Depth of sedation with dexmedetomidine increases transcranial magnetic stimulation-evoked potential amplitude non-linearly.

Humans Transcranial Magnetic Stimulation Dexmedetomidine / pharmacology Evoked Potentials Anesthesia Frontal Lobe
anaesthesia consciousness dexmedetomidine responsiveness sedation transcranial magnetic stimulation-evoked potential

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
10 2023
Historique:
received: 24 06 2021
revised: 09 05 2023
accepted: 30 05 2023
medline: 19 9 2023
pubmed: 19 8 2023
entrez: 18 8 2023
Statut: ppublish

Résumé

Cortical excitability is higher in unconsciousness than in wakefulness, but it is unclear how this relates to anaesthesia. We investigated cortical excitability in response to dexmedetomidine, the effects of which are not fully known. We recorded transcranial magnetic stimulation (TMS) and EEG in frontal and parietal cortex of 20 healthy subjects undergoing dexmedetomidine sedation in four conditions (baseline, light sedation, deep sedation, recovery). We used the first component (0-30 ms) of the TMS-evoked potential (TEP) to measure cortical excitability (amplitude), slope, and positive and negative peak latencies (collectively, TEP indices). We used generalised linear mixed models to test the effect of condition, brain region, and responsiveness on TEP indices. Compared with baseline, amplitude in the frontal cortex increased by 6.52 μV (P<0.001) in light sedation, 4.55 μV (P=0.003) in deep sedation, and 5.03 μV (P<0.001) in recovery. Amplitude did not change in the parietal cortex. Compared with baseline, slope increased in all conditions (P<0.02) in the frontal but not parietal cortex. The frontal cortex showed 5.73 μV higher amplitude (P<0.001), 0.63 μV ms Transcranial magnetic stimulation-evoked potential amplitude changes non-linearly as a function of depth of sedation by dexmedetomidine, with a region-specific paradoxical increase. Future research should investigate other anaesthetics to elucidate the link between cortical excitability and depth of sedation.

Sections du résumé

BACKGROUND
Cortical excitability is higher in unconsciousness than in wakefulness, but it is unclear how this relates to anaesthesia. We investigated cortical excitability in response to dexmedetomidine, the effects of which are not fully known.
METHODS
We recorded transcranial magnetic stimulation (TMS) and EEG in frontal and parietal cortex of 20 healthy subjects undergoing dexmedetomidine sedation in four conditions (baseline, light sedation, deep sedation, recovery). We used the first component (0-30 ms) of the TMS-evoked potential (TEP) to measure cortical excitability (amplitude), slope, and positive and negative peak latencies (collectively, TEP indices). We used generalised linear mixed models to test the effect of condition, brain region, and responsiveness on TEP indices.
RESULTS
Compared with baseline, amplitude in the frontal cortex increased by 6.52 μV (P<0.001) in light sedation, 4.55 μV (P=0.003) in deep sedation, and 5.03 μV (P<0.001) in recovery. Amplitude did not change in the parietal cortex. Compared with baseline, slope increased in all conditions (P<0.02) in the frontal but not parietal cortex. The frontal cortex showed 5.73 μV higher amplitude (P<0.001), 0.63 μV ms
CONCLUSIONS
Transcranial magnetic stimulation-evoked potential amplitude changes non-linearly as a function of depth of sedation by dexmedetomidine, with a region-specific paradoxical increase. Future research should investigate other anaesthetics to elucidate the link between cortical excitability and depth of sedation.

Identifiants

DOI: 10.1016/j.bja.2023.05.030 PMID: 37596183
pubmed: 37596183
pii: S0007-0912(23)00347-1
doi: 10.1016/j.bja.2023.05.030
pii:
doi:

Substances chimiques

Dexmedetomidine 67VB76HONO

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

715-725

Informations de copyright

Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Auteurs

Paolo Cardone (P)

Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium.

Olivier Bodart (O)

Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium; Department of Neurology, University of Liège, Liège, Belgium.

Murielle Kirsch (M)

Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anaesthesia and Intensive Care Medicine, University of Liège, Liège, Belgium.

Julien Sanfilippo (J)

Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium.

Alessandra Virgillito (A)

Department of Rehabilitation, ASL Toscana Nordovest, Livorno, Italy.

Charlotte Martial (C)

Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium.

Jessica Simon (J)

Psychology and Neuroscience of Cognition, University of Liège, Liège, Belgium.

Sarah Wannez (S)

Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.

Robert D Sanders (RD)

Specialty of Anaesthetics, University of Sydney, Camperdown, Australia; Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia.

Steven Laureys (S)

Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium; Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, University Laval, Québec City, QC, Canada.

Marcello Massimini (M)

Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, Milan, Italy; IRCCS Fondazione Don Gnocchi, Milan, Italy.

Gilles Vandewalle (G)

Sleep and Chronobiology Lab, GIGA-Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium.

Vincent Bonhomme (V)

Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anaesthesia and Intensive Care Medicine, University of Liège, Liège, Belgium; University Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier Régional de la Citadelle (CHR Citadelle), Liège, Belgium. Electronic address: vincent.bonhomme@chuliege.be.

Olivia Gosseries (O)

Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau, University of Liège, Liège, Belgium. Electronic address: ogosseries@uliege.be.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Depth of sedation with dexmedetomidine...
questionsmedicales.fr › Thérapeutique › Magnétothérapie › Stimulation magnétique transcrânienne › Depth of sedation with dexmedetomidine...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Azoles › Imidazoles › Dexmédétomidine › Depth of sedation with dexmedetomidine...
questionsmedicales.fr › Phénomènes physiologiques de l'appareil locomoteur et du système nerveux › Phénomènes physiologiques du système nerveux › Excitabilité corticale › Potentiels évoqués › Depth of sedation with dexmedetomidine...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Depth of sedation with dexmedetomidine...
questionsmedicales.fr › Système nerveux › Système nerveux central › Encéphale › Prosencéphale › Télencéphale › Cerveau › Cortex cérébral › Lobe frontal › Depth of sedation with dexmedetomidine...