Incidence of postoperative delirium and quality of recovery in older patients undergoing gastrectomy under general anaesthesia with remimazolam vs. propofol: a randomised non-inferiority study.

Introduction: Due to its haemodynamic stability and rapid recovery from anaesthesia, remimazolam is an attractive hypnotic drug for general anaesthesia in older patients. However, remimazolam must show non-inferiority in terms of the incidence of delirium and quality of postoperative recovery to be used as an alternative to propofol for maintenance of general anaesthesia.

Methods: Patients aged ≥ 65 y scheduled to undergo gastrectomy were randomly allocated to maintenance of general anaesthesia with a remimazolam infusion (remimazolam group) or propofol target-controlled infusion (propofol group) in a 1:1 ratio.

Emergence from general anaesthesia: stochastic or deterministic?

Is emergence from general anaesthesia fundamentally stochastic or deterministic? A recent study using genetically identical mice found significant intra-individual and inter-individual variability in emergence times. This variability was better explained by a stochastic neural dynamics model than by traditional deterministic pharmacokinetic-pharmacodynamic models. These findings offer a new perspective on the intrinsic nature of anaesthetic emergence as a stochastic process; however, they also raise important questions about how we define and measure emergence.

Electroencephalogram Correlates of Delayed Emergence After Remimazolam-Induced Anesthesia Compared to Propofol.

Background: Delayed emergence from anesthesia presents clinical challenges, including prolonged stays in the postanesthesia care unit (PACU). The neurobiological mechanisms underlying delayed emergence, particularly in remimazolam-induced anesthesia, remain poorly understood. This study aimed to explore patterns of brain electrical activity of delayed emergence in remimazolam-induced anesthesia by comparing dynamic changes in electroencephalogram (EEG) activity under various anesthesia states of remimazolam and propofol, focusing on the prefrontal region.

Sub-Second Fluctuation between Top-Down and Bottom-Up Modes Distinguishes Diverse Human Brain States.

Information continuously flows between regions of the human brain, exhibiting distinct patterns that dynamically shift across states of consciousness, cognitive modes, and neuropsychiatric conditions. In this study, we introduce Relative Phase Analysis (RPA), a method that leverages phase-lead/lag relationships to reveal the real-time dynamics of dominant directional patterns and their rapid transitions. We demonstrate that the human brain switches on a sub-second timescale between a top-down mode-where anterior regions drive posterior activity-and a bottom-up mode, characterized by reverse directionality.

Intravenous psilocybin induces dose-dependent changes in functional network organization in rat cortex.

Psilocybin produces an altered state of consciousness in humans and is associated with complex spatiotemporal changes in cortical networks. Given the emphasis on rodent models for mechanistic studies, there is a need for characterization of the effect of psilocybin on cortex-wide network dynamics. Previous electroencephalographic studies of psychedelics in rodents have primarily used sparse electrode arrays with limited spatial resolution, precluding network level analysis, and have been restricted to lower gamma frequencies.

Proximity to Explosive Synchronization Determines Network Collapse and Recovery Trajectories in Neural and Economic Crises.

When complex systems move away from criticality-a balance between order and chaos-they are no longer optimized. Furthermore, when criticality is lost too quickly, or recovery is delayed, system damage can result. However, the mechanism for these abnormally fast or slow critical transitions remains unknown.

Consciousness and the Dying Brain.

The near-death experience has been reported since antiquity and is often characterized by the perception of light, interactions with other entities, and life recall. Near-death experiences can occur in a variety of situations, but they have been studied systematically after in-hospital cardiac arrest, with an incidence of 10 to 20%. Long attributed to metaphysical or supernatural causes, there have been recent advances in understanding the neurophysiologic basis of this unique category of conscious experience.

Brain network hypersensitivity underlies pain crises in sickle cell disease.

Sickle cell disease (SCD) is a genetic disorder causing painful and unpredictable Vaso-occlusive crises (VOCs) through blood vessel blockages. In this study, we propose explosive synchronization (ES) as a novel approach to comprehend the hypersensitivity and occurrence of VOCs in the SCD brain network. We hypothesized that the accumulated disruptions in the brain network induced by SCD might lead to strengthened ES and hypersensitivity.

Psilocybin induces dose-dependent changes in functional network organization in rat cortex.

Psilocybin produces an altered state of consciousness in humans and is associated with complex spatiotemporal changes in brain networks. Given the emphasis on rodent models for mechanistic studies, there is a need for characterization of the effect of psilocybin on brain-wide network dynamics. Previous rodent studies of psychedelics, using electroencephalogram, have primarily been done with sparse electrode arrays that offered limited spatial resolution precluding network level analysis, and have been restricted to lower gamma frequencies.

Electroencephalographic Features of Elderly Patients during Anesthesia Induction with Remimazolam: A Substudy of a Randomized Controlled Trial.

Background: Although remimazolam is used as a general anesthetic in elderly patients due to its hemodynamic stability, the electroencephalogram characteristics of remimazolam are not well known. The purpose of this study was to identify the electroencephalographic features of remimazolam-induced unconsciousness in elderly patients and compare them with propofol.

Methods: Remimazolam (n = 26) or propofol (n = 26) were randomly administered for anesthesia induction in surgical patients.

Brain network hypersensitivity underlies pain crises in sickle cell disease.

Sickle cell disease (SCD) is a genetic disorder causing blood vessel blockages and painful Vaso-occlusive crises (VOCs). VOCs, characterized by severe pain due to blocked blood flow, are recurrent and unpredictable, posing challenges for preventive strategies. In this study we propose explosive synchronization (ES), a phenomenon characterized by abrupt brain network phase transitions, as a novel approach to address this challenge.

A scoping review for building a criticality-based conceptual framework of altered states of consciousness.

The healthy conscious brain is thought to operate near a critical state, reflecting optimal information processing and high susceptibility to external stimuli. Conversely, deviations from the critical state are hypothesized to give rise to altered states of consciousness (ASC). Measures of criticality could therefore be an effective way of establishing the conscious state of an individual.

Caffeine, Postoperative Delirium And Change In Outcomes after Surgery (CAPACHINOS)-2: protocol for a randomised controlled trial.

Introduction: Delirium is a major public health issue for surgical patients and their families because it is associated with increased mortality, cognitive and functional decline, prolonged hospital admission and increased healthcare expenditures. Based on preliminary data, this trial tests the hypothesis that intravenous caffeine, given postoperatively, will reduce the incidence of delirium in older adults after major non-cardiac surgery.

Methods And Analysis: The CAffeine, Postoperative Delirium And CHange In Outcomes after Surgery-2 (CAPACHINOS-2) Trial is a single-centre, placebo-controlled, randomised clinical trial that will be conducted at Michigan Medicine.

Explosive Synchronization-Based Brain Modulation Reduces Hypersensitivity in the Brain Network: A Computational Model Study.

Fibromyalgia (FM) is a chronic pain condition that is characterized by hypersensitivity to multimodal sensory stimuli, widespread pain, and fatigue. We have previously proposed explosive synchronization (ES), a phenomenon wherein a small perturbation to a network can lead to an abrupt state transition, as a potential mechanism of the hypersensitive FM brain. Therefore, we hypothesized that converting a brain network from ES to general synchronization (GS) may reduce the hypersensitivity of FM brain.

Delirium, Caffeine, and Perioperative Cortical Dynamics.

Delirium is a major public health issue associated with considerable morbidity and mortality, particularly after surgery. While the neurobiology of delirium remains incompletely understood, emerging evidence suggests that cognition requires close proximity to a system state called , which reflects a point of dynamic instability that allows for flexible access to a wide range of brain states. Deviations from criticality are associated with neurocognitive disorders, though the relationship between criticality and delirium has not been formally tested.

Criticality Creates a Functional Platform for Network Transitions Between Internal and External Processing Modes in the Human Brain.

Continuous switching between internal and external modes in the brain appears important for generating models of the self and the world. However, how the brain transitions between these two modes remains unknown. We propose that a large synchronization fluctuation of brain networks, emerging only near criticality (i.

Neurophysiologic Complexity in Children Increases with Developmental Age and Is Reduced by General Anesthesia.

Background: Neurophysiologic complexity in the cortex has been shown to reflect changes in the level of consciousness in adults but remains incompletely understood in the developing brain. This study aimed to address changes in cortical complexity related to age and anesthetic state transitions. This study tested the hypotheses that cortical complexity would (1) increase with developmental age and (2) decrease during general anesthesia.

Neural Correlates of the Shamanic State of Consciousness.

Psychedelics have been recognized as model interventions for studying altered states of consciousness. However, few empirical studies of the shamanic state of consciousness, which is anecdotally similar to the psychedelic state, exist. We investigated the neural correlates of shamanic trance using high-density electroencephalography (EEG) in 24 shamanic practitioners and 24 healthy controls during rest, shamanic drumming, and classical music listening, followed by an assessment of altered states of consciousness.

Alpha oscillation, criticality, and responsiveness in complex brain networks.

Brains in unconsciousness are characterized by significantly limited responsiveness to stimuli. Even during conscious wakefulness, responsiveness is highly dependent on ongoing brain activity, specifically, of alpha oscillations (∼10 Hz). We hypothesized that the variety of brain responses to external stimuli result from the interaction between state-specific and transient alpha oscillations and stimuli.

Topographic Reconfiguration of Local and Shared Information in Anesthetic-Induced Unconsciousness.

Theoretical consideration predicts that the alteration of local and shared information in the brain is a key element in the mechanism of anesthetic-induced unconsciousness. Ordinal pattern analysis, such as permutation entropy (PE) and symbolic mutual information (SMI), have been successful in quantifying local and shared information in neurophysiological data; however, they have been rarely applied to altered states of consciousness, especially to data obtained with functional magnetic resonance imaging (fMRI). PE and SMI analysis, together with the superb spatial resolution of fMRI recording, enables us to explore the local information of specific brain areas, the shared information between the areas, and the relationship between the two.

Various synchronous states due to coupling strength inhomogeneity and coupling functions in systems of coupled identical oscillators.

We study the effects of coupling strength inhomogeneity and coupling functions on locking behaviors of coupled identical oscillators, some of which are relatively weakly coupled to others while some are relatively strongly coupled. Through the stability analysis and numerical simulations, we show that several categories of fully locked or partially locked states can emerge and obtain the conditions for these categories. In this system with coupling strength inhomogeneity, locked and drifting subpopulations are determined by the coupling strength distribution and the shape of the coupling functions.

Relationship of critical dynamics, functional connectivity, and states of consciousness in large-scale human brain networks.

Recent modeling and empirical studies support the hypothesis that large-scale brain networks function near a critical state. Similar functional connectivity patterns derived from resting state empirical data and brain network models at criticality provide further support. However, despite the strong implication of a relationship, there has been no principled explanation of how criticality shapes the characteristic functional connectivity in large-scale brain networks.