Subjective experiences during dexmedetomidine- or propofol-induced unresponsiveness and non-rapid eye movement sleep in healthy male subjects

Abstract

Background: Anaesthetic-induced unresponsiveness and non-rapid eye movement (NREM) sleep share common neural pathways and neurophysiological features. We hypothesised that these states bear resemblance also at the experiential level.

Methods: We compared, in a within-subject design, the prevalence and content of experiences in reports obtained after anaesthetic-induced unresponsiveness and NREM sleep. Healthy males (N=39) received dexmedetomidine (n=20) or propofol (n=19) in stepwise doses to induce unresponsiveness. Those rousable were interviewed and left unstimulated, and the procedure was repeated. Finally, the anaesthetic dose was increased 50%, and the participants were interviewed after recovery. The same participants (N=37) were also later interviewed after NREM sleep awakenings.

Results: Most subjects were rousable, with no difference between anaesthetic agents (P=0.480). Lower drug plasma concentrations were associated with being rousable for both dexmedetomidine (P=0.007) and propofol (P=0.002) but not with recall of experiences in either drug group (dexmedetomidine: P=0.543; propofol: P=0.460). Of the 76 and 73 interviews performed after anaesthetic-induced unresponsiveness and NREM sleep, 69.7% and 64.4% included experiences, respectively. Recall did not differ between anaesthetic-induced unresponsiveness and NREM sleep (P=0.581), or between dexmedetomidine and propofol in any of the three awakening rounds (P>0.05). Disconnected dream-like experiences (62.3% vs 51.1%; P=0.418) and memory incorporation of the research setting (88.7% vs 78.7%; P=0.204) were equally often present in anaesthesia and sleep interviews, respectively, whereas awareness, signifying connected consciousness, was rarely reported in either state.

Conclusions: Anaesthetic-induced unresponsiveness and NREM sleep are characterised by disconnected conscious experiences with corresponding recall frequencies and content.

Clinical trial registration: Clinical trial registration. This study was part of a larger study registered at ClinicalTrials.gov (NCT01889004).

Keywords: anaesthesia; awareness; consciousness; dexmedetomidine; dreaming; propofol; sleep; unresponsiveness.

Fig 1

Design of Experiments 1 and 2. (a) Anaesthesia experiment. R1, first regaining of responsiveness; R2, second regaining of responsiveness; R3, recovery to responsiveness; UR1, first period of unresponsiveness; UR2, second period of unresponsiveness; UR3, third period of unresponsiveness with higher drug concentration level. (b) Sleep experiment. N1, NREM sleep stage N1; N2, NREM sleep stage N2; N3, NREM sleep stage N3. NREM, non-rapid eye movement; PET, positron emission tomography.