Modulating consciousness during anesthesia through a non-pharmacological approach
Slow oscillations (SOs) measured using electroencephalography (EEG) are a common feature of states with little to no conscious experience, such as coma, sleep, and anesthesia. A novel neuromodulation technique has recently been shown to amplify SOs during sleep, through the administration of auditory stimuli in synchrony with the peak of endogenous SOs. This auditory neuromodulation technique holds promise for the amplification of anesthesia SOs, and consequently, the non-pharmacological modulation of consciousness. To date, auditory neuromodulation has never been investigated during anesthesia. The objective of this study is to establish the feasibility of using auditory neuromodulation to enhance anesthesia SOs in a clinically relevant setting that mimics general anesthesia and surgical pain. Our central hypothesis is that auditory neuromodulation can enhance SOs during general anesthesia, with and without painful stimulation, translating to a deepened anesthetic state. More specifically, this study will 1) develop an auditory neuromodulation software compatible with a high-density EEG system, which can automatically predict the peak of anesthesia SOs, trigger auditory stimulations at a desired SO phase, and assess the whole-brain consciousness alterations it induces; 2) test auditory neuromodulation in surgical patients in the operating room in order to characterize its effect on SOs and anesthetic depth; and 3) assess the translational potential of auditory neuromodulation to surgical anesthesia by characterizing its effect on anesthesia SOs in the presence of painful stimulation. Upon completion of this study, we expect to have preliminary evidence suggesting that auditory neuromodulation can be used to complement pharmacological agents in the maintenance of a balanced anesthetic state. This study will have revolutionary implications for the way anesthesia is conceptualized and administered and could ultimately lead to safer and more balance anesthesia for patient populations.
Catherine Duclos , Hôpital du Sacré-Cœur de Montréal
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