健康男性受试者在右美托咪定或丙泊酚诱导无反应和非快速眼动睡眠期间的主观体验。
Subjective experiences during dexmedetomidine- or propofol-induced unresponsiveness and non-rapid eye movement sleep in healthy male subjects.
机构信息
Department of Psychology and Speech-Language Pathology, Turku Brain and Mind Center, University of Turku, Turku, Finland; Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland; Department of Cognitive Neuroscience and Philosophy, School of Bioscience, University of Skövde, Skövde, Sweden.
Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
出版信息
Br J Anaesth. 2023 Aug;131(2):348-359. doi: 10.1016/j.bja.2023.04.026. Epub 2023 May 31.
BACKGROUND
Anaesthetic-induced unresponsiveness and non-rapid eye movement (NREM) sleep share common neural pathways and neurophysiological features. We hypothesised that these states bear resemblance also at the experiential level.
METHODS
We compared, in a within-subject design, the prevalence and content of experiences in reports obtained after anaesthetic-induced unresponsiveness and NREM sleep. Healthy males (N=39) received dexmedetomidine (n=20) or propofol (n=19) in stepwise doses to induce unresponsiveness. Those rousable were interviewed and left unstimulated, and the procedure was repeated. Finally, the anaesthetic dose was increased 50%, and the participants were interviewed after recovery. The same participants (N=37) were also later interviewed after NREM sleep awakenings.
RESULTS
Most subjects were rousable, with no difference between anaesthetic agents (P=0.480). Lower drug plasma concentrations were associated with being rousable for both dexmedetomidine (P=0.007) and propofol (P=0.002) but not with recall of experiences in either drug group (dexmedetomidine: P=0.543; propofol: P=0.460). Of the 76 and 73 interviews performed after anaesthetic-induced unresponsiveness and NREM sleep, 69.7% and 64.4% included experiences, respectively. Recall did not differ between anaesthetic-induced unresponsiveness and NREM sleep (P=0.581), or between dexmedetomidine and propofol in any of the three awakening rounds (P>0.05). Disconnected dream-like experiences (62.3% vs 51.1%; P=0.418) and memory incorporation of the research setting (88.7% vs 78.7%; P=0.204) were equally often present in anaesthesia and sleep interviews, respectively, whereas awareness, signifying connected consciousness, was rarely reported in either state.
CONCLUSIONS
Anaesthetic-induced unresponsiveness and NREM sleep are characterised by disconnected conscious experiences with corresponding recall frequencies and content.
CLINICAL TRIAL REGISTRATION
Clinical trial registration. This study was part of a larger study registered at ClinicalTrials.gov (NCT01889004).
背景
麻醉诱导的无反应状态和非快速眼动（NREM）睡眠共享共同的神经通路和神经生理特征。我们假设这些状态在体验层面上也有相似之处。
方法
我们在一项个体内设计中，比较了麻醉诱导无反应状态和 NREM 睡眠后报告中出现的体验的普遍性和内容。健康男性（N=39）接受右美托咪定（n=20）或丙泊酚（n=19）逐步剂量诱导无反应状态。可唤醒的患者接受采访并保持不被刺激，然后重复该过程。最后，将麻醉剂剂量增加 50%，并在恢复后对参与者进行采访。相同的参与者（N=37）之后也在 NREM 睡眠唤醒后接受了采访。
结果
大多数受试者可被唤醒，两种麻醉剂之间无差异（P=0.480）。较低的药物血浆浓度与可唤醒的能力有关，无论是使用右美托咪定（P=0.007）还是丙泊酚（P=0.002），但与两种药物组的体验回忆无关（右美托咪定：P=0.543；丙泊酚：P=0.460）。在麻醉诱导无反应状态和 NREM 睡眠后进行的 76 次和 73 次采访中，分别有 69.7%和 64.4%包括体验。在麻醉诱导无反应状态和 NREM 睡眠之间，或在任何三个唤醒轮次中，右美托咪定和丙泊酚之间的回忆均无差异（P=0.581）。与 NREM 睡眠相比，麻醉诱导无反应状态下更常出现分离的梦境样体验（62.3%对 51.1%；P=0.418）和研究环境的记忆融合（88.7%对 78.7%；P=0.204），而在任何状态下都很少报告意识，表明存在连贯的意识。
结论
麻醉诱导的无反应状态和 NREM 睡眠的特征是有意识的体验与相应的回忆频率和内容分离。
临床试验注册
本研究是在 ClinicalTrials.gov（NCT01889004）注册的更大研究的一部分。
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