ArticleAnesthesiology2017
Paradoxical Emergence: Administration of Subanesthetic Ketamine during Isoflurane Anesthesia Induces Burst Suppression but Accelerates Recovery.
Article in Anesthesiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers.
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Who cites it
30 citing papers in PubMed, 64 citations in OpenAlex.
- Effect of Perioperative Subanesthetic Dose of Esketamine on Postoperative Recovery Quality in Patients Undergoing Laparoscopic Gastrointestinal Surgery: A Randomised, Double-Blind, Controlled Trial.Drug design, development and therapy · 2025Trial
- Effects of intra-operative administration of subanesthetic s-ketamine on emergence from sevoflurane anesthesia: a randomized double-blind placebo-controlled study.BMC anesthesiology · 2023Trial
- Subanaesthetic dose of esketamine during induction delays anaesthesia recovery a randomized, double-blind clinical trial.BMC anesthesiology · 2022Trial
- Detection of Electrophysiological Activity of Amygdala during Anesthesia Using Stereo-EEG: A Preliminary Research in Anesthetized Epileptic Patients.BioMed research international · 2020Trial
- Intraoperative ketamine for prevention of depressive symptoms after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial.British journal of anaesthesia · 2018Trial
- Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial.Lancet (London, England) · 2017Trial
- Ketamine Across the Dose-State Continuum: EEG Signatures, Network Dynamics, and Implications for Brain-State Monitoring in Anesthesia and Critical Care.Brain sciences · 2026Review
- Dose-related adaptive reconstruction of DMN in isoflurane administration: a study in the rat.BMC anesthesiology · 2023Article
- Inactivation of Prefrontal Cortex Delays Emergence From Sevoflurane Anesthesia.Frontiers in systems neuroscience · 2021Article
- Cholinergic Modulation of General Anesthesia.Current neuropharmacology · 2021Article
- Analgesic and Antidepressant Effects of the Clinical Glutamate Modulators Acetyl-L-Carnitine and Ketamine.Frontiers in neuroscience · 2021Review
- D-Amphetamine Rapidly Reverses Dexmedetomidine-Induced Unconsciousness in Rats.Frontiers in pharmacology · 2021Article
- Macrocirculatory Parameters and Oxygen Debt Indices in Pigs During Propofol Or Alfaxalone Anesthesia When Subjected to Experimental Stepwise Hemorrhage.Frontiers in veterinary science · 2021Article
- Etiology of Burst Suppression EEG Patterns.Frontiers in psychology · 2021Article
- Association Between Burst-Suppression Latency and Burst-Suppression Ratio Under Isoflurane or Adjuvant Drugs With Isoflurane Anesthesia in Mice.Frontiers in pharmacology · 2021Article
- Burst Suppression During General Anesthesia and Postoperative Outcomes: Mini Review.Frontiers in systems neuroscience · 2021Review
- Global genetic deletion of CaScientific reports · 2020Article
- Efficacy of procaine combined with ketamine and propofol in pediatric epidural anesthesia.Experimental and therapeutic medicine · 2020Article
- Can Intraoperative Low-DoseFrontiers in pharmacology · 2020Review
- Acute continuous nocturnal light exposure decreases BSR under sevoflurane anesthesia in C57BL/6J mice: possible role of differentially spared light-sensitive pathways under anesthesia.American journal of translational research · 2020Article
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Abstract
backgroundPromoting arousal by manipulating certain brain regions and/or neurotransmitters has been a recent research focus, with the goal of trying to improve recovery from general anesthesia. The current study tested the hypothesis that a single subanesthetic dose of ketamine during isoflurane anesthesia would increase cholinergic tone in the prefrontal cortex and accelerate recovery.
methodsAdult male rats were implanted with electroencephalography electrodes (frontal, parietal, and occipital cortex) and a microdialysis guide cannula targeted for the prefrontal cortex. After establishing general anesthesia with isoflurane, animals were randomly assigned to receive a saline control or ketamine injection. When isoflurane was discontinued nearly 90 min after drug or saline administration, recovery from anesthesia was measured by experimenters and blinded observers. During the entire experiment, electrophysiologic signals were recorded and acetylcholine was quantified by high-performance liquid chromatography with electrochemical detection.
resultsA single dose of subanesthetic ketamine caused an initial 125% increase in burst suppression ratio (last isoflurane sample: 37.48 ± 24.11% vs. isoflurane after ketamine injection: 84.36 ± 8.95%; P < 0.0001), but also a significant 44% reduction in emergence time (saline: 877 ± 335 s vs. ketamine: 494 ± 108 s; P = 0.0005; n = 10 per treatment). Furthermore, ketamine caused a significant 317% increase in cortical acetylcholine release (mean after ketamine injection: 0.18 ± 0.16 pmol vs. ketamine recovery: 0.75 ± 0.41 pmol; P = 0.0002) after isoflurane anesthesia was discontinued.
conclusionsAdministration of subanesthetic doses of ketamine during isoflurane anesthesia increases anesthetic depth but-paradoxically-accelerates the recovery of consciousness, possibly through cholinergic mechanisms.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.