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Decreased thalamic activity is a correlate for disconnectedness during anesthesia with Propofol, Dexmedetomidine and Sevoflurane but not S-ketamine
Turku PET Centre, University of Turku and Turku University Hospital, Turku FI, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, University of Turku, Turku FI, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Satakunta Central Hospital, Pori FI, Finland.
Turku PET Centre, University of Turku and Turku University Hospital, Turku FI, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, University of Turku, Turku FI, Finland.
Department of Anesthesiology and Perioperative Medicine, University of California, CA, Irvine, United States.
Turku PET Centre, University of Turku and Turku University Hospital, Turku FI, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, University of Turku, Turku FI, Finland.
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2023 (English)In: Journal of Neuroscience, ISSN 0270-6474, E-ISSN 1529-2401, Vol. 43, no 26, p. 4884-4895Article in journal (Refereed) Published
Abstract [en]

Establishing the neural mechanisms responsible for the altered global states of consciousness during anesthesia and dissociating these from other drug-related effects remains a challenge in consciousness research. We investigated differences in brain activity between connectedness and disconnectedness by administering various anesthetics at concentrations designed to render 50% of the subjects unresponsive. One hundred and sixty healthy male subjects were randomized to receive either propofol (1.7 μg/ml; n = 40), dexmedetomidine (1.5 ng/ml; n = 40), sevoflurane (0.9% end-tidal; n = 40), S-ketamine (0.75 μg/ml; n = 20), or saline placebo (n = 20) for 60 min using target-controlled infusions or vaporizer with end-tidal monitoring. Disconnectedness was defined as unresponsiveness to verbal commands probed at 2.5-min intervals and unawareness of external events in a postanesthesia interview. High-resolution positron emission tomography (PET) was used to quantify regional cerebral metabolic rates of glucose (CMRglu) utilization. Contrasting scans where the subjects were classified as connected and responsive versus disconnected and unresponsive revealed that for all anesthetics, except S-ketamine, the level of thalamic activity differed between these states. A conjunction analysis across the propofol, dexmedetomidine and sevoflurane groups confirmed the thalamus as the primary structure where reduced metabolic activity was related to disconnectedness. Widespread cortical metabolic suppression was observed when these subjects, classified as either connected or disconnected, were compared with the placebo group, suggesting that these findings may represent necessary but alone insufficient mechanisms for the change in the state of consciousness.

Place, publisher, year, edition, pages
Society for Neuroscience , 2023. Vol. 43, no 26, p. 4884-4895
Keywords [en]
Anesthesia, connected, consciousness, disconnected, neuroimaging, positron emission tomography
National Category
Anesthesiology and Intensive Care Neurosciences
Identifiers
URN: urn:nbn:se:umu:diva-212052DOI: 10.1523/JNEUROSCI.2339-22.2023ISI: 001032235600003PubMedID: 37225435Scopus ID: 2-s2.0-85163612479OAI: oai:DiVA.org:umu-212052DiVA, id: diva2:1782931
Available from: 2023-07-18 Created: 2023-07-18 Last updated: 2025-04-24Bibliographically approved

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