Anesthesiology最新文献

{"title":"Frailty and Cardiac Complications after Minor and Major Noncardiac Surgery in Older Adults.","authors":"Chan Mi Park,Jessica J Lie,Darae Ko,Xiecheng Chen,Dae Hyun Kim","doi":"10.1097/aln.0000000000005447","DOIUrl":"https://doi.org/10.1097/aln.0000000000005447","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"7 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Pediatric Scale for Quality of Recovery (PedSQoR).","authors":"Cameron Graydon,Paul A Stricker,Stephen Kelleher,Joseph Cravero,Nazmul Karim,Wallis T Muhly,Paul Lee-Archer","doi":"10.1097/aln.0000000000005503","DOIUrl":"https://doi.org/10.1097/aln.0000000000005503","url":null,"abstract":"BACKGROUNDMeasuring the quality of a patient's recovery is vital, and reliable patient-centered outcome metrics are needed for clinical investigations and quality improvement. Currently, assessment tools to measure quality of recovery in pediatric patients are lacking. This study aimed to develop a scale to assess the quality of recovery (QoR) construct in pediatric patients.METHODSUsing a mixed-methods investigative model, item generation was achieved using two complementary approaches. First, a comprehensive review of the literature identified tools and questions that assessed the endpoints relevant to recovery in children. Questions were categorized and then assessed by an expert Delphi panel who determined the most significant domains and items to be included. Concurrently, semi-structured interviews were conducted with patients and their families to identify themes related to recovery that were important to patients and families. The resulting pilot questionnaire was administered to patients and their families presenting for elective surgery in the US and Australia.RESULTSThe literature search identified 41 instruments, comprising 216 questions relevant to recovery. After the initial Delphi round, the item list was reduced to 91 questions, and then to 50 questions after the second round. The themes identified in the semi-structured interviews aligned with domains considered important by a panel of experts. A 50-item questionnaire was administered to 1162 children, at multiple time points post-surgery. Item reduction and factor analysis resulted in the 20-item Pediatric Scale for Quality of Recovery (PedSQoR) that assesses the domains relevant to physical and psychological recovery.CONCLUSIONSThe PedSQoR scale is a 20-item questionnaire designed to provide a holistic representation of a child's physical, emotional, and psychological recovery after surgery and anesthesia. It was developed and validated with consumer involvement and a strong patient-centered focus. Once further validation has been established, it is expected to become a standardized endpoint in pediatric perioperative trials and quality improvement projects.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"41 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine tone numeric rating score as an early indicator of major postpartum hemorrhage during cesarean delivery: A prospective observational study.","authors":"Natalie J Koons,Chloe Stanwyck,James J Xie,Guillermina Michel,Deirdre J Lyell,Brendan Carvalho,Brian T Bateman,Jessica R Ansari","doi":"10.1097/aln.0000000000005476","DOIUrl":"https://doi.org/10.1097/aln.0000000000005476","url":null,"abstract":"BACKGROUNDPostpartum hemorrhage (PPH) is the leading preventable cause of maternal mortality. Most PPH cases are caused by uterine atony, which is inconsistently defined in clinical care. We used the electronic health record (EHR) to prompt communication between the anesthesia and obstetric care teams about uterine tone using a validated 11-point numeric rating scale (NRS) at 0, 5, and 10-minutes after placental delivery for all cesarean deliveries (CDs) at our institution. Our primary hypothesis was that lower uterine tone NRS would be strongly associated with progression to major PPH.METHODSThis was a single-center, prospective observational study conducted over a one-year period. The primary predictor was the 0-10 uterine tone NRS recorded 10-minutes after placental delivery, and the primary outcome was major PPH, defined as quantitative blood loss (QBL) ≥ 1,500 mL. Area under the receiver operating characteristic (AUROC) curves were created, and relative risk of major PPH for each one-point change in the tone score estimated. Key secondary outcomes analyzed included associations between tone scores, PPH, and blood transfusion.RESULTS1,599 consecutive CDs were performed by obstetricians from academic (39.3%), county public health (21.1%), and private practice (38.8%) services. Major PPH complicated 9.9% and transfusion 6.7% of CDs. Uterine tone NRS was documented at 0-minutes after placental delivery in 91.6%, 5-minutes in 97.4%, and 10-minutes in 97.0% of CDs. The 10-minute NRS was a strong predictor of major PPH, with an AUROC of 0.78 (95% CI 0.73-0.82). Each one-point decrease in NRS increased the risk of major PPH by 71% (95% CI 0.58-0.86). A 10-minute uterine tone NRS ≤ 6 had high positive predictive value for major PPH (32.9%) as well as PPH (64.2%) and transfusion (20.6%).CONCLUSIONSStandardized uterine tone assessments on a 0-10 scale are feasible to implement and strongly associated with progression to major PPH and blood transfusion. Future studies should investigate whether implementation of PPH interventions based on uterine tone NRS can reduce major PPH and hemorrhage-associated morbidity.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"16 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxygen supplementation in pediatric sedation-prospective, multicenter, randomized controlled trial.","authors":"Ji-Hyun Lee,Hyunjung Ko,Jung-Bin Park,Sang-Hwan Ji,Jin-Tae Kim","doi":"10.1097/aln.0000000000005500","DOIUrl":"https://doi.org/10.1097/aln.0000000000005500","url":null,"abstract":"BACKGROUNDChildren undergoing moderate to deep sedation for diagnostic and therapeutic procedures are susceptible to hypoxemia because of their anatomical and physiological features. However, optimal oxygen administration methods are unclear. This study aimed to evaluate the efficacy of oxygen supplementation during sedation using either low-flow or high-flow nasal cannula (HFNC).METHODSThis prospective, multicenter randomized controlled trial included children (<18 years) undergoing moderate to deep sedation. The participants were randomly assigned to three groups as follows: (1) control (no oxygen), (2) low-flow (LF) (2-6 L/min oxygen via nasal cannula), and (3) high-flow (HF) (oxygen administration via HFNC with a flow rate of 2 L/kg and 50% fraction of inspired oxygen). The primary outcome was hypoxemia incidence (saturation of peripheral oxygen, SpO2 ≤95% for more than 5 s). Secondary outcomes included SpO2 <90%, rescue interventions, and sedation-related complications. Between-group differences were compared using a logistic regression model.RESULTSA total of 253 participants were randomized, with 250 completing the study. Hypoxemia occurred in 27.6% of participants in the Control group, 7.2% in the LF group, and 1.2% in the HF group (p<0.001). The odds of hypoxemia in the LF and HF groups were lower than that in the Control group [odds ratio, OR=0.184 (95% CI, 0.067 - 0.503), p=0.001 for LF; OR=0.026 (95% CI, 0.003 - 0.207), p<0.001 for HF]. However, hypoxemia incidence of the HF group was not statistically lower than the LF group (OR 0.143 (95% CI, 0.017- 1.245), p=0.078). Rescue interventions were conducted more frequently in the Control group (52.9%) than in the LF (10.8%) and HF (3.6%) groups (p<0.001). Sedation-related complications such as desaturation and apnea were lower in the LF and HF groups than in the Control group (p<0.001).CONCLUSIONRoutine oxygen supplementation prevents hypoxemia during pediatric moderate and deep sedation. Low-flow oxygen can be a reasonable choice as it effectively reduces hypoxemia while being more cost-effective and widely accessible than high-flow oxygen.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"218 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of sedative doses of propofol, dexmedetomidine, and fentanyl on memory and pain in healthy young adults: A randomized controlled single-blind crossover study using functional magnetic resonance imaging at 7 Tesla.","authors":"Keith M Vogt,Marcus A Simmons,Sujatha N Reddy,Alex C Burlew,Courtney N Kozdron,Danielle R Lavage,Sheri Wang,Kane O Pryor,Steven L Shafer,Tamer Ibrahim,Howard J Aizenstein,Lynne M Reder,James W Ibinson,Julie A Fiez","doi":"10.1097/aln.0000000000005489","DOIUrl":"https://doi.org/10.1097/aln.0000000000005489","url":null,"abstract":"BACKGROUNDAnesthetic agents are well known for their effects on memory and pain, however, prior studies quantifying anesthetic-modulation of memory have not included experimental noxious stimulation. This study used functional magnetic resonance imaging (fMRI) to determine how low doses of propofol, dexmedetomidine, and fentanyl affect the brain systems for memory encoding and pain perception.METHODSThis was a single-blind 1:1:1 randomized placebo-controlled crossover study of 92 healthy volunteers age 18-40. Effect-site concentrations were targeted for propofol (1.0 mcg/ml), dexmedetomidine (0.15 ng/ml), or fentanyl (0.9 ng/ml). Participants listened to a series of 80 words creating a mental picture. Thirty were accompanied by a 2 s painful shock. Blood oxygen-weighted images were obtained at 7 Tesla using a custom head coil. The primary outcome was next-day memory performance, measured by d´, a normalized measure of correct identifications versus false positives. Mixed models were fit to test outcome differences between drug groups. Only statistically significant (p < 0.05) changes are reported, after adjustment for multiple comparisons.RESULTSRecollection, reported as mean d´ (95% confidence interval), was 1.16 (0.97-1.34) under No Drug. This was reduced under propofol 0.51 (0.182-0.842), P=0.006, but not dexmedetomidine 1.04 (0.73-1.35), P=0.99, or fentanyl 0.98 (0.68-1.28), P=0.99. Propofol decreased memory-encoding activation of the hippocampus and amygdala. Propofol reduced pain-related activation in the insula, anterior cingulate, hippocampus, and amygdala. Dexmedetomidine showed decreased memory-related activation in the hippocampus, but did not change pain ratings nor show activation differences in pain-processing areas. Fentanyl showed decreased memory activation in the hippocampus and amygdala. During painful stimulation, fentanyl decreased activation in the primary somatosensory cortex, insula, and increased activation in the anterior cingulate, hippocampus, and amygdala.CONCLUSIONSThese findings add important details to the complex framework of how these distinct anesthetics affect different aspects of cognition through diverse neuroanatomical targets in the brain.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"4 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Nitric Oxide Conditioning Reduces Acute Kidney Injury in Cardiac Surgery Patients with Chronic Kidney Disease (the DEFENDER-trial): a Randomized Controlled Trial.","authors":"Nikolay O Kamenshchikov,Mark A Tyo,Lorenzo Berra,Igor V Kravchenko,Boris N Kozlov,Anna M Gusakova,Yuri K Podoksenov","doi":"10.1097/aln.0000000000005494","DOIUrl":"https://doi.org/10.1097/aln.0000000000005494","url":null,"abstract":"BACKGROUNDPostoperative Acute kidney injury (AKI) is a significant concern for cardiac surgery patients with chronic kidney disease (CKD). Effective pharmacological interventions to mitigate these risks are urgently needed. This study aimed to evaluate the efficacy and safety of perioperative nitric oxide (NO) administration in preventing AKI and limiting CKD progression in patients undergoing cardiac surgery.METHODSA total of 136 patients with CKD undergoing elective cardiac surgery with cardiopulmonary bypass (CPB) were randomized into two equal groups: the NO group (n=68), receiving 80 parts per million NO during the intraoperative period and for 6 hours post-surgery, and the control group (n=68), receiving a sham treatment. The primary outcome was AKI incidence within 7 days post-surgery.RESULTSAKI incidence was significantly lower in the NO group (16/68 patients, 23.5%) compared to the control group (27/68 patients, 39.7%) with a relative risk (RR) of 0.59 (95% CI 0.35-0.99; р=0.043). Six months post-surgery, the glomerular filtration rate was higher in the NO group (50 mL/min/1.73 m2 [45; 54]) compared to the control group (45 mL/min/1.73 m2 [41; 51], p=0.038). Postoperative pneumonia was significantly less frequent in the NO group: 10/68 (14.7%) vs 20/68 (29.4%) RR 0.5; (95% CI 0.25-0.99; р=0.039). NO administration was safe: methemoglobin and nitrogen dioxide levels remained within acceptable ranges, oxidative-nitrosyl stress did not increase, and there were no significant differences between the groups in blood transfusion requirements, platelet counts, or postoperative blood loss volumes.CONCLUSIONSPerioperative NO administration in CKD patients undergoing cardiac surgery with CPB is safe, reduces the incidence of AKI, and slows the progression of renal dysfunction.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"20 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etiology of Acceleromyographic Train-of-four Overshoot: A Hypothesis.","authors":"Aaron F Kopman, Sorin J Brull","doi":"10.1097/ALN.0000000000005377","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005377","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative pain during cesarean delivery under neuraxial anesthesia: A systematic review and meta-analysis.","authors":"Elinor A Charles, Hester Carter, Susanna Stanford, Lindsay Blake, Victoria Eley, Brendan Carvalho, Pervez Sultan, Justin Kua, James E O'Carroll","doi":"10.1097/ALN.0000000000005486","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005486","url":null,"abstract":"<p><strong>Background: </strong>Neuraxial anesthesia is the gold standard technique for cesarean delivery, however pain during cesarean delivery may be underreported. The primary aim of this systematic review and meta-analysis was to determine the incidence of patient reported intraoperative pain during cesarean delivery under neuraxial anesthesia.</p><p><strong>Methods: </strong>A literature search of databases (PubMed MEDLINE, Embase, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and Central Register of Controlled Trials) was conducted. Search topics included terminology concerning cesarean delivery, neuraxial anesthesia, pain, and incidence. Meta-analyses were performed to calculate pooled incidences of patient reported pain and how mode of anesthesia influenced the incidence of patient reported pain, with included papers assessed for risk of bias.</p><p><strong>Results: </strong>A total of 2061 abstracts were screened; 34 articles were included (21 randomized studies and 13 non-randomized studies). The crude incidence of intraoperative pain under neuraxial anesthesia was 10.8% (1,229 out of 11,351 patients) and the pooled incidence was 17% (95%CI: 13% - 22%; 1,229 out of 11,351 patients). Patients who received spinal anesthesia had the lowest pooled incidence of pain of 14% (95%CI: 10.0% - 20.0%; 662 out of 8,002 patients) and those who received epidural top-up had the highest pooled incidence of pain of 33% (95%CI: 17.0% - 54.0%; 253 out of 1,395 patients). Risk of bias assessments showed high risk of bias in half of the included studies.</p><p><strong>Conclusions: </strong>Patient reported pain during cesarean delivery under neuraxial anesthesia is common, with spinal and combined spinal-epidural anesthesia reporting a lower incidence of pain than epidural anesthesia. Intraoperative pain can have significant psychological impact for patients and medicolegal implications for providers. Further prospective studies are required to characterize and understand the impact of patient experiences of pain and develop techniques to reduce this complication.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Risk Assessment Model for Predicting Perioperative Venous Thromboembolism in Patients receiving surgery under anesthesia care.","authors":"Aline M Grimm, Felix Borngaesser, Fran Ganz-Lord, Annika Bald, Peter Shamamian, Michael E Kiyatkin, Maíra I Rudolph, Greta M Eikermann, Ankeeta Shukla, Ling Zhang, Simon T Schaefer, Maximilian Schaefer, Sophia Riesemann, Annika Eyth, Pooja Kumar, Matthias Eikermann, Alex C Spyropoulos, Christopher Tam, Ibraheem M Karaye","doi":"10.1097/ALN.0000000000005480","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005480","url":null,"abstract":"<p><strong>Background: </strong>Perioperative venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), contributes significantly to morbidity, mortality, and healthcare costs of care. A reliable risk assessment model is essential for identifying patients at risk for perioperative VTE. This study aimed to develop and validate a model to predict VTE aligned with the Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Indicator 12 (PSI-12), which tracks VTE occurrences from hospital admission through discharge. This approach may improve early identification and targeted prevention.</p><p><strong>Methods: </strong>We retrospectively analyzed hospital registry data from surgical patients at two tertiary care hospitals in the US: Montefiore Medical Center (MMC) in the Bronx, NY, and Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA. Data from MMC between 2016 and 2021 were used for prediction model creation, while data from 2021 to 2023 served for internal temporal validation. We classified perioperative VTE if patients carried a new ICD code for DVT or PE, and a VTE-related imaging order was documented. Stepwise backward logistic regression and bootstrap resampling were employed for model development. Model performance was evaluated using the receiver operating characteristic (ROC) curves, and Brier score.</p><p><strong>Results: </strong>Among 319,134 surgical patients included in the study, 2,647 (0.8%) were diagnosed with perioperative VTE following hospital admission. The model exhibited robust discriminatory performance across all cohorts, with areas under the receiver operating characteristic curve (AUC) of 0.87 (95%-confidence-interval [95%CI], 0.86-0.89) in the development cohort, 0.84 (95%CI, 0.81-0.87) in the internal temporal validation cohort, and 0.76 (95%CI, 0.75-0.77) in the external validation cohort. By contrast, the Caprini Score and Roger's risk assessment model exhibit significantly lower predictive accuracies of 0.66 and 0.51 respectively. Additionally, the prediction score exhibited strong performance in predicting VTE both in patients before surgery (AUC=0.91; 95%CI, 0.89-0.93) and in those after surgery (AUC=0.84; 95%CI, 0.82-0.86).</p><p><strong>Conclusions: </strong>We developed a clinically intuitive risk assessment model that predicts perioperative VTE across diverse surgical populations, based on the AHRQ's definition. This model demonstrates superior performance compared to existing instruments, offering the potential for improved VTE prevention during hospitalization.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased global and regional connectivity in propofol-induced unconsciousness: human intracranial electroencephalography study.","authors":"Mikyung Choe, Yunhee Choi, Jii Kwon, Hee-Pyoung Park, Seung-Hyun Jin, June Sic Kim, Seokhyun Lee, Chun Kee Chung","doi":"10.1097/ALN.0000000000005479","DOIUrl":"https://doi.org/10.1097/ALN.0000000000005479","url":null,"abstract":"<p><strong>Background: </strong>The conscious state is maintained through intact communication between brain regions. However, studies on global and regional connectivity changes in unconscious state have been inconsistent. These inconsistencies could arise from unclear definition of unconsciousness, spatial and temporal limitations of neuroimaging modalities, and estimating only single connectivity measure. Here, we investigated global and regional changes in amplitude and phase based functional connectivity in propofol-induced unconsciousness, which is widely recognized as unconsciousness.</p><p><strong>Methods: </strong>We calculated amplitude and phase based functional connectivity using amplitude envelope correlation (AEC), weighted phase lag index (wPLI), and magnitude squared coherence (MSC) from intracranial electroencephalography data of 73 patients. Global changes in connectivity, complexity, and network efficiency were estimated. Regional connectivity changes between Brodmann areas, between 7 cortical lobes, and between resting state networks were assessed across all frequency bands. Additionally, we employed machine learning analysis to identify specific regions in classifying conscious and unconscious states.</p><p><strong>Results: </strong>In the unconscious state, global connectivity increased across all frequency bands, while global complexity and efficiency decreased, accompanied by increased delta and decreased high gamma power spectral density. Regional connectivity increased between entire cortical regions across all frequency bands. Machine learning analysis revealed that posterior connectivity was the most influential in classifying consciousness. Amplitude-based connectivity predominantly increased in the delta and theta bands, while phase-based connectivity predominantly increased from the beta to high gamma bands.</p><p><strong>Conclusions: </strong>Propofol anesthesia suppresses cortical activity and induces oscillatory changes characterized by increased delta power and decreased high gamma power. These changes are accompanied by increased functional connectivity and reduced network complexity and efficiency. These changes limit the brain's ability to generate a diverse repertoire of activity, ultimately leading to unconsciousness. Posterior connectivity, which showed high accuracy in predicting conscious states, would be crucial for sustaining consciousness.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":""},"PeriodicalIF":9.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}