UNderstanding CONSciousness Connectedness and Intraoperative Unresponsiveness Study

Study Overview
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Brief Summary
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This study will be a single-site, controlled, unblinded study at the University of Wisconsin to examine changes in the electroencephalogram during anesthesia and waking.

Detailed Description
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* 20 subjects will be recruited per drug, and subjects can be recruited to undergo multiple sedation protocols. Screening: Subjects will respond to the volunteer posts for the study by calling into a study specific phone number. They will complete a phone screening to determine basic eligibility for the study. At the beginning of the sedation session, participants will affirm that in the interval since their baseline visit, they have not acquired any of the cited exclusion criteria that would preclude participation. A review of these exclusion criteria will be completed by the Anesthesiologist. A standard pre-anesthetic assessment will be performed, including confirmation of NPO status, and documented using the standard Department of Anesthesiology pre-operative evaluation form. The first sedative will be dexmedetomidine followed by ketamine, propofol and then midazolam (dependent on the availability of the drugs). Total enrollment in the study will be up to 80 subjects. Each sedation experiment will occur on separate days at least 28 days apart, if the subject chooses to participate in more than one session.

Official Title
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UNderstanding CONSciousness Connectedness and Intraoperative Unresponsiveness Study

Conditions
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Consciousness, Unconsciousness

Intervention / Treatment
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* Drug: Dexmedetomidine
* Drug: Ketamine
* Drug: Propofol
* Drug: Midazolam


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18-40 In good health, determined by the PI on the basis of medical history and a standard assessment for anesthesia to be documented as part of the study record Right handed, to standardize for asymmetry in brain functions Exclusion Criteria: Adults <18 years old or >40 years old Pregnancy confirmed on pregnancy test on day of sedation Contraindication to anesthesia or allergy to study drug Difficult anesthesia: American Society of Anesthesiologists Physical Status greater than 1, per the discretion of the PI. Examples of ASA status include, but are not limited to: Any systemic disease present, such as diabetes, cardiac, pulmonary, or other acute or chronic disorder, or history of smoking Narrow angle glaucoma Abnormal airway examination Any abnormality on medical history and physical examination Snoring or sleep disorders including apnea Antecedent pulmonary aspiration risk (e.g., history GI reflux, heartburn, hiatal hernia) Adverse reaction or allergy with anesthesia or other sedatives Chronic medication use History of difficult anesthesia, laryngoscopy or intubation Family history of difficulty with anesthesia or sedation History of vertigo, nausea or vomiting after anesthesia BMI > 35 Contraindication to HD-EEG, TMS or MRI for relative parts of the procedures. MRI exclusion criteria: presence of metallic or electronic implants; history of claustrophobia. TMS exclusion criteria: Presence or history of medical conditions that could increase the chance of seizures (e.g. - stroke, aneurysm, brain surgery, structural brain lesion) cranial metal implants; structural brain lesion; devices that may be affected by TMS (pacemaker, medication pump, cochlear implant, implanted brain stimulator); history of head trauma with loss of consciousness for greater than 5 minutes; family history of seizures; history of antecedent mood disorder. Exclusion from Dexmedetomidine: o Resting heart Rate<60 bpm Exclusion from Propofol: o Reported egg allergy Exclusion from Ketamine: History of post-operative nausea and vomiting History of motion sickness Additional exclusion criteria on the day of sedation: Anything to eat or drink for the preceding 8 hours Any use of over-the-counter or recreational drugs (including alcohol or tobacco) within the preceding 24 hours Any use of sedative or sleep agents within the preceding 24 hours Recent change in health, including cough, cold, or fever Exposure to anesthesia or sedation in the last 6 days

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Drug Administrated<br>Sedatives will be administered to participants while their brain activity is measured. | Drug: Dexmedetomidine<br>* 20 participants will be administered Dexmedetomidine.<br>Drug: Ketamine<br>* 20 participants will be administered Ketamine.<br>Drug: Propofol<br>* 20 participants will be administered Propofol.<br>Drug: Midazolam<br>* 20 participants will be administered Midazolam.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occipital Delta Power Spectral Density by Conscious State and Study Group. | The difference in spontaneous EEG slow wave activity over posterior cortex between states of consciousness measured with high-density EEG equipment and reported in spectral power in the delta band (1-4 Hz) at electrode Oz. Disconnected conscious experience (dreaming), connected conscious experience (awareness of the external world), and unconsciousness (no report) was assessed when participants were roused from sedation or sleep. | Intraoperative (During sedation-- up to 8 hours) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Instances of Disconnected Conscious Experience (Dreaming) vs Connected Conscious Experience (Awareness of External World). | The number of instances of disconnected conscious experience (dreaming) versus connected conscious experience (awareness of the external world) during sedation is measured by subject self-report at the time of researcher initiated inquiry. | Intraoperative (During sedation-- up to 8 hours) | 
| Effect of Study Drug on Ability to Correctly Identify Shapes/Images | The ability to identify shapes/images in visual illusions measured by the NIH Toolbox. Will be reported by a computed score from NIH Toolbox for the Dimensional Change Card Sort Test (DCCS) and the Flanker Inhibitory Control & Attention Test (Flanker). Both Flanker and DCCS use a 2-vector scoring method that takes accuracy and reaction time (if accuracy >=80%) into account, resulting in a computed score that can range in value from 0-10. A higher score indicates better performance on the test. | Intraoperative (During sedation-- up to 8 hours) | 
| Effect of Study Drug on Ability to Correctly Identify Images | The ability to match sounds and images measured by the predictive coding task. Will be reported by a proportion correct as a decimal. | Intraoperative (During sedation-- up to 8 hours) | 
| Effect of Study Drug on Ability to Form Implicit Memory | Subjects will have a list of words read to them while under sedation and their ability to hear these words and form implicit memories of them will be assessed using a two-alternative forced choice task. Results will be reported as the average number of correct responses out of sixteen. | Intraoperative (During sedation-- up to 8 hours) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sedation, Propofol, Dexmedetomidine, Ketamine, Sevoflurane, Electroencephalogram