Detecting Loss and Regain of Consciousness during Propofol Anesthesia using Multimodal Indices of Autonomic State

We have traditionally defined 'loss of consciousness' (LOC) and 'regain of consciousness' (ROC) during general anesthesia in terms of behavioral correlates. We are starting to understand the dynamics in brain activity that may help define those events; however, we have not yet explored the possible autonomic correlates of LOC and ROC. In this study, we investigated the autonomic dynamics immediately surrounding loss and regain of consciousness in nine healthy volunteers under controlled propofol sedation. We used multimodal autonomic indices generated from physiologically accurate models and found that just before and after LOC and ROC could be differentiated with an AUC of 0.80. In addition, we saw that some of the autonomic changes accompanying LOC and ROC verify known information about the mechanism of action of propofol, while others indicate new avenues for exploration of propofol's effect on the autonomic nervous system. Overall, our work suggests that the autonomic dynamics surrounding the events of loss and regain of consciousness are worthy of further investigation.Clinical Relevance-This introduces the possibility of autonomic biomarkers for loss and regain of consciousness during general anesthesia that are more precise than behavioral tracking alone.