Propofol Anesthesia Alters Spatial and Topologic Organization of Rat Brain Metabolism

Accurate Machine Learning-based Monitoring of Anesthesia Depth with EEG Recording

General anesthesia, pivotal for surgical procedures, requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments. Traditional assessment methods, relying on physiological indicators or behavioral responses, fall short of accurately capturing the nuanced states of unconsciousness. This study introduces a machine learning-based approach to decode anesthesia depth, leveraging EEG data across different anesthesia states induced by propofol and esketamine in rats. Our findings demonstrate the model's robust predictive accuracy, underscored by a novel intra-subject dataset partitioning and a 5-fold cross-validation method. The research diverges from conventional monitoring by utilizing anesthetic infusion rates as objective indicators of anesthesia states, highlighting distinct EEG patterns and enhancing prediction accuracy. Moreover, the model's ability to generalize across individuals suggests its potential for broad clinical application, distinguishing between anesthetic agents and their depths. Despite relying on rat EEG data, which poses questions about real-world applicability, our approach marks a significant advance in anesthesia monitoring.

Exploring effects of anesthesia on complexity, differentiation, and integrated information in rat EEG

To investigate mechanisms underlying loss of consciousness, it is important to extend methods established in humans to rodents as well. Perturbational complexity index (PCI) is a promising metric of "capacity for consciousness" and is based on a perturbational approach that allows inferring a system's capacity for causal integration and differentiation of information. These properties have been proposed as necessary for conscious systems. Measures based on spontaneous electroencephalography recordings, however, may be more practical for certain clinical purposes and may better reflect ongoing dynamics. Here, we compare PCI (using electrical stimulation for perturbing cortical activity) to several spontaneous electroencephalography-based measures of signal diversity and integrated information in rats undergoing propofol, sevoflurane, and ketamine anesthesia. We find that, along with PCI, the spontaneous electroencephalography-based measures, Lempel-Ziv complexity (LZ) and geometric integrated information (ΦG), were best able to distinguish between awake and propofol and sevoflurane anesthesia. However, PCI was anti-correlated with spontaneous measures of integrated information, which generally increased during propofol and sevoflurane anesthesia, contrary to expectations. Together with an observed divergence in network properties estimated from directed functional connectivity (current results) and effective connectivity (earlier results), the perturbation-based results seem to suggest that anesthesia disrupts global cortico-cortical information transfer, whereas spontaneous activity suggests the opposite. We speculate that these seemingly diverging results may be because of suppressed encoding specificity of information or driving subcortical projections from, e.g., the thalamus. We conclude that certain perturbation-based measures (PCI) and spontaneous measures (LZ and ΦG) may be complementary and mutually informative when studying altered states of consciousness.

Altitude effect on Propofol Pharmacokinetics in Rats

BACKGROUND

Propofol is an intravenous agent for clinical anesthesia. As the influence of the hypobaric-hypoxic environment (Qinghai-Tibetan region, altitude: 2800-4300 m, PaO2: 15.1-12.4 kPa) on the metabolism of Propofol is complex, the research results on the metabolic characteristics of Propofol in high-altitude areas remain unclear. This study aimed to investigate the pharmacokinetic characteristics of Propofol in a high-altitude hypoxic environment using animal experiments.

METHODS

Rats were randomly divided into three groups: high-altitude, medium-altitude, and plain groups. The time of disappearance and recovery of the rat righting reflex was recorded as the time of anesthesia induction and awakening, respectively. The plasma concentration of Propofol was determined by gas chromatography-mass spectrometry. A pharmacokinetic analysis software was used to analyze the blood-drug concentrations and obtain the pharmacokinetic parameters.

RESULTS

We observed that when Propofol anesthetizes rats, the anesthesia induction time was shortened, and the recovery time was prolonged with increased altitude. Compared with the plain group, the clearance of Propofol decreased, whereas the half-life, area under the concentration-time curve, peak plasma concentration, and average residence time extension increased.

CONCLUSION

The pharmacokinetic characteristics of Propofol are significantly altered in high-altitude hypoxic environments.

Alterations in rat brain modular organization during unconsciousness are dependent on communication efficiency and metabolic cost

Spontaneous brain activity exhibits a highly structured modular organization that varies across individuals and reconfigures over time. Although it has been proposed that brain organization is shaped by an economic trade-off between minimizing costs and facilitating efficient information transfer, it remains untested whether modular variability and its changes during unconscious conditions might be constrained by the economy of brain organization. We acquired functional MRI and FDG-PET in rats under three different levels of consciousness induced by propofol administration. We examined alterations in brain modular variability during loss of consciousness from mild sedation to deep anesthesia. We also investigated the relationships between modular variability with glucose metabolism and functional connectivity strength as well as their alterations during unconsciousness. We observed that modular variability increased during loss of consciousness. Critically, across-individual modular variability is oppositely associated with functional connectivity strength and cerebral metabolism, and with deepening dosage of anesthesia, becoming increasingly dependent on basal metabolism over functional connectivity. These results suggested that, propofol-induced unconsciousness may lead to brain modular reorganization, which are putatively shaped by re-negotiations between energetic resources and communication efficiency.

Propofol modulates neural dynamics of thalamo-cortical system associated with anesthetic levels in rats

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.

Serum lactate monitoring may help to predict neurological function impairment caused by acute metabolism crisis

To investigate the predictive value of serum lactate on neurological function impairment and the possible etiology. In this retrospective study, all the adult patients admitted to ICU more than 24 h after general anesthesia elective neurosurgery from January 2018 to January 2019 were recruited. The data of the serum lactate every 8 h during the 24 h of ICU admission were acquired and analyzed. 169 patients were included in the outcomes analysis. The average serum lactate after ICU admission was 3.7(3.4-4.1) mmol/L, higher than normal, and serum lactate elevated commonly after neurosurgery. The serum lactate at ICU admission (lactate_serum0h) was not correlated with the outcomes, whereas the predictive value increased as the monitoring time was extended. The result indicated that lactate_serum8h, the lactate_serum16h, and the lactate_serum24h were correlated with the primary outcome (difference of GCS scores before the surgery and after 24 h of ICU admission (ΔGCS_24h) (p < 0.05). The lactate_serum16h and the lactate_serum 24 h were correlated with all the outcomes except for the hospital LOS. The ROC curve suggested that the lactate_serum24h achieved the best predictive value. Patients with serum lactate non-recovered trend after 24 h of ICU stay had decreased GCS scores and vice versa, as indicated by the graph of the dynamic changes in the serum lactate. The predictive value of the serum glucose/serum lactate ratio at ICU admission (G/L_serum) was analyzed, and the result indicated that it was correlated with the ΔGCS_24h (p < 0.05), the G/L_serum can predict neurological impairment earlier. Dynamic serum lactate monitoring and the G/L_serum at ICU admission have predict value on neurological function impairment after neurosurgery which might be attributed to ACMC.

Differential Alterations to the Metabolic Connectivity of the Cortical and Subcortical Regions in Rat Brain During Ketamine-Induced Unconsciousness

BACKGROUND

Ketamine anesthesia increased glucose metabolism in most brain regions compared to another intravenous anesthetic propofol. However, whether the changes in cerebral metabolic networks induced by ketamine share the same mechanism with propofol remains to be explored. The purpose of the present study was to identify specific features of metabolic network in rat brains during ketamine-induced subanesthesia state and anesthesia state compared to awake state.

METHODS

We acquired fluorodeoxyglucose positron emission tomography (FDG-PET) images in 20 healthy adult Sprague-Dawley rats that were intravenously administrated saline and ketamine to achieve different conscious states: awake (normal saline), subanesthesia (30 mg kg -1 h -1 ), and anesthesia (160 mg kg -1 h -1 ). Based on the FDG-PET data, the alterations in cerebral glucose metabolism and metabolic topography were investigated by graph-theory analysis.

RESULTS

The baseline metabolism in rat brains was found significantly increased during ketamine-induced subanesthesia and anesthesia. The graph-theory analysis manifested a reduction in metabolism connectivity and network global/local efficiency across cortical regions and an increase across subcortical regions during ketamine-induced anesthesia (nonparametric permutation test: global efficiency between awake and anesthesia, cortex: P = .016, subcortex: P = .015; global efficiency between subanesthesia and anesthesia, subcortex: P = .012).

CONCLUSIONS

Ketamine broadly increased brain metabolism alongside decreased metabolic connectivity and network efficiency of cortex network. Modulation of these cortical metabolic networks may be a candidate mechanism underlying general anesthesia-induced loss of consciousness.

Cortical Complexity and Connectivity during Isoflurane-induced General Anesthesia: A Rat Study

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.

Mapping white matter structural and network alterations in betel quid-dependent chewers using high angular resolution diffusion imaging

BACKGROUND

To evaluate brain white matter diffusion characteristics and anatomical network alterations in betel quid dependence (BQD) chewers using high angular resolution diffusion imaging (HARDI).

METHODS

The current study recruited 53 BQD chewers and 37 healthy controls (HC) in two groups. We explored regional diffusion metrics alternations in the BQD group compared with the HC group using automated fiber quantification (AFQ). We further employed the white matter (WM) anatomical network of HARDI to explore connectivity alterations in BQD chewers using graph theory.

RESULTS

BQD chewers presented significantly lower FA values in the left and right cingulum cingulate, the left and right thalamic radiation, and the right uncinate. The BQD has a significantly higher RD value in the right uncinate fasciculus than the HC group. At the global WM anatomical network level, global network efficiency (p = 0.008) was poorer and Lp (p = 0.016) was greater in the BQD group. At the nodal WM anatomical network level, nodal efficiency (p < 0.05) was lower in the BQD group.

CONCLUSION

Our findings provide novel morphometric evidence that brain structural changes in BQD are characterized by white matter diffusivity and anatomical network connectivity among regions of the brain, potentially leading to the enhanced reward system and impaired inhibitory control.

Neural correlates of beneficial effects of young plasma treatment in aged mice: PET-SPM analyses and neuro-behavioural/molecular biological studies

PURPOSE

To investigate the in vivo neurofunctional changes and therapeutic effects of young blood plasma (YBP) in aged mice, as well as the molecular mechanisms underlying the therapeutic effects of YBP ex vivo and in vitro.

METHODS

Aged C57/BL6 mice received systemic administrations of phosphate-buffered saline (PBS) or YBP twice a week, for 4 weeks. In vivo 2-[¹⁸F]-fluoro-2-deoxy-D-glucose positron emission tomography (¹⁸F-FDG PET) under conscious state and cognitive behavioural tests were performed after 4-week treatment. In addition, an in vitro senescent model was established, and the expressions of key cognition-associated proteins and/or the alterations of key neuronal pathways were analysed in both brain tissues and cultured cells.

RESULTS

Aged mice treated with YBP demonstrated higher glucose metabolism in the right hippocampus and bilateral somatosensory cortices, and lower glucose metabolism in the right bed nucleus of stria terminalis and left cerebellum. YBP treatment exerted beneficial effects on the spatial and long-term social recognition memory, and significantly increased the expressions of several cognition-related proteins and altered the key neuronal signalling pathways in the hippocampus and somatosensory cortex. Further in vitro studies suggested that YBP but not aged blood plasma significantly upregulated the expressions of several cognition-associated proteins.

CONCLUSION

Our results highlight the role of the hippocampus and somatosensory cortex in YBP-induced beneficial effects on recognition memory in aged mice. ¹⁸F-FDG PET imaging under conscious state provides a new avenue for exploring the mechanisms underlying YBP treatment against age-related cognitive decline.

Metabolomics and Whole-Exome Sequencing in Patients with Differential Sensitivity to Sevoflurane: A Protocol for a Prospective Observational Trial

Introduction: Different sensitivity to volatile anesthetics in Drosophila, nematodes and mice is related to mutation of energy metabolism genes. In clinical practice, we find that the end-tidal sevoflurane concentration (ET_sevo) differs among patients at the same depth of anesthesia, indicating that the sensitivity to sevoflurane varies among patients. However, the underlying mechanism remains unclear. The sensitivity of an anesthetic is associated with the postoperative outcomes of patients and the mechanism of action of volatile anesthetics. We therefore propose this protocol to determine whether differences in metabolite profile and genetic variations contribute to patients' sensitivity to volatile anesthetics. Methods and Analysis: This is a single-centre, prospective observational study. 720 patients undergoing abdominal surgery were included. General anesthesia was induced with inhaled sevoflurane, a bolus of sufentanil (0.2-0.4 μg/kg) and cis-atracurium (0.2-0.3 mg/kg). The end-tidal sevoflurane concentration (ET_sevo) was adjusted to maintain a BIS (bispectral index) value between 40-60. The mean ET_sevo from 20 min after endotracheal intubation to 2 h after the beginning of surgery (steady state) was calculated for each patient. Patients were further divided into a high-sensitivity group (mean ET_sevo - SD) and a low-sensitivity group (mean ET_sevo + SD) to investigate the sensitivity to sevoflurane. Cases were paired from the high-sensitivity group (group H) and low-sensitivity group (group L) according to age, sex, body mass index (BMI), ASA physical status classification, vital signs, BIS, ephedrine use, sufentanildose, and cis-atracurium dose at anesthesia induction and steady state. Differences in metabolite levels, single nucleotide polymorphisms (SNPs) and protein-coding gene sequence variations between group H and group L will be determined through plasma metabolomics, whole-exome sequencing (WES), genome-wide association study (GWAS), and bioinformatics analyses. These results will be analysed to determine the reasons for the differential sensitivity to sevoflurane in humans. Ethics and Dissemination: This prospective observational study protocol has received ethical approval from the Ethical Committee of West China Hospital of Sichuan University on May 19, 2017 (Approval No. 78). Informed consent will be obtained before patient enrolment. The results will be submitted to international peer-review journals. Trial Registration Number: ChiCTR1800014327.

How Energy Supports Our Brain to Yield Consciousness: Insights From Neuroimaging Based on the Neuroenergetics Hypothesis

Consciousness is considered a result of specific neuronal processes and mechanisms in the brain. Various suggested neuronal mechanisms, including the information integration theory (IIT), global neuronal workspace theory (GNWS), and neuronal construction of time and space as in the context of the temporospatial theory of consciousness (TTC), have been laid forth. However, despite their focus on different neuronal mechanisms, these theories neglect the energetic-metabolic basis of the neuronal mechanisms that are supposed to yield consciousness. Based on the findings of physiology-induced (sleep), pharmacology-induced (general anesthesia), and pathology-induced [vegetative state/unresponsive wakeful syndrome (VS/UWS)] loss of consciousness in both human subjects and animals, we, in this study, suggest that the energetic-metabolic processes focusing on ATP, glucose, and γ-aminobutyrate/glutamate are indispensable for functional connectivity (FC) of normal brain networks that renders consciousness possible. Therefore, we describe the energetic-metabolic predispositions of consciousness (EPC) that complement the current theories focused on the neural correlates of consciousness (NCC).