal phase-amplitude coupling in paediatric patients undergoing sevoflurane-based general anaesthesia. Br J Anaesth 2023; 130:595-602. [PMID: 36922266 DOI: 10.1016/j.bja.2023.01.025] [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: 09/19/2022] [Revised: 01/03/2023] [Accepted: 01/28/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Sevoflurane-induced anaesthesia generates frontal alpha oscillations as early as 6 months of age, whereas strong delta oscillations are present at birth. In adults, delta oscillations and alpha oscillations are coupled: the phase of delta waves modulates the amplitude of alpha oscillations in a phenomenon known as phase-amplitude coupling. We hypothesise that delta-alpha phase-amplitude coupling exists in young children and is a feature of sevoflurane-based general anaesthesia distinct from emergence after anaesthesia. METHODS Electroencephalographic data from 31 paediatric patients aged 10 months to 3 yr undergoing elective surgery with sevoflurane-based anaesthesia were analysed retrospectively. Delta-alpha phase-amplitude coupling was evaluated during maintenance of anaesthesia and during emergence. RESULTS Delta-alpha phase-amplitude coupling was observed in the study population. Strength of phase-amplitude coupling, represented by the delta-alpha mean amplitude vector, was greater during general anaesthesia than during emergence (Wilcoxon paired signed-rank test, Z=3.107, P=0.002). Frontal alpha amplitude during anaesthesia was not uniformly distributed across all delta phases. During general anaesthesia, alpha power was restricted to the positive phase of the delta wave (omnibus circular uniformity, general anaesthesia: P<0.001, mean phase: 114º; 99% confidence interval: 90º-139º; emergence: P=0.35, mean phase 181º, 99% confidence interval: 110º-253º). CONCLUSIONS Sevoflurane-based anaesthesia is associated with delta-alpha phase-amplitude coupling in paediatric patients. These findings improve our understanding of cortical dynamics in children undergoing general anaesthesia, which might improve paediatric intraoperative depth of anaesthesia monitoring techniques.
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Affiliation(s)
- Luai Zakaria
- Department of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women's Hospital, Boston, USA; Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Adela Desowska
- Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Charles B Berde
- Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Laura Cornelissen
- Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
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Azuma S, Asamoto M, Hattori K, Otsuji M, Uchida K, Yamada Y. Quantitative relationship between anteriorization of alpha oscillations and level of general anesthesia. J Clin Monit Comput 2023; 37:609-618. [PMID: 36316519 DOI: 10.1007/s10877-022-00932-z] [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: 07/25/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
A typical electroencephalogram (EEG) change induced by general anesthesia is anteriorization-disappearance of occipital alpha oscillations followed by the development of frontal alpha oscillations. Investigating the quantitative relationship between such a specific EEG change and the level of anesthesia has academic and clinical importance. We quantified the degree of anteriorization and investigated its detailed relationship with the level of anesthesia. We acquired 21-electrode EEG data and bispectral index (BIS) values of 50 patients undergoing surgery from before anesthesia induction until after patient arousal. For each epoch of a 10.24-s window with 1-s offsets, we calculated frontal alpha power [Formula: see text], occipital alpha power [Formula: see text], and their difference [Formula: see text] to quantify anteriorization. We calculated Spearman's rank correlation coefficients between these values and the BIS value. We used locally weighted regression to estimate [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] at each BIS value. Thirty-six patients (26 females and 10 males aged 24-85 years) were analyzed. The 95% confidence intervals for the mean of Fisher transformations of Spearman's rank correlation coefficients between [Formula: see text], [Formula: see text], and [Formula: see text] and BIS value were [- 0.68, - 0.26], [0.02, 0.62], and [- 1.11, - 0.91], respectively. The change in [Formula: see text] and [Formula: see text] with BIS value showed different patterns by the type of anesthetic agent, whereas that in [Formula: see text] was more consistent with smaller individual variance. Anteriorization, quantified by the difference between frontal and occipital alpha powers, continuously developed in conjunction with general anesthesia. Quantifying anteriorization may provide an objective indicator of the level of anesthesia.
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Affiliation(s)
- Seiichi Azuma
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaaki Asamoto
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.
| | - Kohshi Hattori
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Anesthesiology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Mikiya Otsuji
- Department of Anesthesiology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshitsugu Yamada
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Anesthesiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
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14
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Walter N, Hinterberger T. Self-organized criticality as a framework for consciousness: A review study. Front Psychol 2022; 13:911620. [PMID: 35911009 PMCID: PMC9336647 DOI: 10.3389/fpsyg.2022.911620] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/29/2022] [Indexed: 01/04/2023] Open
Abstract
Objective No current model of consciousness is univocally accepted on either theoretical or empirical grounds, and the need for a solid unifying framework is evident. Special attention has been given to the premise that self-organized criticality (SOC) is a fundamental property of neural system. SOC provides a competitive model to describe the physical mechanisms underlying spontaneous brain activity, and thus, critical dynamics were proposed as general gauges of information processing representing a strong candidate for a surrogate measure of consciousness. As SOC could be a neurodynamical framework, which may be able to bring together existing theories and experimental evidence, the purpose of this work was to provide a comprehensive overview of progress of research on SOC in association with consciousness. Methods A comprehensive search of publications on consciousness and SOC published between 1998 and 2021 was conducted. The Web of Science database was searched, and annual number of publications and citations, type of articles, and applied methods were determined. Results A total of 71 publications were identified. The annual number of citations steadily increased over the years. Original articles comprised 50.7% and reviews/theoretical articles 43.6%. Sixteen studies reported on human data and in seven studies data were recorded in animals. Computational models were utilized in n = 12 studies. EcoG data were assessed in n = 4 articles, fMRI in n = 4 studies, and EEG/MEG in n = 10 studies. Notably, different analytical tools were applied in the EEG/MEG studies to assess a surrogate measure of criticality such as the detrended fluctuation analysis, the pair correlation function, parameters from the neuronal avalanche analysis and the spectral exponent. Conclusion Recent studies pointed out agreements of critical dynamics with the current most influencing theories in the field of consciousness research, the global workspace theory and the integrated information theory. Thus, the framework of SOC as a neurodynamical parameter for consciousness seems promising. However, identified experimental work was small in numbers, and a heterogeneity of applied analytical tools as a surrogate measure of criticality was observable, which limits the generalizability of findings.
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Wang Z, Zhang F, Yue L, Hu L, Li X, Xu B, Liang Z. Cortical Complexity and Connectivity during Isoflurane-induced General Anesthesia: A Rat Study. J Neural Eng 2022; 19. [PMID: 35472693 DOI: 10.1088/1741-2552/ac6a7b] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/25/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The investigation of neurophysiologic mechanisms of anesthetic drug-induced loss of consciousness (LOC) by using the entropy, complexity, and information integration theories at the mesoscopic level has been a hot topic in recent years. However, systematic research is still lacking. APPROACH We analyzed electrocorticography (ECoG) data recorded from nine rats during isoflurane-induced unconsciousness. To characterize the complexity and connectivity changes, we investigated ECoG power, symbolic dynamic-based entropy (i.e., permutation entropy (PE)), complexity (i.e., permutation Lempel-Ziv complexity (PLZC)), information integration (i.e., permutation cross mutual information (PCMI)), and PCMI-based cortical brain networks in the frontal, parietal, and occipital cortical regions. MAIN RESULTS Firstly, LOC was accompanied by a raised power in the ECoG beta (12-30 Hz) but a decreased power in the high gamma (55-95 Hz) frequency band in all three brain regions. Secondly, PE and PLZC showed similar change trends in the lower frequency band (0.1-45 Hz), declining after LOC (p<0.05) and increasing after recovery of consciousness (p<0.001). Thirdly, intra-frontal and inter-frontal-parietal PCMI declined after LOC, in both lower (0.1-45Hz) and higher frequency bands (55-95Hz) (p<0.001). Finally, the local network parameters of the nodal clustering coefficient and nodal efficiency in the frontal region decreased after LOC, in both the lower and higher frequency bands (p<0.05). Moreover, global network parameters of the normalized average clustering coefficient and small world index increased slightly after LOC in the lower frequency band. However, this increase was not statistically significant. SIGNIFICANCE The PE, PLZC, PCMI and PCMI-based brain networks are effective metrics for qualifying the effects of isoflurane.
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Affiliation(s)
- Zhijie Wang
- Yanshan University, Yanshan University, Qinhuangdao 066004, China., Qinhuangdao, 066004, CHINA
| | - Fengrui Zhang
- Department of Psychology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Beijing 100049, China., Beijing, 100049, CHINA
| | - Lupeng Yue
- Department of Psychology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Beijing 100049, China., Beijing, 100049, CHINA
| | - Li Hu
- Department of Psychology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Beijing 100049, China, Beijing, 100049, CHINA
| | - Xiaoli Li
- Department of Psychology, Beijing Normal University, Beijing Normal University, Beijing 100875, China., Beijing, Beijing, 100875, CHINA
| | - Bo Xu
- PLA General Hospital of Southern Theatre Command, Guangzhou 510010, China., Guangzhou, Guangdong, 510010, CHINA
| | - Zhenhu Liang
- Institute of Electrical Engineering, Yanshan University, Yanshan University, Qinhuangdao 066004, China., Qinhuangdao, 066004, CHINA
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Thalamic T-Type Calcium Channels as Targets for Hypnotics and General Anesthetics. Int J Mol Sci 2022; 23:ijms23042349. [PMID: 35216466 PMCID: PMC8876360 DOI: 10.3390/ijms23042349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/19/2022] Open
Abstract
General anesthetics mainly act by modulating synaptic inhibition on the one hand (the potentiation of GABA transmission) or synaptic excitation on the other (the inhibition of NMDA receptors), but they can also have effects on numerous other proteins, receptors, and channels. The effects of general anesthetics on ion channels have been the subject of research since the publication of reports of direct actions of these drugs on ion channel proteins. In particular, there is considerable interest in T-type voltage-gated calcium channels that are abundantly expressed in the thalamus, where they control patterns of cellular excitability and thalamocortical oscillations during awake and sleep states. Here, we summarized and discussed our recent studies focused on the CaV3.1 isoform of T-channels in the nonspecific thalamus (intralaminar and midline nuclei), which acts as a key hub through which natural sleep and general anesthesia are initiated. We used mouse genetics and in vivo and ex vivo electrophysiology to study the role of thalamic T-channels in hypnosis induced by a standard general anesthetic, isoflurane, as well as novel neuroactive steroids. From the results of this study, we conclude that CaV3.1 channels contribute to thalamocortical oscillations during anesthetic-induced hypnosis, particularly the slow-frequency range of δ oscillations (0.5–4 Hz), by generating “window current” that contributes to the resting membrane potential. We posit that the role of the thalamic CaV3.1 isoform of T-channels in the effects of various classes of general anesthetics warrants consideration.
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17
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Shin TJ, Kim PJ, Choi B. How general anesthetics work: from the perspective of reorganized connections within the brain. Korean J Anesthesiol 2022; 75:124-138. [PMID: 35130674 PMCID: PMC8980288 DOI: 10.4097/kja.22078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Gao Z, Zhang J, Wang X, Yao M, Sun L, Ren Y, Qiu D. A retrospective study of electroencephalography burst suppression in children undergoing general anesthesia. Pediatr Investig 2021; 5:271-276. [PMID: 34938968 PMCID: PMC8666939 DOI: 10.1002/ped4.12287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE In children, anesthesia dosages are based on population pharmacokinetics and patient hemodynamics rather than patient-specific brain activity. Brain function is highly susceptible to the effects of anesthetics. OBJECTIVE The primary objective of this retrospective pilot study was to assess the prevalence of electroencephalography (EEG) burst suppression-a sign of deep anesthesia-in children undergoing general anesthesia. METHODS We analyzed EEG in patients aged 1-36 months who received sevoflurane or propofol as the primary anesthetic. Patient enrollment was stratified into two age groups: 1-12 months and 13-36 months. Burst suppression (voltage ≤ 5.0 mV, lasting > 0.5 seconds) was characterized by occurrence over anesthesia time. Associations with patient demographics and anesthetics were determined. RESULTS In total, 54 patients (33 males and 21 females) were included in the study [age 11.0 (5.0-19.5) months; weight 9.2 (6.5-11.0) kg]. The total prevalence of burst suppression was 56% (30/54). Thirty-three percent of patients experienced burst suppression during the surgical phase. The greatest proportion of burst suppression occurred during the induction phase. More burst suppression event occurrences (18/30) were observed in the patient under sevoflurane anesthesia (P = 0.024). Virtually all patients who received propofol boluses had burst suppression (P = 0.033). More burst suppression occurred in patients with hypotension (P < 0.001). During the surgical phase, a younger age was associated with more burst suppression (P = 0.002). INTERPRETATION EEG burst suppression was associated with younger age, inhalation anesthetics, propofol bolus, and lower arterial pressure.
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Affiliation(s)
- Zhengzheng Gao
- Department of AnesthesiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Jianmin Zhang
- Department of AnesthesiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Xiaoxue Wang
- Department of AnesthesiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Mengnan Yao
- Department of AnesthesiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Lan Sun
- Department of AnesthesiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yi Ren
- Department of AnesthesiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Dongyu Qiu
- Department of AnesthesiologyBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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19
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S AA, Ramakrishnan AG. Brain Functional Connectivity as Biomarker for Propofol-Induced Alterations of Consciousness. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1928-1931. [PMID: 34891664 DOI: 10.1109/embc46164.2021.9629617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Understanding neural correlates of consciousness and its alterations poses a grand challenge for modern neuroscience. Even though recent years of research have shown many conceptual and empirical advances, the evolution of a system that can track anesthesia-induced loss of consciousness is hindered by the lack of reliable markers. The work presented herein estimates the functional connectivity (FC) between 21 scalp electroencephalogram (EEG) recordings to evaluate its utility in characterizing changes in brain networks during propofol sedation. The sedation dataset in the University of Cambridge data repository was used for analyses. FC was estimated using the debiased estimator of the squared Weighted Phase Lag Index (dWPLI2). Spectral FC networks before, during, and after sedation was considered for 5 EEG sub-bands. Results demonstrated significantly higher alpha band FC during baseline, mild and moderate sedation, and recovery stages. A striking association between frontal brain activity and propofol-sedation was also noticed. Furthermore, inhibition of frontal to parietal and frontal to occipital connections were observed as characteristic features of propofol-induced alterations in consciousness. A random subspace ensemble framework using logistic model tree as the base classifier, and 18 functional connections as features, yielded a cross-validation accuracy of 98.75% in discriminating baseline, mild and moderate sedation, and recovery stages. These findings validate that EEG-based FC can reliably distinguish altered conscious states associated with anaesthesia.
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Rokos A, Mišić B, Berkun K, Duclos C, Tarnal V, Janke E, Picton P, Golmirzaie G, Basner M, Avidan MS, Kelz MB, Mashour GA, Blain-Moraes S. Distinct and Dissociable EEG Networks Are Associated With Recovery of Cognitive Function Following Anesthesia-Induced Unconsciousness. Front Hum Neurosci 2021; 15:706693. [PMID: 34594193 PMCID: PMC8477048 DOI: 10.3389/fnhum.2021.706693] [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: 05/07/2021] [Accepted: 08/20/2021] [Indexed: 01/02/2023] Open
Abstract
The temporal trajectories and neural mechanisms of recovery of cognitive function after a major perturbation of consciousness is of both clinical and neuroscientific interest. The purpose of the present study was to investigate network-level changes in functional brain connectivity associated with the recovery and return of six cognitive functions after general anesthesia. High-density electroencephalograms (EEG) were recorded from healthy volunteers undergoing a clinically relevant anesthesia protocol (propofol induction and isoflurane maintenance), and age-matched healthy controls. A battery of cognitive tests (motor praxis, visual object learning test, fractal-2-back, abstract matching, psychomotor vigilance test, digital symbol substitution test) was administered at baseline, upon recovery of consciousness (ROC), and at half-hour intervals up to 3 h following ROC. EEG networks were derived using the strength of functional connectivity measured through the weighted phase lag index (wPLI). A partial least squares (PLS) analysis was conducted to assess changes in these networks: (1) between anesthesia and control groups; (2) during the 3-h recovery from anesthesia; and (3) for each cognitive test during recovery from anesthesia. Networks were maximally perturbed upon ROC but returned to baseline 30-60 min following ROC, despite deficits in cognitive performance that persisted up to 3 h following ROC. Additionally, during recovery from anesthesia, cognitive tests conducted at the same time-point activated distinct and dissociable functional connectivity networks across all frequency bands. The results highlight that the return of cognitive function after anesthetic-induced unconsciousness is task-specific, with unique behavioral and brain network trajectories of recovery.
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Affiliation(s)
- Alexander Rokos
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Bratislav Mišić
- Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | | | - Catherine Duclos
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Vijay Tarnal
- Department of Anesthesiology, Center of Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Ellen Janke
- Department of Anesthesiology, Center of Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Paul Picton
- Department of Anesthesiology, Center of Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Goodarz Golmirzaie
- Department of Anesthesiology, Center of Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Mathias Basner
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, WA, United States
| | - Max B. Kelz
- Deparment of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - George A. Mashour
- Department of Anesthesiology, Center of Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Stefanie Blain-Moraes
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Liang Z, Ren N, Wen X, Li H, Guo H, Ma Y, Li Z, Li X. Age-dependent cross frequency coupling features from children to adults during general anesthesia. Neuroimage 2021; 240:118372. [PMID: 34245867 DOI: 10.1016/j.neuroimage.2021.118372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The frequency coupling characteristics in electroencephalogram (EEG) induced by anesthetics have been well studied in adults, but the investigation of the age-dependent cross frequency coupling features from children to adults is still lacking. METHODS We analyzed EEG signals recorded from pediatric to adult patients (n = 131), separated into six age groups: <1 year (n = 15), 1-3 years (n = 23), 3-6 years (n = 19), 6-12 years (n = 18), 12-18 years (n = 16), and 18-45 years (n = 40). Age related EEG power and cross frequency coupling analysis (phase amplitude coupling (PAC) and quadratic phase coupling) of data from maintenance of a surgical state of anesthesia (MOSSA) was conducted. Also, for patients of ages less than 6 years, we analyzed the performance of cross frequency coupling derived indices in distinguishing the states of wakefulness, MOSSA, and recovery of consciousness (ROC). RESULTS (1) During MOSSA, EEG power substantially increased with age from infancy to 3-6 years then decreased with age in the theta-gamma frequency bands. The infant group (<1 year) had the highest slow oscillation (SO) power among all age groups. (2) The distinct PAC pattern is absent in patients less than 1 year of age both in SO-alpha and delta-alpha frequency band coupling during propofol induced unconsciousness. The modulation index between delta and alpha oscillations in MOSSA increased with age. (3) Wavelet bicoherence derived indices reach their peaks in the 3-6 years group and then decrease with age growth. (4) The Diag_En index (normalized entropy of the diagonal bicoherence entries of the bicoherence matrix) performed the best at distinguishing different states for ages less than 6 years (p<0.05). CONCLUSIONS The combination of propofol induction and sevoflurane maintenance exhibited age-dependent EEG power spectra, PAC, and bicoherence, likely related to brain development. These observations suggest new rules for infant and child brain state monitoring during general anesthesia are needed.
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Affiliation(s)
- Zhenhu Liang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, China
| | - Na Ren
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, China
| | - Xin Wen
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China; Key Laboratory of Intelligent Rehabilitation and Neuromodulation of Hebei Province, Qinhuangdao 066004, China
| | - Haiwen Li
- Department of Anesthesiology, the Seventh Medical Center to Chinese PLA General Hospital, Beijing 100700, China; College of Anesthesiology, Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Hang Guo
- Department of Anesthesiology, the Seventh Medical Center to Chinese PLA General Hospital, Beijing 100700, China.
| | - Yaqun Ma
- Department of Anesthesiology, the Seventh Medical Center to Chinese PLA General Hospital, Beijing 100700, China
| | - Zheng Li
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai, Zhuhai, 519087, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, 100875, China; Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai, Zhuhai, 519087, China.
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22
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Wang L, Zhang W, Wu Y, Gao Y, Sun N, Ding H, Ren J, Yu L, Wang L, Yang F, Xi W, Yan M. Cholinergic-Induced Specific Oscillations in the Medial Prefrontal Cortex to Reverse Propofol Anesthesia. Front Neurosci 2021; 15:664410. [PMID: 34121993 PMCID: PMC8187623 DOI: 10.3389/fnins.2021.664410] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
General anesthesia is a drug-induced reversible state comprised of altered states of consciousness, amnesia, analgesia, and immobility. The medial frontal cortex (mPFC) has been discovered to modulate the level of consciousness through cholinergic and glutamatergic pathways. The optogenetic tools combined with in vivo electrophysiological recording were used to study the neural oscillatory modulation mechanisms in mPFC underlying the loss of consciousness (LOC) and emergence. We found that optogenetic activation of both cholinergic and glutamatergic neurons in the basal forebrain (BF) reversed the hypnotic effect of propofol and accelerated the emergence from propofol-induced unconsciousness. The cholinergic light-activation during propofol anesthesia increased the power in the β (12–20 Hz) and low γ (20–30 Hz) bands. Conversely, glutamatergic activation increased the power at less specific broad (1–150 Hz) bands. The cholinergic-induced alteration to specific power bands after LOC had opposite effects to that of propofol. These results suggested that the cholinergic system might act on more specific cortical neural circuits related to propofol anesthesia.
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Affiliation(s)
- Lieju Wang
- Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weijie Zhang
- Department of Anesthesiology, Interdisciplinary Institute of Neuroscience and Technology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Wu
- Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yibo Gao
- Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Na Sun
- Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hao Ding
- Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinxuan Ren
- Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lina Yu
- Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liangliang Wang
- Department of Anesthesiology, Interdisciplinary Institute of Neuroscience and Technology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fen Yang
- Department of Anesthesiology, Interdisciplinary Institute of Neuroscience and Technology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wang Xi
- Department of Anesthesiology, Interdisciplinary Institute of Neuroscience and Technology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Differential classification of states of consciousness using envelope- and phase-based functional connectivity. Neuroimage 2021; 237:118171. [PMID: 34000405 DOI: 10.1016/j.neuroimage.2021.118171] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/14/2022] Open
Abstract
The development of sophisticated computational tools to quantify changes in the brain's oscillatory dynamics across states of consciousness have included both envelope- and phase-based measures of functional connectivity (FC), but there are very few direct comparisons of these techniques using the same dataset. The goal of this study was to compare an envelope-based (i.e. Amplitude Envelope Correlation, AEC) and a phase-based (i.e. weighted Phase Lag Index, wPLI) measure of FC in their classification of states of consciousness. Nine healthy participants underwent a three-hour experimental anesthetic protocol with propofol induction and isoflurane maintenance, in which five minutes of 128-channel electroencephalography were recorded before, during, and after anesthetic-induced unconsciousness, at the following time points: Baseline; light sedation with propofol (Light Sedation); deep unconsciousness following three hours of surgical levels of anesthesia with isoflurane (Unconscious); five minutes prior to the recovery of consciousness (Pre-ROC); and three hours following the recovery of consciousness (Recovery). Support vector machine classification was applied to the source-localized EEG in the alpha (8-13 Hz) frequency band in order to investigate the ability of AEC and wPLI (separately and together) to discriminate i) the four states from Baseline; ii) Unconscious ("deep" unconsciousness) vs. Pre-ROC ("light" unconsciousness); and iii) responsiveness (Baseline, Light Sedation, Recovery) vs. unresponsiveness (Unconscious, Pre-ROC). AEC and wPLI yielded different patterns of global connectivity across states of consciousness, with AEC showing the strongest network connectivity during the Unconscious epoch, and wPLI showing the strongest connectivity during full consciousness (i.e., Baseline and Recovery). Both measures also demonstrated differential predictive contributions across participants and used different brain regions for classification. AEC showed higher classification accuracy overall, particularly for distinguishing anesthetic-induced unconsciousness from Baseline (83.7 ± 0.8%). AEC also showed stronger classification accuracy than wPLI when distinguishing Unconscious from Pre-ROC (i.e., "deep" from "light" unconsciousness) (AEC: 66.3 ± 1.2%; wPLI: 56.2 ± 1.3%), and when distinguishing between responsiveness and unresponsiveness (AEC: 76.0 ± 1.3%; wPLI: 63.6 ± 1.8%). Classification accuracy was not improved compared to AEC when both AEC and wPLI were combined. This analysis of source-localized EEG data demonstrates that envelope- and phase-based FC provide different information about states of consciousness but that, on a group level, AEC is better able to detect relative alterations in brain FC across levels of anesthetic-induced unconsciousness compared to wPLI.
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Evaluation of the density spectral array in the Wada test: report of six cases. Braz J Anesthesiol 2021; 71:288-291. [PMID: 33839177 PMCID: PMC9373226 DOI: 10.1016/j.bjane.2021.02.050] [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: 03/28/2019] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 11/20/2022] Open
Abstract
Wada test is an invasive procedure used in the preoperative evaluation for epilepsy surgery to determine language lateralization, postoperative risk of amnesia syndrome, and to assess the risk of memory deficits. It involves injection of amobarbital into internal carotid artery of the affected hemisphere followed by the healthy hemisphere to shut down brain function. We performed an observational study evaluating the density spectral array (DSA) of the bilateral bispectral index VISTA™ Monitoring System (BVMS) in 6 patients with drug-resistant epilepsy undergoing Wada test. DSA revealed the presence of bifrontal alpha waves in absence of loss of consciousness in all patients.
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Brain network motifs are markers of loss and recovery of consciousness. Sci Rep 2021; 11:3892. [PMID: 33594110 PMCID: PMC7887248 DOI: 10.1038/s41598-021-83482-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 02/03/2021] [Indexed: 01/12/2023] Open
Abstract
Motifs are patterns of inter-connections between nodes of a network, and have been investigated as building blocks of directed networks. This study explored the re-organization of 3-node motifs during loss and recovery of consciousness. Nine healthy subjects underwent a 3-h anesthetic protocol while 128-channel electroencephalography (EEG) was recorded. In the alpha (8-13 Hz) band, 5-min epochs of EEG were extracted for: Baseline; Induction; Unconscious; 30-, 10- and 5-min pre-recovery of responsiveness; 30- and 180-min post-recovery of responsiveness. We constructed a functional brain network using the weighted and directed phase lag index, on which we calculated the frequency and topology of 3-node motifs. Three motifs (motifs 1, 2 and 5) were significantly present across participants and epochs, when compared to random networks (p < 0.05). The topology of motifs 1 and 5 changed significantly between responsive and unresponsive epochs (p-values < 0.01; Kendall's W = 0.664 (motif 1) and 0.529 (motif 5)). Motif 1 was constituted of long-range chain-like connections, while motif 5 was constituted of short-range, loop-like connections. Our results suggest that anesthetic-induced unconsciousness is associated with a topological re-organization of network motifs. As motif topological re-organization may precede (motif 5) or accompany (motif 1) the return of responsiveness, motifs could contribute to the understanding of the neural correlates of consciousness.
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Validation of a new approach for distinguishing anesthetized from awake state in patients using directed transfer function applied to raw EEG. J Clin Monit Comput 2020; 35:1381-1394. [PMID: 33064257 PMCID: PMC8542550 DOI: 10.1007/s10877-020-00603-x] [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: 06/29/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
We test whether a measure based on the directed transfer function (DTF) calculated from short segments of electroencephalography (EEG) time-series can be used to monitor the state of the patients also during sevoflurane anesthesia as it can for patients undergoing propofol anesthesia. We collected and analyzed 25-channel EEG from 7 patients (3 females, ages 41–56 years) undergoing surgical anesthesia with sevoflurane, and quantified the sensor space directed connectivity for every 1-s epoch using DTF. The resulting connectivity parameters were compared to corresponding parameters from our previous study (n = 8, patients anesthetized with propofol and remifentanil, but otherwise using a similar protocol). Statistical comparisons between and within studies were done using permutation statistics, a data driven algorithm based on the DTF-parameters was employed to classify the epochs as coming from awake or anesthetized state. According to results of the permutation tests, DTF-parameter topographies were significantly different between the awake and anesthesia state at the group level. However, the topographies were not significantly different when comparing results computed from sevoflurane and propofol data, neither in the awake nor in anesthetized state. Optimizing the algorithm for simultaneously having high sensitivity and specificity in classification yielded an accuracy of 95.1% (SE = 0.96%), with sensitivity of 98.4% (SE = 0.80%) and specificity of 94.8% (SE = 0.10%). These findings indicate that the DTF changes in a similar manner when humans undergo general anesthesia caused by two distinct anesthetic agents with different molecular mechanisms of action.
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Zhang Y, Wang Y, Yan F, Song D, Wang H, Wang Q, Huang L. Influence of pre-anesthesia dynamic frontal-parietal communication on individual susceptibility to propofol. Clin Neurophysiol 2020; 131:2566-2577. [PMID: 32927212 DOI: 10.1016/j.clinph.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/16/2020] [Accepted: 07/09/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We investigated whether pre-anesthesia dynamic frontal-parietal functional connectivity was correlated with the observed interindividual differences in propofol susceptibility. METHODS Three resting-state EEG datasets were used in the study (N = 29, N = 21 and N = 20). We estimated the pre-anesthesia strength and fluctuations of frontal-parietal functional connectivity by using sliding-window analysis. Propofol served as the sole anesthetic drug, and it was administered by using a target-controlled infusion system. Individual susceptibility to propofol was assessed by the induction time, from infusion onset until a bispectral index value of 60 was reached, for subjects in dataset-1 and dataset-2, and susceptibility was assessed by behavioral data for subjects in the external dataset. RESULTS We observed in the three datasets that subjects with high susceptibility to propofol had lower pre-anesthesia strength and lower fluctuation of frontal-parietal functional connectivity than the low-susceptibility group at alpha band. Moreover, the induction time was significantly correlated with the estimated pre-anesthesia frontal-parietal functional connectivity measures. We also validated the robustness of these findings by using different window lengths in sliding-window analysis. CONCLUSIONS Subjects with weaker pre-anesthesia dynamic frontal-parietal communication are more likely to be anesthetized. SIGNIFICANCE These observations suggest that the titration procedure for propofol should consider the pre-anesthesia brain functional state.
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Affiliation(s)
- Yun Zhang
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Fei Yan
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dawei Song
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haidong Wang
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Qiang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, Xi'an, China.
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28
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Reimann HM, Niendorf T. The (Un)Conscious Mouse as a Model for Human Brain Functions: Key Principles of Anesthesia and Their Impact on Translational Neuroimaging. Front Syst Neurosci 2020; 14:8. [PMID: 32508601 PMCID: PMC7248373 DOI: 10.3389/fnsys.2020.00008] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
In recent years, technical and procedural advances have brought functional magnetic resonance imaging (fMRI) to the field of murine neuroscience. Due to its unique capacity to measure functional activity non-invasively, across the entire brain, fMRI allows for the direct comparison of large-scale murine and human brain functions. This opens an avenue for bidirectional translational strategies to address fundamental questions ranging from neurological disorders to the nature of consciousness. The key challenges of murine fMRI are: (1) to generate and maintain functional brain states that approximate those of calm and relaxed human volunteers, while (2) preserving neurovascular coupling and physiological baseline conditions. Low-dose anesthetic protocols are commonly applied in murine functional brain studies to prevent stress and facilitate a calm and relaxed condition among animals. Yet, current mono-anesthesia has been shown to impair neural transmission and hemodynamic integrity. By linking the current state of murine electrophysiology, Ca2+ imaging and fMRI of anesthetic effects to findings from human studies, this systematic review proposes general principles to design, apply and monitor anesthetic protocols in a more sophisticated way. The further development of balanced multimodal anesthesia, combining two or more drugs with complementary modes of action helps to shape and maintain specific brain states and relevant aspects of murine physiology. Functional connectivity and its dynamic repertoire as assessed by fMRI can be used to make inferences about cortical states and provide additional information about whole-brain functional dynamics. Based on this, a simple and comprehensive functional neurosignature pattern can be determined for use in defining brain states and anesthetic depth in rest and in response to stimuli. Such a signature can be evaluated and shared between labs to indicate the brain state of a mouse during experiments, an important step toward translating findings across species.
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Affiliation(s)
- Henning M. Reimann
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Germany
- Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
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Banks MI, Krause BM, Endemann CM, Campbell DI, Kovach CK, Dyken ME, Kawasaki H, Nourski KV. Cortical functional connectivity indexes arousal state during sleep and anesthesia. Neuroimage 2020; 211:116627. [PMID: 32045640 DOI: 10.1016/j.neuroimage.2020.116627] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/28/2020] [Accepted: 02/07/2020] [Indexed: 02/06/2023] Open
Abstract
Disruption of cortical connectivity likely contributes to loss of consciousness (LOC) during both sleep and general anesthesia, but the degree of overlap in the underlying mechanisms is unclear. Both sleep and anesthesia comprise states of varying levels of arousal and consciousness, including states of largely maintained conscious experience (sleep: N1, REM; anesthesia: sedated but responsive) as well as states of substantially reduced conscious experience (sleep: N2/N3; anesthesia: unresponsive). Here, we tested the hypotheses that (1) cortical connectivity will exhibit clear changes when transitioning into states of reduced consciousness, and (2) these changes will be similar for arousal states of comparable levels of consciousness during sleep and anesthesia. Using intracranial recordings from five adult neurosurgical patients, we compared resting state cortical functional connectivity (as measured by weighted phase lag index, wPLI) in the same subjects across arousal states during natural sleep [wake (WS), N1, N2, N3, REM] and propofol anesthesia [pre-drug wake (WA), sedated/responsive (S), and unresponsive (U)]. Analysis of alpha-band connectivity indicated a transition boundary distinguishing states of maintained and reduced conscious experience in both sleep and anesthesia. In wake states WS and WA, alpha-band wPLI within the temporal lobe was dominant. This pattern was largely unchanged in N1, REM, and S. Transitions into states of reduced consciousness N2, N3, and U were characterized by dramatic changes in connectivity, with dominant connections shifting to prefrontal cortex. Secondary analyses indicated similarities in reorganization of cortical connectivity in sleep and anesthesia. Shifts from temporal to frontal cortical connectivity may reflect impaired sensory processing in states of reduced consciousness. The data indicate that functional connectivity can serve as a biomarker of arousal state and suggest common mechanisms of LOC in sleep and anesthesia.
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Affiliation(s)
- Matthew I Banks
- Department of Anesthesiology, University of Wisconsin, Madison, WI, 52704, USA; Department of Neuroscience, University of Wisconsin, Madison, WI, 53706, USA.
| | - Bryan M Krause
- Department of Anesthesiology, University of Wisconsin, Madison, WI, 52704, USA
| | | | - Declan I Campbell
- Department of Anesthesiology, University of Wisconsin, Madison, WI, 52704, USA
| | | | - Mark Eric Dyken
- Department of Neurology, The University of Iowa, Iowa City, IA, 52242, USA
| | - Hiroto Kawasaki
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, 52242, USA
| | - Kirill V Nourski
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, 52242, USA; Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, 52242, USA
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30
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Abstract
Integrated information theory (IIT) describes consciousness as information integrated across highly differentiated but irreducible constituent parts in a system. However, in a complex dynamic system such as the brain, the optimal conditions for large integrated information systems have not been elucidated. In this study, we hypothesized that network criticality, a balanced state between a large variation in functional network configuration and a large constraint on structural network configuration, may be the basis of the emergence of a large Φ¯, a surrogate of integrated information. We also hypothesized that as consciousness diminishes, the brain loses network criticality and Φ¯ decreases. We tested these hypotheses with a large-scale brain network model and high-density electroencephalography (EEG) acquired during various levels of human consciousness under general anesthesia. In the modeling study, maximal criticality coincided with maximal Φ¯. The EEG study demonstrated an explicit relationship between Φ¯, criticality, and level of consciousness. The conscious resting state showed the largest Φ¯ and criticality, whereas the balance between variation and constraint in the brain network broke down as the response rate dwindled. The results suggest network criticality as a necessary condition of a large Φ¯ in the human brain.
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31
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Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Recent studies of anesthetic-induced unconsciousness in healthy volunteers have focused on functional brain connectivity patterns, but the protocols rarely parallel the depth and duration of surgical anesthesia. Furthermore, it is unknown whether there is a single functional connectivity pattern that correlates with general anesthesia for the duration of prolonged anesthetic exposure.
Methods
The authors analyzed electroencephalographic data in 30 healthy participants who underwent induction of anesthesia with propofol followed by 3 h of isoflurane anesthesia at age-adjusted 1.3 minimum alveolar concentration. Functional connectivity was assessed by frequency-resolved weighted phase lag index between frontal and parietal channels and between prefrontal and frontal channels, which were classified into a discrete set of states through k-means cluster analysis. Temporal dynamics were evaluated by the occurrence rate and dwell time distribution for each state as well as the transition probabilities between states.
Results
Burst suppression was present, with mean suppression ratio reducing from 44.8 ± 32.3% to 14.0 ± 20.2% (mean ± SD) during isoflurane anesthesia (P < 0.001). Aside from burst suppression, eight connectivity states were classified by optimizing the reproducibility of clustering solutions, with each characterized by distinct properties. The temporal progression of dominant states revealed a successive shifting trajectory from the state associated with alpha frontal-parietal connectivity to those associated with delta and alpha prefrontal-frontal connectivity during induction, which was reversed during emergence. Cortical connectivity was dynamic during maintenance period, and it was more probable to remain in the same state (82.0 ± 8.3%) than to switch to a different state (P < 0.001). However, transitions to other states were structured, i.e., occurred more frequently than expected by chance.
Conclusions
Anesthesia-induced alterations of functional connectivity are dynamic despite the stable and prolonged administration of isoflurane, in the absence of any noxious stimuli. Changes in connectivity over time will likely yield more information as a marker or mechanism of surgical anesthesia than any single pattern.
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Beekoo D, Yuan K, Dai S, Chen L, Di M, Wang S, Liu H, ShangGuan W. Analyzing Electroencephalography (EEG) Waves Provides a Reliable Tool to Assess the Depth of Sevoflurane Anesthesia in Pediatric Patients. Med Sci Monit 2019; 25:4035-4040. [PMID: 31146277 PMCID: PMC6559006 DOI: 10.12659/msm.915640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Studies have reported that BIS is unreliable in children because its algorithm provides misleading information about the actual depth of anesthesia. Raw EEG analysis provides direct neurophysiologic measurement of cerebral activity. The relationship between age and EEG has rarely been reported, thus the aim of the present study was to compare raw electroencephalography (EEG) among different age groups of surgical patients under general anesthesia with 1.0 MAC sevoflurane. MATERIAL AND METHODS We enrolled 135 patients aged 0-80 years old (ASA physical status I or II) undergoing surgery, who were divided into 6 groups: 1-12 months old (group 1), 1-3 years old (group 2), 3-6 years old (group 3), 6-18 years old (group 4), 18-65 years old (group 5), and 65-80 years old (group 6). Different raw EEG waves (alpha, delta, and theta) were compared for all subjects. RESULTS The BIS values in groups 1 to 6 were 52.2±12.7, 55.0±8.0, 44.5±7.3, 43.8±7.3, 44.2±6.2, and 49.1±6.2 respectively. Compared with groups 1 and 2 (52.2±12.7, 55.0±8.0), BIS values of groups 3, 4, and 5 (44.5±7.3, 43.8±7.3, 44.2±6.2, respectively) were lower (P<0.05). Theta frequency was observed in the 6 groups. The EEG frequencies in groups 1 to 6 were 6.0 (5.5-6.0), 6.0 (5.5-6.0), 6.0 (5.5-6.0), 6.0 (6.0-7.0), 6.3 (6.0-7.0), and 6.0 (5.1-6.0), respectively. Compared with group 6, EEG frequencies in groups 4 and 5 were higher (P<0.05). BIS value was significantly correlated with EEG frequency (R²=0.063, P<0.01). CONCLUSIONS Analyzing raw EEG waves provides more accurate judgement of depth of anesthesia, especially in pediatric cases in which monitors often provide misleading values.
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Affiliation(s)
- Deepti Beekoo
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Kaiming Yuan
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Shuyang Dai
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Lifen Chen
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Meiqin Di
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Sicong Wang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Huacheng Liu
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Wangning ShangGuan
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
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Lee M, Baird B, Gosseries O, Nieminen JO, Boly M, Postle BR, Tononi G, Lee SW. Connectivity differences between consciousness and unconsciousness in non-rapid eye movement sleep: a TMS-EEG study. Sci Rep 2019; 9:5175. [PMID: 30914674 PMCID: PMC6435892 DOI: 10.1038/s41598-019-41274-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/05/2019] [Indexed: 01/27/2023] Open
Abstract
The neuronal connectivity patterns that differentiate consciousness from unconsciousness remain unclear. Previous studies have demonstrated that effective connectivity, as assessed by transcranial magnetic stimulation combined with electroencephalography (TMS-EEG), breaks down during the loss of consciousness. This study investigated changes in EEG connectivity associated with consciousness during non-rapid eye movement (NREM) sleep following parietal TMS. Compared with unconsciousness, conscious experiences during NREM sleep were associated with reduced phase-locking at low frequencies (<4 Hz). Transitivity and clustering coefficient in the delta and theta bands were also significantly lower during consciousness compared to unconsciousness, with differences in the clustering coefficient observed in scalp electrodes over parietal-occipital regions. There were no significant differences in Granger-causality patterns in frontal-to-parietal or parietal-to-frontal connectivity between reported unconsciousness and reported consciousness. Together these results suggest that alterations in spectral and spatial characteristics of network properties in posterior brain areas, in particular decreased local (segregated) connectivity at low frequencies, is a potential indicator of consciousness during sleep.
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Affiliation(s)
- Minji Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Benjamin Baird
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Olivia Gosseries
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
- Department of Psychology, University of Wisconsin, Madison, USA
- Coma Science Group, GIGA-Consciousness & Neurology Department, University and University Hospital of Liege, Liege, Belgium
| | - Jaakko O Nieminen
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Melanie Boly
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
- Department of Neurology, University of Wisconsin, Madison, WI, USA
| | - Bradley R Postle
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
- Department of Psychology, University of Wisconsin, Madison, USA
| | - Giulio Tononi
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin, Madison, USA
| | - Seong-Whan Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea.
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Differentiating Drug-related and State-related Effects of Dexmedetomidine and Propofol on the Electroencephalogram. Anesthesiology 2019; 129:22-36. [PMID: 29642080 DOI: 10.1097/aln.0000000000002192] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Differentiating drug-related changes and state-related changes on the electroencephalogram during anesthetic-induced unconsciousness has remained a challenge. To distinguish these, we designed a rigorous experimental protocol with two drugs known to have distinct molecular mechanisms of action. We hypothesized that drug- and state-related changes can be separated. METHODS Forty-seven healthy participants were randomized to receive dexmedetomidine (n = 23) or propofol (n = 24) as target-controlled infusions until loss of responsiveness. Then, an attempt was made to arouse the participant to regain responsiveness while keeping the drug infusion constant. Finally, the concentration was increased 1.5-fold to achieve presumable loss of consciousness. We conducted statistical comparisons between the drugs and different states of consciousness for spectral bandwidths, and observed how drug-induced electroencephalogram patterns reversed upon awakening. Cross-frequency coupling was also analyzed between slow-wave phase and alpha power. RESULTS Eighteen (78%) and 10 (42%) subjects were arousable during the constant drug infusion in the dexmedetomidine and propofol groups, respectively (P = 0.011 between the drugs). Corresponding with deepening anesthetic level, slow-wave power increased, and a state-dependent alpha anteriorization was detected with both drugs, especially with propofol. The slow-wave and frontal alpha activities were momentarily disrupted as the subjects regained responsiveness at awakening. Negative phase-amplitude coupling before and during loss of responsiveness frontally and positive coupling during the highest drug concentration posteriorly were observed in the propofol but not in the dexmedetomidine group. CONCLUSIONS Electroencephalogram effects of dexmedetomidine and propofol are strongly drug- and state-dependent. Changes in slow-wave and alpha activity seemed to best detect different states of consciousness.
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Palanca BJA, Avidan MS, Mashour GA. Human neural correlates of sevoflurane-induced unconsciousness. Br J Anaesth 2019; 119:573-582. [PMID: 29121298 DOI: 10.1093/bja/aex244] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 01/01/2023] Open
Abstract
Sevoflurane, a volatile anaesthetic agent well-tolerated for inhalation induction, provides a useful opportunity to elucidate the processes whereby halogenated ethers disrupt consciousness and cognition. Multiple molecular targets of sevoflurane have been identified, complementing imaging and electrophysiologic markers for the mechanistically obscure progression from wakefulness to unconsciousness. Recent investigations have more precisely detailed scalp EEG activity during this transition, with practical clinical implications. The relative timing of scalp potentials in frontal and parietal EEG signals suggests that sevoflurane might perturb the propagation of neural information between underlying cortical regions. Spatially distributed brain activity during general anaesthesia has been further investigated with positron emission tomography (PET) and resting-state functional magnetic resonance imaging (fMRI). Combined EEG and PET investigations have identified changes in cerebral blood flow and metabolic activity in frontal, parietal, and thalamic regions during sevoflurane-induced loss of consciousness. More recent fMRI investigations have revealed that sevoflurane weakens the signal correlations among brain regions that share functionality and specialization during wakefulness. In particular, two such resting-state networks have shown progressive breakdown in intracortical and thalamocortical connectivity with increasing anaesthetic concentrations: the Default Mode Network (introspection and episodic memory) and the Ventral Attention Network (orienting of attention to salient feature of the external world). These data support the hypotheses that perturbations in temporally correlated activity across brain regions contribute to the transition between states of sevoflurane sedation and general anaesthesia.
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Affiliation(s)
- B J A Palanca
- Division of Biology and Biomedical Sciences.,Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - M S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - G A Mashour
- Department of Anesthesiology, Center for Consciousness Science and Neuroscience Graduate Program, University of Michigan Medical School, Ann Arbor, MI, USA
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36
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Mashour GA, Avidan MS. Black swans: challenging the relationship of anaesthetic-induced unconsciousness and electroencephalographic oscillations in the frontal cortex. Br J Anaesth 2018; 119:563-565. [PMID: 29121275 DOI: 10.1093/bja/aex207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G A Mashour
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - M S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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37
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Palanca BJA, Wildes TS, Ju YS, Ching S, Avidan MS. Electroencephalography and delirium in the postoperative period. Br J Anaesth 2018; 119:294-307. [PMID: 28854540 DOI: 10.1093/bja/aew475] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Delirium commonly manifests in the postoperative period as a clinical syndrome resulting from acute brain dysfunction or encephalopathy. Delirium is characterized by acute and often fluctuating changes in attention and cognition. Emergence delirium typically presents and resolves within minutes to hours after termination of general anaesthesia. Postoperative delirium hours to days after an invasive procedure can herald poor outcomes. Easily recognized when patients are hyperactive or agitated, delirium often evades diagnosis as it most frequently presents with hypoactivity and somnolence. EEG offers objective measurements to complement clinical assessment of this complex fluctuating disorder. Although EEG features of delirium in the postoperative period remain incompletely characterized, a shift of EEG power into low frequencies is a typical finding shared among encephalopathies that manifest with delirium. In aggregate, existing data suggest that serial or continuous EEG in the postoperative period facilitates monitoring of delirium development and severity and assists in detecting epileptic aetiologies. Future studies are needed to clarify the precise EEG features that can reliably predict or diagnose delirium in the postoperative period, and to provide mechanistic insights into this pathologically diverse neurological disorder.
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Affiliation(s)
| | | | | | - S Ching
- Department of Electrical and Systems Engineering.,Department of Biomedical Engineering
| | - M S Avidan
- Department of Anesthesiology.,Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine in St Louis, St Louis, MO, USA
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Kim H, Moon JY, Mashour GA, Lee U. Mechanisms of hysteresis in human brain networks during transitions of consciousness and unconsciousness: Theoretical principles and empirical evidence. PLoS Comput Biol 2018; 14:e1006424. [PMID: 30161118 PMCID: PMC6135517 DOI: 10.1371/journal.pcbi.1006424] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/12/2018] [Accepted: 08/08/2018] [Indexed: 11/18/2022] Open
Abstract
Hysteresis, the discrepancy in forward and reverse pathways of state transitions, is observed during changing levels of consciousness. Identifying the underlying mechanism of hysteresis phenomena in the brain will enhance the ability to understand, monitor, and control state transitions related to consciousness. We hypothesized that hysteresis in brain networks shares the same underlying mechanism of hysteresis as other biological and non-biological networks. In particular, we hypothesized that the principle of explosive synchronization, which can mediate abrupt state transitions, would be critical to explaining hysteresis in the brain during conscious state transitions. We analyzed high-density electroencephalogram (EEG) that was acquired in healthy human volunteers during conscious state transitions induced by the general anesthetics sevoflurane or ketamine. We developed a novel method to monitor the temporal evolution of EEG networks in a parameter space, which consists of the strength and topography of EEG-based networks. Furthermore, we studied conditions of explosive synchronization in anatomically informed human brain network models. We identified hysteresis in the trajectory of functional brain networks during state transitions. The model study and empirical data analysis explained various hysteresis phenomena during the loss and recovery of consciousness in a principled way: (1) more potent anesthetics induce a larger hysteresis; (2) a larger range of EEG frequencies facilitates transitions into unconsciousness and impedes the return of consciousness; (3) hysteresis of connectivity is larger than that of EEG power; and (4) the structure and strength of functional brain networks reconfigure differently during the loss vs. recovery of consciousness. We conclude that the hysteresis phenomena observed during the loss and recovery of consciousness are generic network features. Furthermore, the state transitions are grounded in the same principle as state transitions in complex non-biological networks, especially during perturbation. These findings suggest the possibility of predicting and modulating hysteresis of conscious state transitions in large-scale brain networks. Hysteresis, characterized by distinct forward and reverse phase transitions, is ubiquitous in nature. For example, there are distinct temperatures for water freezing and ice melting. Similarly, it has been found that state transitions related to consciousness exhibit hysteresis. In particular, the concentration of general anesthetics required to achieve loss of consciousness is significantly higher than the concentration at which consciousness is regained. However, it is unknown whether this is trivially reducible to the pharmacology of these drugs or if it is something related to brain function itself. In this study, we took a novel, network-based approach and hypothesized that the hysteresis observed during anesthetic state transitions shares the same underlying mechanism as that observed in non-biological networks. Our computational modeling, analytic study, and high-density human EEG analysis suggest that various hysteresis phenomena during loss and recovery of consciousness can be explained in principled ways by generic network features. Identifying these network mechanisms of hysteresis in the brain also provides a unified framework for understanding the radically different conscious state transitions associated with sleep, anesthesia, and disorders of consciousness.
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Affiliation(s)
- Hyoungkyu Kim
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Joon-Young Moon
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - George A. Mashour
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - UnCheol Lee
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States of America
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, United States of America
- * E-mail:
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39
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Sanders RD, Banks MI, Darracq M, Moran R, Sleigh J, Gosseries O, Bonhomme V, Brichant JF, Rosanova M, Raz A, Tononi G, Massimini M, Laureys S, Boly M. Propofol-induced unresponsiveness is associated with impaired feedforward connectivity in cortical hierarchy. Br J Anaesth 2018; 121:1084-1096. [PMID: 30336853 DOI: 10.1016/j.bja.2018.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Impaired consciousness has been associated with impaired cortical signal propagation after transcranial magnetic stimulation (TMS). We hypothesised that the reduced current propagation under propofol-induced unresponsiveness is associated with changes in both feedforward and feedback connectivity across the cortical hierarchy. METHODS Eight subjects underwent left occipital TMS coupled with high-density EEG recordings during wakefulness and propofol-induced unconsciousness. Spectral analysis was applied to responses recorded from sensors overlying six hierarchical cortical sources involved in visual processing. Dynamic causal modelling (DCM) of induced time-frequency responses and evoked response potentials were used to investigate propofol's effects on connectivity between regions. RESULTS Sensor space analysis demonstrated that propofol reduced both induced and evoked power after TMS in occipital, parietal, and frontal electrodes. Bayesian model selection supported a DCM with hierarchical feedforward and feedback connections. DCM of induced EEG responses revealed that the primary effect of propofol was impaired feedforward responses in cross-frequency theta/alpha-gamma coupling and within frequency theta coupling (F contrast, family-wise error corrected P<0.05). An exploratory analysis (thresholded at uncorrected P<0.001) also suggested that propofol impaired feedforward and feedback beta band coupling. Post hoc analyses showed impairments in all feedforward connections and one feedback connection from parietal to occipital cortex. DCM of the evoked response potential showed impaired feedforward connectivity between left-sided occipital and parietal cortex (T contrast P=0.004, Bonferroni corrected). CONCLUSIONS Propofol-induced loss of consciousness is associated with impaired hierarchical feedforward connectivity assessed by EEG after occipital TMS.
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Affiliation(s)
- R D Sanders
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
| | - M I Banks
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - M Darracq
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - R Moran
- Faculty of Engineering, University of Bristol, Bristol, UK
| | - J Sleigh
- Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
| | - O Gosseries
- Coma Science Group, GIGA-consciousness, University of Liège, Liège, Belgium
| | - V Bonhomme
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anestheisa and ICM, CHU Liège, Liège, Belgium; University Department of Anesthesia and ICM, CHR Citadelle, Liège, Belgium
| | - J F Brichant
- Department of Anestheisa and ICM, CHU Liège, Liège, Belgium
| | - M Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - A Raz
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; Rambam Healthcare Campus, Haifa, Israel
| | - G Tononi
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - M Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - S Laureys
- Coma Science Group, GIGA-consciousness, University of Liège, Liège, Belgium; Department of Neurology, CHU Liège, Liège, Belgium
| | - M Boly
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA; Department of Neurology, University of Wisconsin, Madison, WI, USA
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40
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Sugasawa Y, Fukuda M, Ando N, Inoue R, Nakauchi S, Miura M, Nishimura K. Modulation of hyperpolarization-activated cation current I h by volatile anesthetic sevoflurane in the mouse striatum during postnatal development. Neurosci Res 2018; 132:8-16. [DOI: 10.1016/j.neures.2017.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 09/18/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
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41
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Xi C, Sun S, Pan C, Ji F, Cui X, Li T. Different effects of propofol and dexmedetomidine sedation on electroencephalogram patterns: Wakefulness, moderate sedation, deep sedation and recovery. PLoS One 2018; 13:e0199120. [PMID: 29920532 PMCID: PMC6007908 DOI: 10.1371/journal.pone.0199120] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/31/2018] [Indexed: 02/08/2023] Open
Abstract
Sedation induces changes in electroencephalography (EEG) dynamics. However, the distinct EEG dynamic characteristics at comparable sedation levels have not been well studied, resulting in potential interpretation errors in EEG monitoring during sedation. We aimed to analyze the EEG dynamics of dexmedetomidine and propofol at comparable sedation levels and to explore EEG changes with increased sedation levels for each agent. We measured the Bispectral Index (BIS) and 20-channel EEG under dexmedetomidine and propofol sedation from wakefulness, moderate sedation, and deep sedation to recovery in healthy volunteers (n = 10) in a randomized, 2-day, crossover study. Observer's Assessment of Alertness and Sedation (OAA/S) score was used to assess sedation levels. Despite similar changes in increased delta oscillations, multiple differences in the EEG spatiotemporal dynamics were observed between these two agents. During moderate sedation, both dexmedetomidine and propofol induced increased spindle power; however, dexmedetomidine decreased the global alpha/beta/gamma power, whereas propofol decreased the alpha power in the occipital area and increased the global spindle/beta/gamma power. During deep sedation, dexmedetomidine was associated with increased fronto-central spindle power and decreased global alpha/beta/gamma power, but propofol was associated with increased theta/alpha/spindle/beta power, which was maximized in the frontal area. The transition of topographic alpha/spindle/beta power distribution from moderate sedation to deep sedation completely differed between these two agents. Our study demonstrated that there was a distinct hierarchy of EEG changes with increased sedation depths by propofol and dexmedetomidine. Differences in EEG dynamics at the same sedation level might account for differences in the BIS value and reflect the different sedation mechanisms. EEG-based clinical sedation monitoring should consider the effect of drug types on EEG dynamics.
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Affiliation(s)
- Chunhua Xi
- Department of Anesthesiology, Beijing Tongren Hospital affiliated to Capital Medical University, Beijing, China
| | - Shiyue Sun
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Chuxiong Pan
- Department of Anesthesiology, Beijing Tongren Hospital affiliated to Capital Medical University, Beijing, China
| | - Fang Ji
- Department of Anesthesiology, Beijing Tongren Hospital affiliated to Capital Medical University, Beijing, China
| | - Xu Cui
- Department of Anesthesiology, Beijing Tongren Hospital affiliated to Capital Medical University, Beijing, China
| | - Tianzuo Li
- Department of Anesthesiology, Beijing Shijitan Hospital affiliated to Capital Medical University, Beijing, China
- * E-mail:
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42
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Thiery T, Lajnef T, Combrisson E, Dehgan A, Rainville P, Mashour GA, Blain-Moraes S, Jerbi K. Long-range temporal correlations in the brain distinguish conscious wakefulness from induced unconsciousness. Neuroimage 2018; 179:30-39. [PMID: 29885482 DOI: 10.1016/j.neuroimage.2018.05.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/18/2018] [Accepted: 05/29/2018] [Indexed: 12/20/2022] Open
Abstract
Rhythmic neuronal synchronization across large-scale networks is thought to play a key role in the regulation of conscious states. Changes in neuronal oscillation amplitude across states of consciousness have been widely reported, but little is known about possible changes in the temporal dynamics of these oscillations. The temporal structure of brain oscillations may provide novel insights into the neural mechanisms underlying consciousness. To address this question, we examined long-range temporal correlations (LRTC) of EEG oscillation amplitudes recorded during both wakefulness and anesthetic-induced unconsciousness. Importantly, the time-varying EEG oscillation envelopes were assessed over the course of a sevoflurane sedation protocol during which the participants alternated between states of consciousness and unconsciousness. Both spectral power and LRTC in oscillation amplitude were computed across multiple frequency bands. State-dependent differences in these features were assessed using non-parametric tests and supervised machine learning. We found that periods of unconsciousness were associated with increases in LRTC in beta (15-30Hz) amplitude over frontocentral channels and with a suppression of alpha (8-13Hz) amplitude over occipitoparietal electrodes. Moreover, classifiers trained to predict states of consciousness on single epochs demonstrated that the combination of beta LRTC with alpha amplitude provided the highest classification accuracy (above 80%). These results suggest that loss of consciousness is accompanied by an augmentation of temporal persistence in neuronal oscillation amplitude, which may reflect an increase in regularity and a decrease in network repertoire compared to the brain's activity during resting-state consciousness.
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Affiliation(s)
- Thomas Thiery
- Psychology Department, University of Montreal, QC, Canada.
| | - Tarek Lajnef
- Psychology Department, University of Montreal, QC, Canada
| | - Etienne Combrisson
- Psychology Department, University of Montreal, QC, Canada; Center of Research and Innovation in Sport, Mental Processes and Motor Performance, University Claude Bernard Lyon I, University of Lyon, Villeurbanne, France; Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, UMR 5292, University of Lyon, Villeurbanne, France
| | - Arthur Dehgan
- Psychology Department, University of Montreal, QC, Canada
| | | | - George A Mashour
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, USA
| | - Stefanie Blain-Moraes
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Karim Jerbi
- Psychology Department, University of Montreal, QC, Canada
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43
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Cornelissen L, Kim SE, Lee JM, Brown EN, Purdon PL, Berde CB. Electroencephalographic markers of brain development during sevoflurane anaesthesia in children up to 3 years old. Br J Anaesth 2018; 120:1274-1286. [PMID: 29793594 PMCID: PMC6617966 DOI: 10.1016/j.bja.2018.01.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND General anaesthetics generate spatially defined brain oscillations in the EEG that relate fundamentally to neural-circuit architecture. Few studies detailing the neural-circuit activity of general anaesthesia in children have been described. The study aim was to identify age-related changes in EEG characteristics that mirror different stages of early human brain development during sevoflurane anaesthesia. METHODS Multichannel EEG recordings were performed in 91 children aged 0-3 yr undergoing elective surgery. We mapped spatial power and coherence over the frontal, parietal, temporal, and occipital cortices during maintenance anaesthesia. RESULTS During sevoflurane exposure: (i) slow-delta (0.1-4 Hz) oscillations were present in all ages, (ii) theta (4-8 Hz) and alpha (8-12 Hz) oscillations emerge by ∼4 months, (iii) alpha oscillations increased in power from 4 to 10 months, (iv) frontal alpha-oscillation predominance emerged at ∼6 months, (v) frontal slow oscillations were coherent from birth until 6 months, and (vi) frontal alpha oscillations became coherent ∼10 months and persisted in older ages. CONCLUSIONS Key developmental milestones in the maturation of the thalamo-cortical circuitry likely generate changes in EEG patterns in infants undergoing sevoflurane general anaesthesia. Characterisation of anaesthesia-induced EEG oscillations in children demonstrates the importance of developing age-dependent strategies to monitor properly the brain states of children receiving general anaesthesia. These data have the potential to guide future studies investigating neurodevelopmental pathologies involving altered excitatory-inhibitory balance, such as epilepsy or Rett syndrome.
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Affiliation(s)
- L Cornelissen
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
| | - S E Kim
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J M Lee
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - E N Brown
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - P L Purdon
- Department of Anaesthesia, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - C B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
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Abstract
Electroencephalography (EEG) has a long history in neuroscience starting with its original description in humans by Hans Berger in 1929 (Berger, 1932). Investigations of EEG under anesthesia started soon after in the mid-1930s (Gibbs, 1937). No single methodology paper can credibly cover all of the issues relating to this rich field. The purpose of this chapter is to introduce some caveats that complicate and inform analysis of the EEG. Special emphasis will be given to common issues such as choice of reference electrode, filtering, artifact rejection, and spectral analysis. We will specifically emphasize high-density EEG recordings that have become the norm due to technological improvement in electrode and data acquisition design methods. In the last section we will discuss some applications of EEG analysis techniques to the study of the effects of anesthetics on the nervous system.
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Affiliation(s)
- Alex Proekt
- Perelman School of Medicine, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, United States.
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45
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Ye D, Ewing A. On the Action of General Anesthetics on Cellular Function: Barbiturate Alters the Exocytosis of Catecholamines in a Model Cell System. Chemphyschem 2018; 19:1173-1179. [PMID: 29356266 DOI: 10.1002/cphc.201701255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/18/2018] [Indexed: 11/08/2022]
Abstract
General anesthetics are essential in many areas, however, the cellular mechanisms of anesthetic-induced amnesia and unconsciousness are incompletely understood. Exocytosis is the main mechanism of signal transduction and neuronal communication through the release of chemical transmitters from vesicles to the extracellular environment. Here, we use disk electrodes placed on top of PC12 cells to show that treatment with barbiturate induces fewer molecules released during exocytosis and changes the event dynamics perhaps by inducing a less stable fusion pore that is prone to close faster during partial exocytosis. Larger events are essentially abolished. However, use of intracellular vesicle impact electrochemical cytometry using a nano-tip electrode inserted into a cell shows that the distribution of vesicle transmitter content does not change after barbiturate treatment. This indicates that barbiturate selectively alters the pore size of larger events or perhaps differentially between types of vesicles. Alteration of exocytosis in this manner could be linked to the effects of general anesthetics on memory loss.
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Affiliation(s)
- Daixin Ye
- Department of Chemistry and Molecular Biology, University of Gothenburg, Kemivägen 10, 41296, Gothenburg, Sweden
| | - Andrew Ewing
- Department of Chemistry and Molecular Biology, University of Gothenburg, Kemivägen 10, 41296, Gothenburg, Sweden.,Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Kemivägen 10, 41296, Gothenburg, Sweden
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46
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Network Properties in Transitions of Consciousness during Propofol-induced Sedation. Sci Rep 2017; 7:16791. [PMID: 29196672 PMCID: PMC5711919 DOI: 10.1038/s41598-017-15082-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/20/2017] [Indexed: 01/10/2023] Open
Abstract
Reliable electroencephalography (EEG) signatures of transitions between consciousness and unconsciousness under anaesthesia have not yet been identified. Herein we examined network changes using graph theoretical analysis of high-density EEG during patient-titrated propofol-induced sedation. Responsiveness was used as a surrogate for consciousness. We divided the data into five states: baseline, transition into unresponsiveness, unresponsiveness, transition into responsiveness, and recovery. Power spectral analysis showed that delta power increased from responsiveness to unresponsiveness. In unresponsiveness, delta waves propagated from frontal to parietal regions as a traveling wave. Local increases in delta connectivity were evident in parietal but not frontal regions. Graph theory analysis showed that increased local efficiency could differentiate the levels of responsiveness. Interestingly, during transitions of responsive states, increased beta connectivity was noted relative to consciousness and unconsciousness, again with increased local efficiency. Abrupt network changes are evident in the transitions in responsiveness, with increased beta band power/connectivity marking transitions between responsive states, while the delta power/connectivity changes were consistent with the fading of consciousness using its surrogate responsiveness. These results provide novel insights into the neural correlates of these behavioural transitions and EEG signatures for monitoring the levels of consciousness under sedation.
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47
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Northoff G. “Paradox of slow frequencies” – Are slow frequencies in upper cortical layers a neural predisposition of the level/state of consciousness (NPC)? Conscious Cogn 2017; 54:20-35. [DOI: 10.1016/j.concog.2017.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/05/2017] [Accepted: 03/13/2017] [Indexed: 01/01/2023]
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Neurophysiologic Correlates of Ketamine Sedation and Anesthesia: A High-density Electroencephalography Study in Healthy Volunteers. Anesthesiology 2017; 127:58-69. [PMID: 28486269 DOI: 10.1097/aln.0000000000001671] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous studies have demonstrated inconsistent neurophysiologic effects of ketamine, although discrepant findings might relate to differences in doses studied, brain regions analyzed, coadministration of other anesthetic medications, and resolution of the electroencephalograph. The objective of this study was to characterize the dose-dependent effects of ketamine on cortical oscillations and functional connectivity. METHODS Ten healthy human volunteers were recruited for study participation. The data were recorded using a 128-channel electroencephalograph during baseline consciousness, subanesthetic dosing (0.5 mg/kg over 40 min), anesthetic dosing (1.5 mg/kg bolus), and recovery. No other sedative or anesthetic medications were administered. Spectrograms, topomaps, and functional connectivity (weighted and directed phase lag index) were computed and analyzed. RESULTS Frontal theta bandwidth power increased most dramatically during ketamine anesthesia (mean power ± SD, 4.25 ± 1.90 dB) compared to the baseline (0.64 ± 0.28 dB), subanesthetic (0.60 ± 0.30 dB), and recovery (0.68 ± 0.41 dB) states; P < 0.001. Gamma power also increased during ketamine anesthesia. Weighted phase lag index demonstrated theta phase locking within anterior regions (0.2349 ± 0.1170, P < 0.001) and between anterior and posterior regions (0.2159 ± 0.1538, P < 0.01) during ketamine anesthesia. Alpha power gradually decreased with subanesthetic ketamine, and anterior-to-posterior directed connectivity was maximally reduced (0.0282 ± 0.0772) during ketamine anesthesia compared to all other states (P < 0.05). CONCLUSIONS Ketamine anesthesia correlates most clearly with distinct changes in the theta bandwidth, including increased power and functional connectivity. Anterior-to-posterior connectivity in the alpha bandwidth becomes maximally depressed with anesthetic ketamine administration, suggesting a dose-dependent effect.
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Guidera JA, Taylor NE, Lee JT, Vlasov KY, Pei J, Stephen EP, Mayo JP, Brown EN, Solt K. Sevoflurane Induces Coherent Slow-Delta Oscillations in Rats. Front Neural Circuits 2017; 11:36. [PMID: 28725184 PMCID: PMC5495862 DOI: 10.3389/fncir.2017.00036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/16/2017] [Indexed: 12/04/2022] Open
Abstract
Although general anesthetics are routinely administered to surgical patients to induce loss of consciousness, the mechanisms underlying anesthetic-induced unconsciousness are not fully understood. In rats, we characterized changes in the extradural EEG and intracranial local field potentials (LFPs) within the prefrontal cortex (PFC), parietal cortex (PC), and central thalamus (CT) in response to progressively higher doses of the inhaled anesthetic sevoflurane. During induction with a low dose of sevoflurane, beta/low gamma (12–40 Hz) power increased in the frontal EEG and PFC, PC and CT LFPs, and PFC–CT and PFC–PFC LFP beta/low gamma coherence increased. Loss of movement (LOM) coincided with an abrupt decrease in beta/low gamma PFC–CT LFP coherence. Following LOM, cortically coherent slow-delta (0.1–4 Hz) oscillations were observed in the frontal EEG and PFC, PC and CT LFPs. At higher doses of sevoflurane sufficient to induce loss of the righting reflex, coherent slow-delta oscillations were dominant in the frontal EEG and PFC, PC and CT LFPs. Dynamics similar to those observed during induction were observed as animals emerged from sevoflurane anesthesia. We conclude that the rat is a useful animal model for sevoflurane-induced EEG oscillations in humans, and that coherent slow-delta oscillations are a correlate of sevoflurane-induced behavioral arrest and loss of righting in rats.
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Affiliation(s)
- Jennifer A Guidera
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, BostonMA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, CambridgeMA, United States
| | - Norman E Taylor
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, BostonMA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, CambridgeMA, United States.,Department of Anaesthesia, Harvard Medical School, BostonMA, United States
| | - Justin T Lee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, BostonMA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, CambridgeMA, United States
| | - Ksenia Y Vlasov
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, BostonMA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, CambridgeMA, United States
| | - JunZhu Pei
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, BostonMA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, CambridgeMA, United States
| | - Emily P Stephen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, BostonMA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, CambridgeMA, United States
| | - J Patrick Mayo
- Department of Neurobiology, Duke University, DurhamNC, United States
| | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, BostonMA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, CambridgeMA, United States.,Department of Anaesthesia, Harvard Medical School, BostonMA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, CambridgeMA, United States.,The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, CambridgeMA, United States
| | - Ken Solt
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, BostonMA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, CambridgeMA, United States.,Department of Anaesthesia, Harvard Medical School, BostonMA, United States
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Abstract
A quest for a systems-level neuroscientific basis of anesthetic-induced loss and return of consciousness has been in the forefront of research for the past 2 decades. Recent advances toward the discovery of underlying mechanisms have been achieved using experimental electrophysiology, multichannel electroencephalography, magnetoencephalography, and functional magnetic resonance imaging. By the careful dosing of various volatile and IV anesthetic agents to the level of behavioral unresponsiveness, both specific and common changes in functional and effective connectivity across large-scale brain networks have been discovered and interpreted in the context of how the synthesis of neural information might be affected during anesthesia. The results of most investigations to date converge toward the conclusion that a common neural correlate of anesthetic-induced unresponsiveness is a consistent depression or functional disconnection of lateral frontoparietal networks, which are thought to be critical for consciousness of the environment. A reduction in the repertoire of brain states may contribute to the anesthetic disruption of large-scale information integration leading to unconsciousness. In future investigations, a systematic delineation of connectivity changes with multiple anesthetics using the same experimental design, and the same analytical method will be desirable. The critical neural events that account for the transition between responsive and unresponsive states should be assessed at similar anesthetic doses just below and above the loss or return of responsiveness. There will also be a need to identify a robust, sensitive, and reliable measure of information transfer. Ultimately, finding a behavior-independent measure of subjective experience that can track covert cognition in unresponsive subjects and a delineation of causal factors versus correlated events will be essential to understand the neuronal basis of human consciousness and unconsciousness.
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