Evidence map›Paper›PMID 40287361›Full record

ArticleBritish journal of anaesthesia2025

A probabilistic model of behavioural emergence from general anaesthesia in mice.

Martha E Stone, Max B Kelz, Alex Proekt, Andrzej Z Wasilczuk

Abstract read
In one paragraph

Article in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Martha E StoneNeuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, USA.
Max B KelzNeuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, USA.
Alex ProektNeuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
Andrzej Z WasilczukNeuroscience of Unconsciousness and Reanimation Research Alliance, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: andrzej.wasilczuk@pennmedicine.upenn.edu.

Funding

Physician Postdoctoral Research Training in Perioperative Medicine (PPRTPM)T32GM112596 · NIGMS · UNIVERSITY OF PENNSYLVANIA · PI Roderic G Eckenhoff, Max Kelz · 2015 to 2026
$3.4M
Brain Wide Anesthetic-Active Neuronal NetworkR01GM151556 · NIGMS · UNIVERSITY OF PENNSYLVANIA · PI Alexander Proekt · 2023 to 2026
$2.2M
Personalized Anesthetic Pharmacology Across the LifespanR01GM144377 · NIGMS · UNIVERSITY OF PENNSYLVANIA · PI KELZ, MAX · 2021 to 2024
$2.1M
NIGMS NIH HHS R01 GM144377NIGMS NIH HHS R01 GM151556NIGMS NIH HHS T32 GM112596
6 · The paper itself

Abstract

backgroundTime to emergence from general anaesthesia is highly variable between individuals. This variability has been attributed to individual differences in anaesthetic sensitivity. However, this hypothesis has not been verified experimentally. We explicitly test this hypothesis by quantifying emergence from anaesthesia repeatedly in the same individuals over time.

methodsGenetically identical adult (12-24 weeks old) male (n=40) and female (n=20) C57BL/6J mice were exposed to 2 h of isoflurane (0.90 vol%) on 10 separate occasions. Time to emergence was measured using the return of the righting reflex. Predictions of the standard effect-site pharmacokinetic-pharmacodynamic (PK-PD) model and neuronal dynamics model of stochastic fluctuations between the awake and anaesthetised states were fit to observed emergence times. Repeated steady-state assessments of the righting reflex obtained during the last 2 h of a 4-h exposure to 0.3, 0.4, 0.6, or 0.7 vol% isoflurane (n=20 per concentration) were used to determine individual probabilities of losing the righting reflex, which was defined as an individual's anaesthetic sensitivity.

resultsEmergence times varied by at least two orders of magnitude after identical anaesthetic exposure. We did not find consistent inter-individual differences in emergence times. Instead, we found that variability in emergence times across trials in each individual was as large as that between two different individuals. Emergence times were not correlated across time. Consistent with previous work, we identified large individual differences in anaesthetic sensitivity which persisted on a time scale of at least 1 week. A standard PK-PD model failed to reproduce inter-trial variability. In contrast, the neuronal dynamics model reproduced both population- and individual-level variability in emergence times.

conclusionsStochastic state switching contributes to inherent variability in emergence from general anaesthesia. Delayed emergence occurred in a small proportion of anaesthetic exposures in a genetically homogeneous population. The neuronal dynamics model predicts that anaesthetic emergence times will be probabilistically long, which might explain delayed emergence observed in clinical settings.

Indexed as

Anesthesia, GeneralAnesthesia Recovery PeriodAnesthetics, InhalationBehavior, AnimalIsofluraneModels, StatisticalAnimalsFemaleMaleMiceMice, Inbred C57BLReflex, RightingAnesthetics, InhalationIsofluraneemergencemechanisms of anaesthesianeuronal dynamicspharmacodynamicsresistance to state transitionsreturn of consciousnessstochastic state switching

Identifiers

PMID40287361
PMCPMC12226763

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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.