• Anesthesiology · Jun 2019

    Observational Study

    Dynamic Cortical Connectivity during General Anesthesia in Surgical Patients.

    Simple measurement of cortical functional connectivity will not be enough to assess adequacy of general anesthesia.

    pearl
    • Phillip E Vlisides, Duan Li, Mackenzie Zierau, Andrew P Lapointe, Ka I Ip, Amy M McKinney, and George A Mashour.
    • From the Department of Anesthesiology (P.E.V., D.L., M.Z., A.P.L., K.I.I., A.M.M., G.A.M.) the Center for Consciousness Science (P.E.V., D.L., G.A.M.) the Neuroscience Graduate Program (G.A.M.), University of Michigan Medical School Ann Arbor, Michigan the Department of Psychology, University of Michigan, Ann Arbor, Michigan (K.I.I.).
    • Anesthesiology. 2019 Jun 1; 130 (6): 885-897.

    BackgroundFunctional connectivity across the cortex has been posited to be important for consciousness and anesthesia, but functional connectivity patterns during the course of surgery and general anesthesia are unknown. The authors tested the hypothesis that disrupted cortical connectivity patterns would correlate with surgical anesthesia.MethodsSurgical patients (n = 53) were recruited for study participation. Whole-scalp (16-channel) wireless electroencephalographic data were prospectively collected throughout the perioperative period. Functional connectivity was assessed using weighted phase lag index. During anesthetic maintenance, the temporal dynamics of connectivity states were characterized via Markov chain analysis, and state transition probabilities were quantified.ResultsCompared to baseline (weighted phase lag index, 0.163, ± 0.091), alpha frontal-parietal connectivity was not significantly different across the remaining anesthetic and perioperative epochs, ranging from 0.100 (± 0.041) to 0.218 (± 0.136) (P > 0.05 for all time periods). In contrast, there were significant increases in alpha prefrontal-frontal connectivity (peak = 0.201 [0.154, 0.248]; P < 0.001), theta prefrontal-frontal connectivity (peak = 0.137 [0.091, 0.182]; P < 0.001), and theta frontal-parietal connectivity (peak = 0.128 [0.084, 0.173]; P < 0.001) during anesthetic maintenance. Additionally, shifts occurred between states of high prefrontal-frontal connectivity (alpha, beta) with suppressed frontal-parietal connectivity, and high frontal-parietal connectivity (alpha, theta) with reduced prefrontal-frontal connectivity. These shifts occurred in a nonrandom manner (P < 0.05 compared to random transitions), suggesting structured transitions of connectivity during general anesthesia.ConclusionsFunctional connectivity patterns dynamically shift during surgery and general anesthesia but do so in a structured way. Thus, a single measure of functional connectivity will likely not be a reliable correlate of surgical anesthesia.

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    Simple measurement of cortical functional connectivity will not be enough to assess adequacy of general anesthesia.

    Daniel Jolley  Daniel Jolley
     
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