Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114;
Harvard Medical School, Boston, MA 02115.
Proc Natl Acad Sci U S A. 2017 Aug 8;114(32):E6660-E6668. doi: 10.1073/pnas.1700148114. Epub 2017 Jul 25.
General anesthesia (GA) is a reversible drug-induced state of altered arousal required for more than 60,000 surgical procedures each day in the United States alone. Sedation and unconsciousness under GA are associated with stereotyped electrophysiological oscillations that are thought to reflect profound disruptions of activity in neuronal circuits that mediate awareness and cognition. Computational models make specific predictions about the role of the cortex and thalamus in these oscillations. In this paper, we provide in vivo evidence in rats that alpha oscillations (10-15 Hz) induced by the commonly used anesthetic drug propofol are synchronized between the thalamus and the medial prefrontal cortex. We also show that at deep levels of unconsciousness where movement ceases, coherent thalamocortical delta oscillations (1-5 Hz) develop, distinct from concurrent slow oscillations (0.1-1 Hz). The structure of these oscillations in both cortex and thalamus closely parallel those observed in the human electroencephalogram during propofol-induced unconsciousness. During emergence from GA, this synchronized activity dissipates in a sequence different from that observed during loss of consciousness. A possible explanation is that recovery from anesthesia-induced unconsciousness follows a "boot-up" sequence actively driven by ascending arousal centers. The involvement of medial prefrontal cortex suggests that when these oscillations (alpha, delta, slow) are observed in humans, self-awareness and internal consciousness would be impaired if not abolished. These studies advance our understanding of anesthesia-induced unconsciousness and altered arousal and further establish principled neurophysiological markers of these states.
全身麻醉(GA)是一种药物诱导的意识改变状态,在美国每天就有超过 6 万例手术需要使用全身麻醉。GA 下的镇静和无意识与刻板的电生理振荡有关,这些振荡被认为反映了介导意识和认知的神经元回路中深刻的活动中断。计算模型对皮层和丘脑在这些振荡中的作用做出了具体的预测。在本文中,我们提供了大鼠体内的证据,表明常用麻醉药物异丙酚诱导的 alpha 振荡(10-15 Hz)在丘脑和内侧前额叶皮层之间是同步的。我们还表明,在运动停止的深度无意识状态下,会出现连贯的丘脑皮质 delta 振荡(1-5 Hz),与同时发生的慢振荡(0.1-1 Hz)不同。皮层和丘脑中的这些振荡结构与异丙酚诱导的无意识期间在人类脑电图中观察到的振荡结构非常相似。在全身麻醉苏醒期间,这种同步活动的消散顺序与意识丧失期间观察到的不同。一种可能的解释是,麻醉诱导的无意识的恢复遵循一个“启动”序列,由上升的觉醒中心主动驱动。内侧前额叶皮层的参与表明,如果没有消除的话,当这些振荡(alpha、delta、slow)在人类中被观察到时,自我意识和内部意识将会受到损害。这些研究增进了我们对麻醉诱导的无意识和觉醒改变的理解,并进一步确立了这些状态的神经生理学标记。