A transient cortical state with sleep-like sensory responses precedes emergence from general anesthesia in humans

Lewis, Laurie; Piantoni, Giovanni; Peterfreund, Robert A.; Eskandar, Emad N.; Harrell, P. Grace; Akeju, Oluwaseun; Aglio, Linda S.; Cash, Sydney S.; Brown, Emery N.; Mukamel, Eran A.; Purdon, Patrick L.

doi:10.7554/elife.33250

Cited by 19 publications

(15 citation statements)

References 66 publications

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“…31 We identified state transitions and aligned DF/F with a window of À180 s~+300 s before and after 2% sevoflurane being turned on or off. 37 The onset of LOC was defined as the transition from a low-amplitude, high-frequency EEG to a high-amplitude, low-frequency EEG, combined with ll e2 Current Biology 31, 1-10.e1-e5, May 10, 2021…”

Section: Surgerymentioning

confidence: 99%

Nucleus accumbens neurons expressing dopamine D1 receptors modulate states of consciousness in sevoflurane anesthesia

Bao

Pan

et al. 2021

Current Biology

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Section: Surgerymentioning

confidence: 99%

Nucleus accumbens neurons expressing dopamine D1 receptors modulate states of consciousness in sevoflurane anesthesia

Bao

Pan

et al. 2021

Current Biology

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“…This phenomenon may differ between anesthetic agents and is larger with the more potent ones (Kuizenga et al, 2018). Several EEG-based pharmacodynamic measures have been used to track the anesthesia recovery process (Purdon et al, 2013), and a phenomenon of hysteresis has been observed for the power spectrum, connectivity measures, structure and strength of networks (Kim et al, 2018), sensory-evoked EEG responses (Lewis et al, 2018), and slow-wave EEG activity saturation (Warnaby et al, 2017). The proposed involved mechanisms remain elusive.…”

Section: Emerging Issuesmentioning

confidence: 99%

General Anesthesia: A Probe to Explore Consciousness

Bonhomme

Staquet

Montupil

et al. 2019

Front. Syst. Neurosci.

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

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“…In spite of the clear preclinical evidence, anesthetic hysteresis (and neural inertia) in humans has been controversial ( Breshears et al, 2010 ; Ferreira et al, 2020 ; Kuizenga et al, 2018 ; Lewis et al, 2018 ; Proekt and Kelz, 2018 ; Pullon et al, 2020 ; Purdon et al, 2013 ; Sepúlveda et al, 2019 ; Warnaby et al, 2017 ) suggesting a need for further investigations. Other than studies employing multichannel EEG or ECoG ( Breshears et al, 2010 ; Lewis et al, 2018 ; Pullon et al, 2020 ; Purdon et al, 2013 ; Warnaby et al, 2017 ), there has been no human neuroimaging, such as functional magnetic resonance imaging (fMRI), investigation of the question.…”

Section: Introductionmentioning

confidence: 99%

Asymmetric neural dynamics characterize loss and recovery of consciousness

et al. 2021

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Anesthetics are known to disrupt neural interactions in cortical and subcortical brain circuits. While the effect of anesthetic drugs on consciousness is reversible, the neural mechanism mediating induction and recovery may be different. Insight into these distinct mechanisms can be gained from a systematic comparison of neural dynamics during slow induction of and emergence from anesthesia. To this end, we used functional magnetic resonance imaging (fMRI) data obtained in healthy volunteers before, during, and after the administration of propofol at incrementally adjusted target concentrations. We analyzed functional connectivity of corticocortical and subcorticocortical networks and the temporal autocorrelation of fMRI signal as an index of neural processing timescales. We found that en route to unconsciousness, temporal autocorrelation across the entire brain gradually increased, whereas functional connectivity gradually decreased. In contrast, regaining consciousness was associated with an abrupt restoration of cortical but not subcortical temporal autocorrelation and an abrupt boost of subcorticocortical functional connectivity. Pharmacokinetic effects could not account for the difference in neural dynamics between induction and emergence. We conclude that the induction and recovery phases of anesthesia follow asymmetric neural dynamics. A rapid increase in the speed of cortical neural processing and subcorticocortical neural interactions may be a mechanism that reboots consciousness.

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A transient cortical state with sleep-like sensory responses precedes emergence from general anesthesia in humans

Cited by 19 publications

References 66 publications

Nucleus accumbens neurons expressing dopamine D1 receptors modulate states of consciousness in sevoflurane anesthesia

Nucleus accumbens neurons expressing dopamine D1 receptors modulate states of consciousness in sevoflurane anesthesia

General Anesthesia: A Probe to Explore Consciousness

Asymmetric neural dynamics characterize loss and recovery of consciousness

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