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News

Researchers investigate perceptual awareness during anaesthesia

Medical Research Council : 24 October, 2013  (Technical Article)
The Medical Research Council is funding studies into levels of consciousness during different doses of anaesthesia to pinpoint accurate levels required for vulnerable patients
Researchers investigate perceptual awareness during anaesthesia


Researchers part funded by the Medical Research Council (MRC) have shown that measuring slow-wave activity in an individual’s brain while they are under anaesthetic offers the clearest picture yet of degrees of perceptual awareness in the brain during the period of anaesthesia. This research could lead to the first personalised method for administering appropriate doses of anaesthetic during operations and potentially reduce the risks associated with being under a general anaesthetic.



The work was carried out at the University of Oxford in the Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) and was funded by the MRC, the Wellcome Trust, International Anaesthesia Research Society and the National Institute of Academic Anaesthesia. The results are published online today in the journal Science Translational Medicine.



Currently, when an individual is given anaesthetic for an operation, their organs’ responses are monitored around the body, such as heart rate and rate of respiration. This method, if it continues to prove successful in subsequent studies would address a need for a direct, accurate method with which to pinpoint an anaesthetised brain’s level of consciousness. While the risk of side-effects from anaesthetic is low and the risk of waking up during an operation lower still, older people and those with cardiac or neurological problems remain more vulnerable to complications from the administration of unnecessarily high doses of anaesthetics.



The research team administered a standard anaesthetic, propofol, over an extended period of time to 16 subjects and exposed the subjects to different kinds of stimuli, while recording the brain’s electrical activity using electroencephalography (EEG). By measuring slow-wave activity, they found that there were commons patterns of behaviour among the group as they lost consciousness – but that these behaviours  happened at different times unique to each individual.



They found that beyond the stage where they stopped responding to standard external stimuli, subjects reached a state where the slow-activity waves in the brain stayed the same, even as higher doses of anaesthetic were given. The researchers also showed that there was a relationship between slow wave saturation amplitude and grey matter volume in the frontal parts of their brains.



Using a combination of EEG and functional magnetic resonance imaging (fMRI) they then measured slow-wave activity in the brains of 12 members of the group. The fMRI data helped reveal that at this ‘saturation’ of the slow wave activity, the brain became ‘isolated’ from the external world; the brain regions that would usually be expected to respond to standard stimuli were no longer activated. This indicates that there is an optimum depth of anaesthesia producing perception loss beyond which further anaesthetic is not needed.



Professor Irene Tracey, Director of the FMRIB at the University of Oxford and senior author of the paper, said: “Despite the hundreds of thousands of anaesthetics administered daily to patients, remarkably there is no robust, individualised indicator of perceptual awareness available. While we can indirectly gauge whether a patient physically responds to their environment, this imaging method offers a much more nuanced approach. The next stage in the development of this method will be to see if it is similarly illuminating when we monitor anaesthetised patients undergoing surgery.”



Professor Hugh Perry, Chairman of the Neurosciences and Mental Health Board at the Medical Research Council, said: “With the growing use of anaesthetics in the elderly and other at-risk groups, understanding the minimal dose required to induce the necessary level of anaesthesia is hugely important. This work, part funded by the MRC, is an excellent example of implementing cutting-edge imaging techniques in a way that provides an excellent scientific foundation for new ways of treating vulnerable patients.”


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