1
|
Egawa S, Ader J, Claassen J. Recovery of consciousness after acute brain injury: a narrative review. J Intensive Care 2024; 12:37. [PMID: 39327599 PMCID: PMC11425956 DOI: 10.1186/s40560-024-00749-9] [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: 05/15/2024] [Accepted: 09/01/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Disorders of consciousness (DoC) are frequently encountered in both, acute and chronic brain injuries. In many countries, early withdrawal of life-sustaining treatments is common practice for these patients even though the accuracy of predicting recovery is debated and delayed recovery can be seen. In this review, we will discuss theoretical concepts of consciousness and pathophysiology, explore effective strategies for management, and discuss the accurate prediction of long-term clinical outcomes. We will also address research challenges. MAIN TEXT DoC are characterized by alterations in arousal and/or content, being classified as coma, unresponsive wakefulness syndrome/vegetative state, minimally conscious state, and confusional state. Patients with willful modulation of brain activity detectable by functional MRI or EEG but not by behavioral examination is a state also known as covert consciousness or cognitive motor dissociation. This state may be as common as every 4th or 5th patient without behavioral evidence of verbal command following and has been identified as an independent predictor of long-term functional recovery. Underlying mechanisms are uncertain but intact arousal and thalamocortical projections maybe be essential. Insights into the mechanisms underlying DoC will be of major importance as these will provide a framework to conceptualize treatment approaches, including medical, mechanical, or electoral brain stimulation. CONCLUSIONS We are beginning to gain insights into the underlying mechanisms of DoC, identifying novel advanced prognostication tools to improve the accuracy of recovery predictions, and are starting to conceptualize targeted treatments to support the recovery of DoC patients. It is essential to determine how these advancements can be implemented and benefit DoC patients across a range of clinical settings and global societal systems. The Curing Coma Campaign has highlighted major gaps knowledge and provides a roadmap to advance the field of coma science with the goal to support the recovery of patients with DoC.
Collapse
Affiliation(s)
- Satoshi Egawa
- Department of Neurology, Neurological Institute, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jeremy Ader
- Department of Neurology, Neurological Institute, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Neurological Institute, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
- NewYork-Presbyterian Hospital, New York, NY, USA.
| |
Collapse
|
2
|
Peng L, Zang X, Liu R, Bai P, Wang L, Yang G. Construction of a nursing assessment framework for patients in anaesthesia recovery period: A modified Delphi study. J Adv Nurs 2024; 80:3653-3665. [PMID: 38444164 DOI: 10.1111/jan.16115] [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: 06/30/2023] [Revised: 01/09/2024] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
AIM To construct a nursing assessment framework for patients in anaesthesia recovery period. DESIGN A three-round modified Delphi method was employed to capture the consensus of 22 panellists. METHODS The initial items in the nursing assessment framework for patients in anaesthesia recovery period were developed based on the mini-clinical evaluation exercise (mini-CEX). A panel of 22 experts participated in this study. The panellists have more than 10 years of experience in either clinical anaesthesia, or post-anesthesia nursing, or operating room nursing, or surgical intensive nursing. Between March and April 2023, the panellists evaluated and recommended revisions to the initial framework. RESULTS This study resulted in the development of a nursing assessment framework for patients in anaesthesia recovery period. The initial version of the framework consisted of six dimensions with 27 items. Six items were modified after the first round of consultation. After the second round, five modifications and four deletions were made based on expert opinion. The third round resulted in a convergence of expert opinion. The framework, which consists of 24 items across five dimensions, was refined. The five dimensions are as follows: History-taking, Physical assessment, Clinical judgement, Organizational efficiency and Humanistic concern. CONCLUSION The nursing assessment framework for patients in anaesthesia recovery period was reached consensus between the 22 experts' opinions. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE The assessment framework constructed in this study could be used for the process evaluation of post-anesthesia nursing. The framework may guide perianesthesia nurses in the timely and effective assessment of patients during this critical phase of care. It may be used for perianesthesia nursing education or to evaluate nurses' assessment skills. REPORTING METHOD The study is reported in accordance with the Guidance on Conducting and Reporting DElphi Studies (CREDES) recommendations. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Lang Peng
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Peking University School of Nursing, Beijing, China
| | | | - Ruili Liu
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Ping Bai
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Lu Wang
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Guoyong Yang
- Postanesthesia Care Unit, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| |
Collapse
|
3
|
Li M, Tang Z, Yu L, Li Y, Ma W, Li J, Li G, Xiong L, Lei N, Guo P, Xie Y. The arousal effect of An-Gong-Niu-Huang-Wan on alcoholic-induced coma rats: A research based on EEG. JOURNAL OF ETHNOPHARMACOLOGY 2024; 328:117974. [PMID: 38467317 DOI: 10.1016/j.jep.2024.117974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Acute alcohol intoxication is one of the leading causes of coma. A well-regarded Chinese herbal formula, known as An-Gong-Niu-Huang-Wan (AGNHW), has garnered recognition for its efficacy in treating various brain disorders associated with impaired consciousness, including acute alcohol-induced coma. Despite its clinical effectiveness, the scientific community lacks comprehensive research on the mechanistic aspects of AGNHW's impact on the electroencephalogram (EEG) patterns observed during alcohol-induced coma. Gaining a deeper understanding of AGNHW's mechanism of action in relation to EEG characteristics would hold immense importance, serving as a solid foundation for further advancing its clinical therapeutic application. AIM OF THE STUDY The study sought to investigate the impact of AGNHW on EEG activity and sleep EEG patterns in rats with alcoholic-induced coma. MATERIALS AND METHODS A rat model of alcohol-induced coma was used to examine the effects of AGNHW on EEG patterns. Male Sprague-Dawley rats were intraperitoneally injected with 32% ethanol to induce a coma, followed by treatment with AGNHW. Wireless electrodes were implanted in the cortex of the rats to obtain EEG signals. Our analysis focused on evaluating alterations in the Rat Coma Scale (RCS), as well as assessing changes in the frequency and distribution of EEG patterns, sleep rhythms, and body temperature subsequent to AGNHW treatment. RESULTS The study found a significant increase in the δ-band power ratio, as well as a decrease in RCS scores and β-band power ratio after modeling. AGNHW treatment significantly reduced the δ-band power ratio and increased the β-band power ratio compared to naloxone, suggesting its superior arousal effects. The results also revealed a decrease in the time proportion of WAKE and REM EEG patterns after modeling, accompanied by a significant increase in the time proportion of NREM EEG patterns. Both naloxone and AGNHW effectively counteracted the disordered sleep EEG patterns. Additionally, AGNHW was more effective than naloxone in improving hypothermia caused by acute alcohol poisoning in rats. CONCLUSION Our study provides evidence for the arousal effects of AGNHW in alcohol-induced coma rats. It also suggests a potential role for AGNHW in regulating post-comatose sleep rhythm disorders.
Collapse
Affiliation(s)
- Minghong Li
- Basic Medical School, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Zilei Tang
- College of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Liuyan Yu
- College of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Yingming Li
- College of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Wenyu Ma
- College of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Jincun Li
- College of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Gang Li
- Basic Medical School, Yunnan University of Chinese Medicine, Kunming, 650500, China; Yunnan Provincial University Key Laboratory of Aromatic Chinese Herb Research, Kunming, 650500, China
| | - Lei Xiong
- School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming, 650500, China; Yunnan Provincial University Key Laboratory of Aromatic Chinese Herb Research, Kunming, 650500, China; Yunnan Innovation Team of Application Research on Traditional Chinese Medicine Theory of Disease Prevention at Yunnan University of Chinese Medicine, Kunming, 650500, China
| | - Na Lei
- Basic Medical School, Yunnan University of Chinese Medicine, Kunming, 650500, China.
| | - Peixin Guo
- College of Ethnic Medicine, Yunnan University of Chinese Medicine, Kunming, 650500, China; Yunnan Innovation Team of Application Research on Traditional Chinese Medicine Theory of Disease Prevention at Yunnan University of Chinese Medicine, Kunming, 650500, China.
| | - Yuhuan Xie
- Yunnan Provincial University Key Laboratory of Aromatic Chinese Herb Research, Kunming, 650500, China; Yunnan Innovation Team of Application Research on Traditional Chinese Medicine Theory of Disease Prevention at Yunnan University of Chinese Medicine, Kunming, 650500, China.
| |
Collapse
|
4
|
Kajino T, Yamauchi Y, Kojima T. Laryngeal stimulation test to identify the optimal timing for deep tracheal extubation in children. Paediatr Anaesth 2024; 34:383-384. [PMID: 38164879 DOI: 10.1111/pan.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Tatsuo Kajino
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Yusuke Yamauchi
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan
- Division of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
5
|
Lersch F, Zingg TJG, Knapp J, Stüber F, Hight D, Kaiser HA. [Processed EEG for personalized dosing of anesthetics during general anesthesia]. DIE ANAESTHESIOLOGIE 2023; 72:662-676. [PMID: 37552241 PMCID: PMC10457248 DOI: 10.1007/s00101-023-01313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 08/09/2023]
Abstract
Electroencephalogram (EEG)-guided anesthesia is indispensable in modern operating rooms and has become established as the standard form of monitoring. Many anesthesiologists rely on processed EEG indices in the hope of averting anesthesia-related complications, such as intraoperative awareness, postoperative delirium and other cognitive complications in their patients. This educational review aims to provide information on the five most prevalent monitors used to guide depth of sedation during general anesthesia. This article elucidates the principles underpinning the application of these monitors where known, which are generally based on power in various EEG frequency bands and on the burst suppression pattern. Convinced that EEG-guided anesthesia has the potential of benefitting many surgical patients, it is felt that many basic principles and shortcomings of processed EEG indices need to be better understood in the clinical practice. After discussing the different monitors and clinically relevant data from the literature, the article gives a short practical guidance on how to critically interpret processed EEG information and troubleshooting of confounded indices in the context of clinical situations.
Collapse
Affiliation(s)
- F Lersch
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - T J G Zingg
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - J Knapp
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - F Stüber
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - D Hight
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz
| | - H A Kaiser
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Inselspital, Universitätsspital Bern, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz.
- Zentrum für Anästhesiologie und Intensivmedizin, Hirslanden Klinik Aarau, Hirslanden AG, Schänisweg, 5001, Aarau, Schweiz.
| |
Collapse
|
6
|
Kajino T, Yamauchi Y, Kojima T. The pupillometer's test during emergence from anesthesia could provide useful information on the timing for extubation in children. Paediatr Anaesth 2023. [PMID: 37186347 DOI: 10.1111/pan.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/16/2022] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Tatsuo Kajino
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Yusuke Yamauchi
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Japan
- Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Obu, Japan
| |
Collapse
|
7
|
Kinoshita M, Sakai Y, Katome K, Matsumoto T, Sakurai S, Jinnouchi Y, Tanaka K. Transition in eye gaze as a predictor of emergence from general anesthesia in children and adults: a prospective observational study. BMC Anesthesiol 2022; 22:320. [PMID: 36253763 PMCID: PMC9575208 DOI: 10.1186/s12871-022-01867-3] [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: 06/08/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is useful to monitor eye movements during general anesthesia, but few studies have examined neurological finding of the eyes during emergence from general anesthesia maintained with short-acting opioids and volatile anesthetics. METHODS Thirty children aged 1-6 years and 30 adults aged 20-79 years were enrolled. Patients received general anesthesia maintained with sevoflurane and remifentanil. The timing of three physical-behavioral responses-eye-gaze transition (the cycle from conjugate to disconjugate and back to conjugate), resumption of somatic movement (limbs or body), and resumption of respiration-were recorded until spontaneous awakening. The primary outcome measure was the timing of the physical-behavioral responses. Secondary outcome measures were the incidence of eye-gaze transition, and the bispectral index, concentration of end-tidal sevoflurane, and heart rate at the timing of eye-gaze transition. RESULTS Eye-gaze transition was evident in 29 children (96.7%; 95% confidence interval, 82.8-99.9). After the end of surgery, eye-gaze transition was observed significantly earlier than resumption of somatic movement or respiration (472 [standard deviation 219] s, 723 [235] s, and 754 [232] s, respectively; p < 0.001). In adults, 3 cases (10%; 95% CI, 0.2-26.5) showed eye-gaze transition during emergence from anesthesia. The incidence of eye-gaze transition was significantly lower in adults than in children (p < 0.001). CONCLUSION In children, eye-gaze transition was observed significantly earlier than other physical-behavioral responses during emergence from general anesthesia and seemed to reflect emergence from anesthesia. In contrast, observation of eye gaze was not a useful indicator of emergence from anesthesia in adults.
Collapse
Affiliation(s)
- Michiko Kinoshita
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan.
| | - Yoko Sakai
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan
| | - Kimiko Katome
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan
| | - Tomomi Matsumoto
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan
| | - Shizuka Sakurai
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan
| | - Yuka Jinnouchi
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan
| | - Katsuya Tanaka
- Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan
| |
Collapse
|
8
|
Mashour GA, Pal D, Brown EN. Prefrontal cortex as a key node in arousal circuitry. Trends Neurosci 2022; 45:722-732. [PMID: 35995629 PMCID: PMC9492635 DOI: 10.1016/j.tins.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/02/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
The role of the prefrontal cortex (PFC) in the mechanism of consciousness is a matter of active debate. Most theoretical and empirical investigations have focused on whether the PFC is critical for the content of consciousness (i.e., the qualitative aspects of conscious experience). However, there is emerging evidence that, in addition to its well-established roles in cognition, the PFC is a key regulator of the level of consciousness (i.e., the global state of arousal). In this opinion article we review recent data supporting the hypothesis that the medial PFC is a critical node in arousal-promoting networks.
Collapse
Affiliation(s)
- George A Mashour
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA; Center for Consciousness Science, University of Michigan, Ann Arbor, MI, USA; Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA.
| | - Dinesh Pal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Center for Consciousness Science, University of Michigan, Ann Arbor, MI, USA; Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Emery N Brown
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA; Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Zhang J, Cheng Z, Tian Y, Weng L, Zhang Y, Yang X, Schäfer MKE, Guo Q, Huang C. Cerebral Tissue Oxygen Saturation Correlates with Emergence from Propofol-Remifentanil Anesthesia: An Observational Cohort Study. J Clin Med 2022; 11:jcm11164878. [PMID: 36013112 PMCID: PMC9410034 DOI: 10.3390/jcm11164878] [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: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Anesthesia emergence is accompanied by changes in cerebral circulation. It is unknown whether cerebral tissue oxygen saturation (SctO2) could be an indicator of emergence. Changes in SctO2, bispectral index (BIS), mean arterial pressure (MAP), and heart rate (HR) were evaluated during the emergence from propofol-remifentanil anesthesia. At the time of cessation of anesthetic delivery, SctO2, BIS, MAP, and HR values were recorded as baseline. The changes of these parameters from the baseline were recorded as Δ SctO2, Δ BIS, Δ MAP, and Δ HR. The behavioral signs (body movement, coughing, or eye opening) and response to commands (indicating regaining of consciousness) were used to define emergence states. Prediction probability (Pk) was used to examine the accuracy of SctO2, BIS, MAP, and HR as indicators of emergence. SctO2 showed an abrupt and distinctive increase when appearing behavioral signs. BIS, MAP, and HR, also increased but with a large inter-individual variability. Pk value of Δ SctO2 was 0.97 to predict the appearance behavioral signs from 2 min before that, which was much higher than the Pk values of Δ BIS (0.81), Δ MAP (0.71) and Δ HR (0.87). The regaining of consciousness was associated with a further increase in the SctO2 value.
Collapse
Affiliation(s)
- Jianxi Zhang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Zhigang Cheng
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China
| | - Ying Tian
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Lili Weng
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Yiying Zhang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Xin Yang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
| | - Michael K. E. Schäfer
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany
- Focus Program Translational Neurosciences (FTN), Research Center of Immunotherapy, Johannes Gutenberg-University Mainz, 55122 Mainz, Germany
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China
| | - Changsheng Huang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha 410008, China
- Correspondence: ; Tel./Fax: +86-731-84327413
| |
Collapse
|
10
|
Affiliation(s)
- George A. Mashour
- From the Departments of Anesthesiology and Pharmacology, Center for Consciousness Science, Michigan Neuroscience Institute, Neuroscience Graduate Program, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
11
|
Chen YF, Fan SZ, Abbod MF, Shieh JS, Zhang M. Electroencephalogram variability analysis for monitoring depth of anesthesia. J Neural Eng 2021; 18. [PMID: 34695812 DOI: 10.1088/1741-2552/ac3316] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/25/2021] [Indexed: 12/27/2022]
Abstract
Objective. In this paper, a new approach of extracting and measuring the variability in electroencephalogram (EEG) was proposed to assess the depth of anesthesia (DOA) under general anesthesia.Approach. The EEG variability (EEGV) was extracted as a fluctuation in time interval that occurs between two local maxima of EEG. Eight parameters related to EEGV were measured in time and frequency domains, and compared with state-of-the-art DOA estimation parameters, including sample entropy, permutation entropy, median frequency and spectral edge frequency of EEG. The area under the receiver-operator characteristics curve (AUC) and Pearson correlation coefficient were used to validate its performance on 56 patients.Main results. Our proposed EEGV-derived parameters yield significant difference for discriminating between awake and anesthesia stages at a significance level of 0.05, as well as improvement in AUC and correlation coefficient on average, which surpasses the conventional features of EEG in detection accuracy of unconscious state and tracking the level of consciousness.Significance. To sum up, EEGV analysis provides a new perspective in quantifying EEG and corresponding parameters are powerful and promising for monitoring DOA under clinical situations.
Collapse
Affiliation(s)
- Yi-Feng Chen
- Academy for Advanced Interdisciplinary Studies, Southern University of Science and Technology, ShenZhen, GuangDong, 518055, People's Republic of China.,Shenzhen Key Laboratory of Smart Healthcare Engineering, the Department of Biomedical Engineering, Southern University of Science and Technology, ShenZhen, GuangDong, 518055, People's Republic of China
| | - Shou-Zen Fan
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Maysam F Abbod
- College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge, UB8 3PH, United Kingdom
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 32003, Taiwan
| | - Mingming Zhang
- Shenzhen Key Laboratory of Smart Healthcare Engineering, the Department of Biomedical Engineering, Southern University of Science and Technology, ShenZhen, GuangDong, 518055, People's Republic of China
| |
Collapse
|
12
|
Carta G, Seregni A, Casamassima A, Galli M, Geuna S, Pagliaro P, Zago M. Validation and Reliability of a Novel Vagus Nerve Neurodynamic Test and Its Effects on Heart Rate in Healthy Subjects: Little Differences Between Sexes. Front Neurosci 2021; 15:698470. [PMID: 34552462 PMCID: PMC8450330 DOI: 10.3389/fnins.2021.698470] [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: 06/10/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background The vagus nerve (VN), also called the pneumogastric nerve, connects the brainstem to organs contained in the chest and abdomen. Physiologically, VN stimulation can rapidly affect cardiac activity and heart rate (HR). VN neuropathy can increase the risk of arrhythmias and sudden death. Therefore, a selective test of VN function may be very useful. Since peripheral neurodynamic tests (NDT) are reliable for the assessment of neuropathies in somatic nerves, we aimed to validate a novel NDT to assess VN activity, namely, the VN-NTD. Methods In this cross-sectional double-blind, sex-balanced study, 30 participants (15 females) completed a checklist of autonomic dysfunction symptoms. During the VN-NDT administration, HR and symptoms (i.e., mechanical allodynia) were monitored in parallel to a real-time ultrasonography imaging (USI) and motion capture analysis of the neck. The VN-NDT impact on HR and its accuracy for autonomic symptoms reported in the last 7 days were tested. Results The VN-NDT induced a significant HR reduction of about 12 and 8 bpm in males and females [t(1, 119) = 2.425; p < 0.017; ηp2 = 0.047, 95% confidence interval (CI): 0.93–9.18], respectively. No adverse events were observed during VN-NDT. A substantial interexaminer agreement between the evaluators in symptoms induction by VN-NDT was detected [F(1, 119) = 0.540; p = 0.464; ηp2 = 0.005, low effect]. Notably, mechanical allodynia accuracy for gastrointestinal dysfunctions was excellent (p < 0.05; 95% CI: 0.52–0.73; p < 0.001; 95% CI: 0.81–0.96). Conclusions The novel VN-NDT is a valid and accurate test capable of detecting VN activation with high sensitivity. Data provided are suitable for both sexes as a hallmark of HR variation due to VN normal response. The proposed VN-NDT may be reliable as daily routine neurological examination tests for the evaluation of neuropathic signs related to neuroinflammation of the VN. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT04192877.
Collapse
Affiliation(s)
- Giacomo Carta
- Human Anatomy, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy.,Department of Rehabilitation, Sesto Hospital, ASST Nord Milano, Milan, Italy
| | - Agnese Seregni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Andrea Casamassima
- General Surgery Department, S. Maria delle Stelle Hospital, ASST Melegnano e Martesana Melzo, Milan, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Stefano Geuna
- Human Anatomy, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Turin, Turin, Italy
| | - Pasquale Pagliaro
- Human Physiology, Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - Matteo Zago
- Department of Mechanics, Politecnico di Milano, Lecco, Italy
| |
Collapse
|
13
|
Tanaka R, Tanaka S, Hayashi K, Iida K, Sawa T, Kawamata M. The histamine H 1 receptor antagonist hydroxyzine enhances sevoflurane and propofol anesthesia: A quantitative EEG study. Clin Neurophysiol 2021; 132:2054-2061. [PMID: 34284240 DOI: 10.1016/j.clinph.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/26/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine the anesthesia-promoting effects of hydroxyzine on electroencephalograms during sevoflurane anesthesia and during propofol anesthesia. METHODS We analyzed 40 patients scheduled for elective surgery under sevoflurane anesthesia (n = 20) or propofol anesthesia (n = 20). Anesthesia was adjusted at a bispectral index value of 50-60, and then 0.5 mg/kg of hydroxyzine was administered intravenously. We analyzed frontal electroencephalograms before and after hydroxyzine injection with power spectral and bicoherence analyses, which are suitable for assessing the anesthetic depth induced by γ-aminobutyric acid (GABA)ergic anesthetics. RESULTS Hydroxyzine increased the α bicoherence peaks in both sevoflurane anesthesia (mean difference, 11.2%; 95% confidence interval (CI), 7.6 to 14.8; P < 0.001) and propofol anesthesia (mean difference, 5.6%; 95% CI, 1.7 to 9.4; P = 0.008). Hydroxyzine increased the averaged δ bicoherence values in both sevoflurane anesthesia (mean difference, 5.5%; 95% CI, 2.1 to 8.8; P = 0.003) and propofol anesthesia (mean difference, 3.9%; 95% CI, 1.0 to 6.8; P = 0.011). CONCLUSIONS Hydroxyzine enhances both sevoflurane anesthesia and propofol anesthesia probably by facilitation of GABAergic neural circuit mechanisms. SIGNIFICANCE The findings provide a new insight into the role of histaminergic neurons during general anesthesia in humans.
Collapse
Affiliation(s)
- Ryusuke Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan.
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
| | - Kazuko Hayashi
- Department of Anesthesiology, Kyoto Chubu Medical Center, Japan; Department of Anesthesiology, Kyoto Prefectural University of Medicine, Japan
| | - Keisuke Iida
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Japan
| |
Collapse
|
14
|
Mashour GA, Palanca BJA, Basner M, Li D, Wang W, Blain-Moraes S, Lin N, Maier K, Muench M, Tarnal V, Vanini G, Ochroch EA, Hogg R, Schwartz M, Maybrier H, Hardie R, Janke E, Golmirzaie G, Picton P, McKinstry-Wu AR, Avidan MS, Kelz MB. Recovery of consciousness and cognition after general anesthesia in humans. eLife 2021; 10:59525. [PMID: 33970101 PMCID: PMC8163502 DOI: 10.7554/elife.59525] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 05/06/2021] [Indexed: 12/13/2022] Open
Abstract
Understanding how the brain recovers from unconsciousness can inform neurobiological theories of consciousness and guide clinical investigation. To address this question, we conducted a multicenter study of 60 healthy humans, half of whom received general anesthesia for 3 hr and half of whom served as awake controls. We administered a battery of neurocognitive tests and recorded electroencephalography to assess cortical dynamics. We hypothesized that recovery of consciousness and cognition is an extended process, with differential recovery of cognitive functions that would commence with return of responsiveness and end with return of executive function, mediated by prefrontal cortex. We found that, just prior to the recovery of consciousness, frontal-parietal dynamics returned to baseline. Consistent with our hypothesis, cognitive reconstitution after anesthesia evolved over time. Contrary to our hypothesis, executive function returned first. Early engagement of prefrontal cortex in recovery of consciousness and cognition is consistent with global neuronal workspace theory.
Collapse
Affiliation(s)
- George A Mashour
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical SchoolAnn ArborUnited States
| | - Ben JA Palanca
- Department of Anesthesiology, Washington University School of MedicineSt. LouisUnited States
| | - Mathias Basner
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Duan Li
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical SchoolAnn ArborUnited States
| | - Wei Wang
- Department of Mathematics and Statistics, Washington UniversitySt. LouisUnited States
| | - Stefanie Blain-Moraes
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical SchoolAnn ArborUnited States
| | - Nan Lin
- Department of Mathematics and Statistics, Washington UniversitySt. LouisUnited States
| | - Kaitlyn Maier
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Maxwell Muench
- Department of Anesthesiology, Washington University School of MedicineSt. LouisUnited States
| | - Vijay Tarnal
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical SchoolAnn ArborUnited States
| | - Giancarlo Vanini
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical SchoolAnn ArborUnited States
| | - E Andrew Ochroch
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Rosemary Hogg
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Marlon Schwartz
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Hannah Maybrier
- Department of Anesthesiology, Washington University School of MedicineSt. LouisUnited States
| | - Randall Hardie
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Ellen Janke
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical SchoolAnn ArborUnited States
| | - Goodarz Golmirzaie
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical SchoolAnn ArborUnited States
| | - Paul Picton
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical SchoolAnn ArborUnited States
| | - Andrew R McKinstry-Wu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of MedicineSt. LouisUnited States
| | - Max B Kelz
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| |
Collapse
|
15
|
Calderon DP, Schiff ND. Objective and graded calibration of recovery of consciousness in experimental models. Curr Opin Neurol 2021; 34:142-149. [PMID: 33278146 PMCID: PMC7866679 DOI: 10.1097/wco.0000000000000895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Experimental preclinical models of recovery of consciousness (ROC) and anesthesia emergence are crucial for understanding the neuronal circuits restoring arousal during coma emergence. Such models can also potentially help to better understand how events during coma emergence facilitate or hinder recovery from brain injury. Here we provide an overview of current methods used to assess ROC/level of arousal in animal models. This exposes the need for objective approaches to calibrate arousal levels. We outline how correlation of measured behaviors and their reestablishment at multiple stages with cellular, local and broader neuronal networks, gives a fuller understanding of ROC. RECENT FINDINGS Animals emerging from diverse coma-like states share a dynamic process of cortical and behavioral recovery that reveals distinct states consistently sequenced from low-to-high arousal level and trackable in nonhuman primates and rodents. Neuronal activity modulation of layer V-pyramidal neurons and neuronal aggregates within the brainstem and thalamic nuclei play critical roles at specific stages to promote restoration of a conscious state. SUMMARY A comprehensive, graded calibration of cortical, physiological, and behavioral changes in animal models is undoubtedly needed to establish an integrative framework. This approach reveals the contribution of local and systemic neuronal circuits to the underlying mechanisms for recovering consciousness.
Collapse
Affiliation(s)
| | - Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
16
|
Wang D, Song Z, Zhang C, Chen P. Bispectral index monitoring of the clinical effects of propofol closed-loop target-controlled infusion: Systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e23930. [PMID: 33530193 PMCID: PMC7850716 DOI: 10.1097/md.0000000000023930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/07/2020] [Accepted: 11/27/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To investigate whether closed-loop systems under bispectral index anesthesia depth monitoring can reduce the intraoperative propofol dosage. METHODS All randomized controlled trials (RCTs) on reducing propofol dosage under closed-loop systems were collected, and the literature was screened out, the abstracts and full texts were carefully read, and the references were tracked, data extraction and quality evaluation were conducted on the included research, and the RevMan5.3 software was used for meta-analysis. The main results were propofol and the incidence of adverse reactions such as hypertensive hypotension and postoperative cognitive dysfunction. A total of 879 cases were included in 8 articles, including 450 occurrences in the closed-loop system group and 429 cases in the open-loop system group. RESULTS Compared with manual control, closed-loop systems under bispectral index anesthesia depth monitoring reduced the dose of propofol (MD: -0.62, 95% CI: -1.08--0.16, P = .008), with heterogeneity (I2 = 80%). Closed-loop systems significantly reduced the incidence of abnormal blood pressure (MD: -0.02, 95%CI: -0.05-0.01, P = .15, I2 = 74%) and postoperative cognitive dysfunction (MD: -0.08, 95% CI: -0.14 -0.01, P = .02, I2 = 94%). CONCLUSION Bispectral index monitoring of propofol closed-loop target-controlled infusion system can reduce the amount of propofol, reduce the incidence of adverse reactions such as hypertensive or hypotension and postoperative cognitive dysfunction.
Collapse
|
17
|
Viswanath R, Pulickal R, Chirayath JJ, Mullapilly K. Comparison of vital capacity rapid inhalation and tidal ventilation induction with sevoflurane in adults: a prospective cohort study. Med Gas Res 2021; 11:100-103. [PMID: 33942779 PMCID: PMC8174405 DOI: 10.4103/2045-9912.314328] [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] [Indexed: 11/10/2022] Open
Abstract
Vital capacity rapid inhalation induction (VCRII) results in faster achievement of desired minimum alveolar concentration while reducing the incidence of excitatory phenomenon compared to conventional incremental technique. This study aimed to determine whether the VCRII can achieve faster induction of anesthesia in adults compared to the traditional tidal ventilation (TV) technique. Following the approval from the Institutional Ethics Committee, Amala Institute of Medical Sciences, with an approval No. AIMSIEC/07/2017, on July 1, 2017, 51 adults belonging to American Society of Anesthesiologists physical status I–II, undergoing elective surgery at a tertiary care teaching hospital were prospectively assigned to two groups: 25 in VCRII (38.3 ± 13.3 years old, 20 (80%) females) and 26 in TV inhalation induction (35.2 ± 11.9 years old, 17 (65%) females) using 8% sevoflurane in 66% nitrous oxide. The induction time, such as time (in seconds) to the cessation of voluntary finger tapping, time to loss of eyelash reflex, time to return of regular breathing, the return of conjugate gaze, was measured. The primary outcome was time to induction as defined by time to loss of eyelash reflex. Hemodynamic effects of both methods were compared at baseline and 1, 3, 5, 10, 15-minute intervals from induction. Induction was significantly faster in the VCRII group compared with the TV group in all the measured parameters. Hemodynamic parameters were comparable in both the groups. VCRII resulted in a faster induction time compared to the TV technique in adults.
Collapse
Affiliation(s)
- Renjith Viswanath
- Department of Anaesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Raghavan Pulickal
- Department of Anaesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Joe John Chirayath
- Department of Anaesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Kesavan Mullapilly
- Department of Anaesthesiology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| |
Collapse
|
18
|
Gao S, Calderon DP. Robust alternative to the righting reflex to assess arousal in rodents. Sci Rep 2020; 10:20280. [PMID: 33219247 PMCID: PMC7679463 DOI: 10.1038/s41598-020-77162-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
The righting reflex (RR) is frequently used to assess level of arousal and applied to animal models of a range of neurological disorders. RR produces a binary result that, when positive, is used to infer restoration of consciousness, often without further behavioral corroboration. We find that RR is an unreliable metric for arousal/recovery of consciousness. Instead, cortical activity and motor behavior that accompany RR are a non-binary, superior criterion that accurately calibrates and establishes level of arousal in rodents.
Collapse
Affiliation(s)
- Sijia Gao
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, 10065, USA
- School of Electrical and Computer Engineering, Cornell University, New York, NY, 10044, USA
| | - Diany Paola Calderon
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, 10065, USA.
| |
Collapse
|
19
|
Holman AE, Puglia MP. Loss of Corneal Reflex in Children Undergoing Spinal Anesthesia: A Case Series. A A Pract 2019; 14:9-11. [DOI: 10.1213/xaa.0000000000001127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
20
|
Neurologic Examination for Anesthesiologists: Comment. Anesthesiology 2019; 131:945-946. [PMID: 31436545 DOI: 10.1097/aln.0000000000002912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Neurologic Examination for Anesthesiologists: Reply. Anesthesiology 2019; 131:946. [PMID: 31436546 DOI: 10.1097/aln.0000000000002913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Gao S, Proekt A, Renier N, Calderon DP, Pfaff DW. Activating an anterior nucleus gigantocellularis subpopulation triggers emergence from pharmacologically-induced coma in rodents. Nat Commun 2019; 10:2897. [PMID: 31263107 PMCID: PMC6603023 DOI: 10.1038/s41467-019-10797-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/01/2019] [Indexed: 02/08/2023] Open
Abstract
Multiple areas within the reticular activating system (RAS) can hasten awakening from sleep or light planes of anesthesia. However, stimulation in individual sites has shown limited recovery from deep global suppression of brain activity, such as coma. Here we identify a subset of RAS neurons within the anterior portion of nucleus gigantocellularis (aNGC) capable of producing a high degree of awakening represented by a broad high frequency cortical reactivation associated with organized movements and behavioral reactivity to the environment from two different models of deep pharmacologically-induced coma (PIC): isoflurane (1.25%-1.5%) and induced hypoglycemic coma. Activating aNGC neurons triggered awakening by recruiting cholinergic, noradrenergic, and glutamatergic arousal pathways. In summary, we identify an evolutionarily conserved population of RAS neurons, which broadly restore cerebral cortical activation and motor behavior in rodents through the coordinated activation of multiple arousal-promoting circuits.
Collapse
Affiliation(s)
- S Gao
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, 10065, USA
| | - A Proekt
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, 10065, USA
- Laboratory of Neurobiology and Behavior, the Rockefeller University, New York, NY, 10065, USA
| | - N Renier
- ICM, Brain and Spine Institute, Hopital de la Pitie-Salpetriere, Sorbonne Universite, Inserm, CNRS, Paris, 75013, France
| | - D P Calderon
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, 10065, USA.
- Laboratory of Neurobiology and Behavior, the Rockefeller University, New York, NY, 10065, USA.
| | - D W Pfaff
- Laboratory of Neurobiology and Behavior, the Rockefeller University, New York, NY, 10065, USA
| |
Collapse
|