Dreaming and Electroencephalographic Changes during Anesthesia Maintained with Propofol or Desflurane

Leslie, Kate; Sleigh, Jamie; Paech, Michael J.; Voss, Logan J.; Lim, Chiew Woon; Sleigh, Callum

doi:10.1097/aln.0b013e3181adf768

Cited by 99 publications

(87 citation statements)

References 24 publications

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“…Finally, given the importance of ubiquitously high oxidative energy demand for supporting conscious human behavior, 63 we propose that clinical fMRI studies could take advantage of quantitative measures of metabolic energy when evaluating patients. [70][71][72][73][74] Reproduced with permission from Clin Pharmacol Ther. 72 (B) Non-REM sleep shows CMR glc in the visual cortex to be reduced to 0.26±0.06 mmol/g per minute from 0.33±0.07 mmol/g per minute in the awake brain.…”

Section: Discussionmentioning

confidence: 99%

Glutamatergic Function in the Resting Awake Human Brain is Supported by Uniformly High Oxidative Energy

Hyder

Fulbright

Shulman

et al. 2013

J Cereb Blood Flow Metab

110

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Rodent 13 C magnetic resonance spectroscopy studies show that glutamatergic signaling requires high oxidative energy in the awake resting state and allowed calibration of functional magnetic resonance imaging (fMRI) signal in terms of energy relative to the resting energy. Here, we derived energy used for glutamatergic signaling in the awake resting human. We analyzed human data of electroencephalography (EEG), positron emission tomography (PET) maps of oxygen (CMR O2 ) and glucose (CMR glc ) utilization, and calibrated fMRI from a variety of experimental conditions. CMR glc and EEG in the visual cortex were tightly coupled over several conditions, showing that the oxidative demand for signaling was four times greater than the demand for nonsignaling events in the awake state. Variations of CMR O2 and CMR glc from gray-matter regions and networks were within ±10% of means, suggesting that most areas required similar energy for ubiquitously high resting activity. Human calibrated fMRI results suggest that changes of fMRI signal in cognitive studies contribute at most ± 10% CMR O2 changes from rest. The PET data of sleep, vegetative state, and anesthesia show metabolic reductions from rest, uniformly 420% across, indicating no region is selectively reduced when consciousness is lost. Future clinical investigations will benefit from using quantitative metabolic measures. Keywords: astrocytes; baseline; field potentials; glutamate; multiunit activity; resting state INTRODUCTIONThe human brain consumes 20% of the body's energy at rest despite being only 2% of total body mass. 1 Normally glucose oxidation is the source of energy production supporting brain function 2 in which gray-matter signaling (i.e., events associated with neuronal firing) is dominated by glutamatergic neurons. 3 Estimates of the fraction of resting brain energy devoted to signaling were originally quite low. 4 But recent experimental studies in rodents and theoretical modeling have converged on the conclusion that majority of the resting energy consumption supports glutamatergic signaling and the energy demand changes linearly with pyramidal neuron firing rates and glutamate neurotransmitter release and reuptake. [5][6][7][8][9] Therefore in rodent models it is possible, to a first order, to show that the resting energy is primarily dedicated to total glutamatergic signaling, and the changes in neuronal signaling relative to a well-defined resting activity level can be used to calibrate changes in energy consumption during functional magnetic resonance imaging (fMRI) experiments. 10,11 In the awake human brain, however, the fraction of resting energy usage devoted to glutamatergic signaling is less well understood. The magnitude of neuronal signaling in the human brain, and by inference the commensurate energy demand, underscores the functional relevance of resting activity and has profound implications for interpreting fMRI experiments in humans. [12][13][14] Given the rapidly increasing use of resting-state fMRI in mapping networks-defined as a...

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Section: Discussionmentioning

confidence: 99%

Glutamatergic Function in the Resting Awake Human Brain is Supported by Uniformly High Oxidative Energy

Hyder

Fulbright

Shulman

et al. 2013

J Cereb Blood Flow Metab

110

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“…In the latter case, a person can be conscious without experiencing the external world. An example of this is dreaming during natural sleep, but dreaming also seems to occur in more than a quarter of patients anesthetized with propofol or desflurane [43]. Another finding reported by Sanders et al is based on the isolated forearm technique (IFT).…”

Section: Recent Advances Changing Our View Of Palliative Sedationmentioning

confidence: 89%

Assessment of Patient Comfort During Palliative Sedation: Is it always Reliable?

Deschepper

Bilsen

Laureys

2014

Annual Update in Intensive Care and Emergency Medicine 2014

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“…Die Trauminzidenz wird bestimmt durch [28,32]: F Auswahl des Anästhetikums, F Prämedikation, F Zeitpunkt der Befragung, F Alter und Geschlecht sowie F Art und Schwere des operativen Eingriffs.…”

Section: Wahrnehmungen Unter Anästhesie Oder Sedierungunclassified

Sexualbezogene Halluzinationen und Träume unter Anästhesie und Sedierung

Schneemilch

Schiltz²,

Meinshausen³

et al. 2012

Anaesthesist

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Dreams and hallucinations under sedation or anesthesia have been well known phenomena since the introduction of anesthesia. Sexual hallucinations may lead to allegations of sexual molestation or assault by medical doctors or professional nursing staff. Hallucinations under the influence of sedative or hypnotic drugs may be very vivid and as misinterpreted as being real and it is therefore often difficult to disprove the resulting false allegations. In this report the terms drug-induced dreams and hallucinations are defined and the probable mechanism described. By a historical review and case reports the medicolegal consequences are demonstrated and procedures recommended to avoid allegations of sexual assault.

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Dreaming and Electroencephalographic Changes during Anesthesia Maintained with Propofol or Desflurane

Abstract: Anesthetic-related dreaming seems to occur just before awakening and is associated with a rapid eye movement-like electroencephalographic pattern.

Cited by 99 publications

References 24 publications

Glutamatergic Function in the Resting Awake Human Brain is Supported by Uniformly High Oxidative Energy

Glutamatergic Function in the Resting Awake Human Brain is Supported by Uniformly High Oxidative Energy

Assessment of Patient Comfort During Palliative Sedation: Is it always Reliable?

Sexualbezogene Halluzinationen und Träume unter Anästhesie und Sedierung

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