Comparative effects of dexmedetomidine, propofol, sevoflurane, and S-ketamine on regional cerebral glucose metabolism in humans: a positron emission tomography study

Laaksonen, Lauri; Kallioinen, Minna; Långsjö, Jaakko; Laitio, Timo; Scheinin, Arje; Scheinin, Joonas M; Kaisti, Kaike K.; Maksimow, Anu; Kallionpää, Roosa E.; Rajala, V.; Johansson, Jarkko; Kantonen, Oskari; Nyman, Mikko; Sirén, Saija; Valli, Katja; Revonsuo, Antti; Solin, Olof; Vahlberg, Tero; Alkire, Michael T.; Scheinin, Harry

doi:10.1016/j.bja.2018.04.008

Cited by 44 publications

(46 citation statements)

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“…Our results appear at odds with a recent report (Schroeder et al, 2016), where mLOC occurred despite unchanged levels of overall activity during ketamine-induced dissociative anesthesia (Pender, 1971). But, whereas most first-line anesthetics decrease cerebral metabolism (Laaksonen et al, 2018;Pilge et al, 2014), ketamine differentially affects cerebral hemodynamics and neural firing with a net neutral effect (Cavazzuti et al, 1987;Laaksonen et al, 2018). Keeping in mind that functional brain imaging in the clinical setting relies on changes in cerebral metabolism as a proxy for neural firing (e.g., FDG-PET CT or BOLD signal in fMRI), it is not surprising that Schroeder et al (2016) found a preserved overall firing rate.…”

Section: Discussioncontrasting

confidence: 99%

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness

et al. 2019

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Section: Discussioncontrasting

confidence: 99%

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness

et al. 2019

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“…Inter and intra-subject variabilities could be partly due to anesthesia injected to the animals. Indeed, the effects of different anesthetic drugs on glucose metabolism in the human brain have been recently reported [34] showing that propofol decreased glucose metabolism compared to saline placebo. In preclinics, studies using isoflurane anesthesia reported a higher glucose level post-scan compared to pre-scan in rats, suggesting a different impact of isoflurane on glycemia [22,35].…”

Section: Plos Onementioning

confidence: 99%

Comparative test-retest variability of outcome parameters derived from brain [18F]FDG PET studies in non-human primates

et al. 2020

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Introduction Knowledge of the repeatability of quantitative parameters derived from [ 18 F]FDG PET images is essential to define the group size and allow correct interpretation. Here we tested repeatability and accuracy of different [ 18 F]FDG absolute and relative quantification parameters in a standardized preclinical setup in nonhuman primates (NHP). Material and methods Repeated brain [ 18 F]FDG scans were performed in 6 healthy NHP under controlled experimental factors likely to account for variability. Regional cerebral metabolic rate of glucose (CMRglu) was calculated using a Patlak plot with blood input function Semi-quantitative approaches measuring standard uptake values (SUV, SUV×glycemia and SUVR (SUV Ratio) using the pons or cerebellum as a reference region) were considered. Test-retest variability of all quantification parameters were compared in different brain regions in terms of absolute variability and intra-and-inter-subject variabilities. In an independent [ 18 F]FDG PET experiment, robustness of these parameters was evaluated in 4 naive NHP. Results Experimental conditions (injected dose, body weight, animal temperature) were the same at both imaging sessions (p >0.4). No significant difference in the [ 18 F]FDG quantification parameters was found between test and retest sessions. Absolute variability of CMRglu, SUV, SUV×glycemia and normalized SUV ranged from 25 to 43%, 16 to 21%, 23 to 28%, and 7 to 14%, respectively. Intra-subject variability largely explained the absolute variability of all quantitative parameters. They were all significantly correlated to each other and they were all robust. Arterial and venous glycemia were highly correlated (r = 0.9691; p<0.0001).

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“…e performance of the anesthetic depth monitors was better when propofol was used. Very wide variation was found in the combination of AEP and sevoflurane [22,25,[31][32][33]. It seems the monitors are at best at giving the EC50, at which there is a 50% chance that the patient has reached the end point, and we have not yet found an anesthetic depth monitor that has high sensitivity and specificity and not affected by the anesthetic technique.…”

Section: Discussionmentioning

confidence: 87%

A Crossover Comparison of the Sensitivity and the Specificity between BIS and AEP in Predicting Unconsciousness in General Anesthesia

Huang

Wang

Gao

et al. 2020

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Background. There is an increasing concern of awareness and recall during general anesthesia for both the patient and the anesthetist. The bispectral index (BIS) is used to assess the level of sedation and depth of anesthesia and detect consciousness in different anesthetic drugs. Middle-latency auditory evoked potentials (AEPs) also quantify action of anesthetic drugs and detect the transition from consciousness to unconsciousness. We aim to compare the sensitivity and specificity between BIS and AEP in predicting unconsciousness in inhalational sevoflurane anesthesia and intravenous propofol anesthesia. Methods. Totally, 40 patients were randomly allocated into two groups: propofol or sevoflurane group. In the propofol group, anesthesia was induced with target-controlled infusion propofol. In the sevoflurane group, anesthesia was induced by increasing concentrations of sevoflurane. There were 3 end points during induction: sedation, unconsciousness, and anesthesia. Target and effect-site concentrations of propofol, end-tidal concentration of sevoflurane, and BIS and AEP were recorded at each stage. Results. We obtained good EC50 with both monitors, at which there is a 50% chance that the patient has reached the end point, but the index variation was affected by the anesthetic technique. Propofol had higher correlations with stage of anesthesia, BIS, and AEP than sevoflurane. BIS had higher correlations with depth of anesthesia than AEP, but we did not find an anesthetic depth monitor that had high sensitivity and specificity and is not affected by the anesthetic technique. Conclusions. The prediction powers of BIS and AEP do not seem as good as some papers mentioned.

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Comparative effects of dexmedetomidine, propofol, sevoflurane, and S-ketamine on regional cerebral glucose metabolism in humans: a positron emission tomography study

Abstract: NCT02624401.

Cited by 44 publications

References 34 publications

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness

Reduced Repertoire of Cortical Microstates and Neuronal Ensembles in Medically Induced Loss of Consciousness

Comparative test-retest variability of outcome parameters derived from brain [18F]FDG PET studies in non-human primates

A Crossover Comparison of the Sensitivity and the Specificity between BIS and AEP in Predicting Unconsciousness in General Anesthesia

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