The EEG complexity, information integration and brain network changes in minimally conscious state patients during general anesthesia

Objective. General anesthesia (GA) can induce reversible loss of consciousness. Nonetheless, the electroencephalography (EEG) characteristics of patients with minimally consciousness state (MCS) during GA are seldom observed. Approach. We recorded EEG data from nine MCS patients during GA. We used the permutation Lempel-Ziv complexity (PLZC), permutation fluctuation complexity (PFC) to quantify the type I and II complexities. Additionally, we used permutation cross mutual information (PCMI) and PCMI-based brain network to investigate functional connectivity and brain networks in sensor and source spaces. Main results. Compared to the preoperative resting state, during the maintenance of surgical anesthesia state, PLZC decreased (p < 0.001), PFC increased (p < 0.001) and PCMI decreased (p < 0.001) in sensor space. The results for these metrics in source space are consistent with sensor space. Additionally, node network indicators nodal clustering coefficient (NCC) (p < 0.001) and nodal efficiency (NE) (p < 0.001) decreased in these two spaces. Global network indicators normalized average path length (L-ave/L-r) (p < 0.01) and modularity (Q) (p < 0.05) only decreased in sensor space, while the normalized average clustering coefficient (C-ave/C) and small-world index (sigma) did not change significantly. Moreover, the dominance of hub nodes is reduced in frontal regions in these two spaces. After recovery of consciousness, PFC decreased in the two spaces, while PLZC, PCMI increased. NCC, NE, and frontal region hub node dominance increased only in the sensor space. These indicators did not return to preoperative levels. In contrast, global network indicators L-ave/L-r and Q were not significantly different from the preoperative resting state in sensor space. Significance. GA alters the complexity of the EEG, decreases information integration, and is accompanied by a reconfiguration of brain networks in MCS patients. The PLZC, PFC, PCMI and PCMI-based brain network metrics can effectively differentiate the state of consciousness of MCS patients during GA.

Automated summary

General anesthesia affects the consciousness state and brain networks of MCS patients, and EEG metrics can effectively differentiate the consciousness state of these patients.