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Elife. 2018 Aug 10;7. pii: e33250. doi: 10.7554/eLife.33250.

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

Author information

1
Society of Fellows, Harvard University, Cambridge, United States.
2
Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, United States.
3
Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, United States.
4
Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, United States.
5
Harvard Medical School, Boston, United States.
6
Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, United States.
7
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, United States.
8
Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Unites States.
9
Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, United States.
10
Department of Cognitive Science, University of California, San Diego, San Diego, United States.

Abstract

During awake consciousness, the brain intrinsically maintains a dynamical state in which it can coordinate complex responses to sensory input. How the brain reaches this state spontaneously is not known. General anesthesia provides a unique opportunity to examine how the human brain recovers its functional capabilities after profound unconsciousness. We used intracranial electrocorticography and scalp EEG in humans to track neural dynamics during emergence from propofol general anesthesia. We identify a distinct transient brain state that occurs immediately prior to recovery of behavioral responsiveness. This state is characterized by large, spatially distributed, slow sensory-evoked potentials that resemble the K-complexes that are hallmarks of stage two sleep. However, the ongoing spontaneous dynamics in this transitional state differ from sleep. These results identify an asymmetry in the neurophysiology of induction and emergence, as the emerging brain can enter a state with a sleep-like sensory blockade before regaining responsivity to arousing stimuli.

KEYWORDS:

anesthesia; dynamics; electrocorticography; emergence; human; neuroscience

PMID:
30095069
PMCID:
PMC6086660
DOI:
10.7554/eLife.33250
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

LL Co-author of pending patents on EEG monitoring for general anesthesia (US20140316217A1). GP, RP, EE, PH, OA, LA, SC No competing interests declared, EB Co-author of pending patents on EEG monitoring for general anesthesia (US20140316217A1, WO2015108908A3). EM Co-author of pending patents on EEG monitoring for general anesthesia (WO2015108908A3). PP Patrick L Purdon: Co-author of pending patents on EEG monitoring for general anesthesia (US20140316217A1, WO2015108908A3).

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