disconnected consciousness; propofol sedation; sensory gating; serial awakening paradigm; slow wave activity; General Neuroscience
Abstract :
[en] [en] BACKGROUND: Disconnected consciousness describes a state in which subjective experience (i.e., consciousness) becomes isolated from the external world. It appears frequently during sleep or sedation, when subjective experiences remain vivid but are unaffected by external stimuli. Traditional methods of differentiating connected and disconnected consciousness, such as relying on behavioral responsiveness or on post-anesthesia reports, have demonstrated limited accuracy: unresponsiveness has been shown to not necessarily equate to unconsciousness and amnesic effects of anesthesia and sleep can impair explicit recollection of events occurred during sleep/sedation. Due to these methodological challenges, our understanding of the neural mechanisms underlying sensory disconnection remains limited.
METHODS: To overcome these methodological challenges, we employ a distinctive strategy by combining a serial awakening paradigm with auditory stimulation during mild propofol sedation. While under sedation, participants are systematically exposed to auditory stimuli and questioned about their subjective experience (to assess consciousness) and their awareness of the sounds (to evaluate connectedness/disconnectedness from the environment). The data collected through interviews are used to categorize participants into connected and disconnected consciousness states. This method circumvents the requirement for responsiveness in assessing consciousness and mitigates amnesic effects of anesthesia as participants are questioned while still under sedation. Functional MRI data are concurrently collected to investigate cerebral activity patterns during connected and disconnected states, to elucidate sensory disconnection neural gating mechanisms. We examine whether this gating mechanism resides at the thalamic level or results from disruptions in information propagation to higher cortices. Furthermore, we explore the potential role of slow-wave activity (SWA) in inducing disconnected consciousness by quantifying high-frequency BOLD oscillations, a known correlate of slow-wave activity.
DISCUSSION: This study represents a notable advancement in the investigation of sensory disconnection. The serial awakening paradigm effectively mitigates amnesic effects by collecting reports immediately after regaining responsiveness, while still under sedation. Ultimately, this research holds the potential to understand how sensory gating is achieved at the neural level. These biomarkers might be relevant for the development of sensitive anesthesia monitoring to avoid intraoperative connected consciousness and for the assessment of patients suffering from pathologically reduced consciousness.
CLINICAL TRIAL REGISTRATION: European Union Drug Regulating Authorities Clinical Trials Database (EudraCT), identifier 2020-003524-17.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Montupil, Javier ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Mortaheb, Sepehr ; Université de Liège - ULiège > Psychologie et Neuroscience Cognitives (PsyNCog) ; Université de Liège - ULiège > GIGA > GIGA CRC In vivo Imaging - Physiology of Cognition
Panda, Rajanikant ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
Sanders, Robert D; Central Clinical School, Sydney Medical School & NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia ; Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
Phillips, Christophe ; Université de Liège - ULiège > GIGA > GIGA CRC In vivo Imaging - Neuroimaging, data acquisition and processing
Alnagger, Naji ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
Remacle, Emma; Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liège, Liège, Belgium
DEFRESNE, Aline ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Boly, Mélanie ; Université de Liège - ULiège > Département des sciences cliniques > Neurologie ; Department of Psychiatry, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin, Madison, WI, United States
Bahri, Mohamed Ali ; Université de Liège - ULiège > Département de physique ; Université de Liège - ULiège > GIGA > GIGA CRC In vivo Imaging - Aging & Memory
Lamalle, Laurent ; Université de Liège - ULiège > Département des sciences cliniques ; Université de Liège - ULiège > GIGA > GIGA CRC In vivo Imaging - Aging & Memory
Laureys, Steven ; Université de Liège - ULiège > Département des sciences cliniques ; Cervo Brain Research Centre, University Institute in Mental Health of Quebec, Québec, QC, Canada ; Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
Gosseries, Olivia ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
Bonhomme, Vincent ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Anesthesia and Intensive Care Laboratory
Annen, Jitka ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group ; Department of Data Analysis, University of Ghent, Ghent, Belgium
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