Sattin Davide, Duran Dunja, Visintini Sergio, Schiaffi Elena, Panzica Ferruccio, Carozzi Carla, Rossi Sebastiano Davide, Visani Elisa, Tobaldini Eleonora, Carandina Angelica, Citterio Valeria, Magnani Francesca Giulia, Cacciatore Martina, Orena Eleonora, Montano Nicola, Caldiroli Dario, Franceschetti Silvana, Picozzi Mario, Matilde Leonardi
Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Clinical and Experimental Medicine and Medical Humanities-PhD Program, Insubria University, Varese, Italy.
Front Syst Neurosci. 2021 Apr 6;15:652080. doi: 10.3389/fnsys.2021.652080. eCollection 2021.
The analysis of the central and the autonomic nervous systems (CNS, ANS) activities during general anesthesia (GA) provides fundamental information for the study of neural processes that support alterations of the consciousness level. In the present pilot study, we analyzed EEG signals and the heart rate (HR) variability (HRV) in a sample of 11 patients undergoing spinal surgery to investigate their CNS and ANS activities during GA obtained with propofol administration. Data were analyzed during different stages of GA: baseline, the first period of anesthetic induction, the period before the loss of consciousness, the first period after propofol discontinuation, and the period before the recovery of consciousness (ROC). In EEG spectral analysis, we found a decrease in posterior alpha and beta power in all cortical areas observed, except the occipital ones, and an increase in delta power, mainly during the induction phase. In EEG connectivity analysis, we found a significant increase of local efficiency index in alpha and delta bands between baseline and loss of consciousness as well as between baseline and ROC in delta band only and a significant reduction of the characteristic path length in alpha band between the baseline and ROC. Moreover, connectivity results showed that in the alpha band there was mainly a progressive increase in the number and in the strength of incoming connections in the frontal region, while in the beta band the parietal region showed mainly a significant increase in the number and in the strength of outcoming connections values. The HRV analysis showed that the induction of anesthesia with propofol was associated with a progressive decrease in complexity and a consequent increase in the regularity indexes and that the anesthetic procedure determined bradycardia which was accompanied by an increase in cardiac sympathetic modulation and a decrease in cardiac parasympathetic modulation during the induction. Overall, the results of this pilot study showed as propofol-induced anesthesia caused modifications on EEG signal, leading to a "rebalance" between long and short-range cortical connections, and had a direct effect on the cardiac system. Our data suggest interesting perspectives for the interactions between the central and autonomic nervous systems for the modulation of the consciousness level.
全身麻醉（GA）期间中枢神经系统（CNS）和自主神经系统（ANS）活动的分析为研究支持意识水平改变的神经过程提供了基础信息。在本初步研究中，我们分析了11例接受脊柱手术患者的脑电图（EEG）信号和心率（HR）变异性（HRV），以研究丙泊酚给药诱导全身麻醉期间其CNS和ANS的活动。在全身麻醉的不同阶段对数据进行了分析：基线期、麻醉诱导的第一阶段、意识丧失前阶段、丙泊酚停药后的第一阶段以及意识恢复前阶段（ROC）。在EEG频谱分析中，我们发现除枕叶外，所有观察到的皮质区域的后α和β功率均降低，而δ功率增加，主要发生在诱导期。在EEG连通性分析中，我们发现α和δ频段的局部效率指数在基线和意识丧失之间以及仅在δ频段的基线和ROC之间显著增加，而α频段的特征路径长度在基线和ROC之间显著缩短。此外，连通性结果表明，在α频段，额叶区域传入连接的数量和强度主要呈逐渐增加趋势，而在β频段，顶叶区域传出连接值的数量和强度主要显著增加。HRV分析表明，丙泊酚诱导麻醉与复杂性逐渐降低以及规律性指数相应增加有关，并且麻醉过程导致心动过缓，在诱导期间伴有心脏交感神经调制增加和心脏副交感神经调制减少。总体而言，本初步研究结果表明，丙泊酚诱导的麻醉对EEG信号产生了改变，导致长程和短程皮质连接之间的“重新平衡”，并对心脏系统有直接影响。我们的数据为中枢神经系统和自主神经系统之间相互作用调节意识水平提供了有趣的观点。
