Zhili Huang's research group reviewed the new progress of the neuroregulatory mechanism of general anesthesia in Pharmacological Reviews

General anesthetics have been used in clinical practice for 180 years
.
At present, there are more than 300 million surgical procedures performed worldwide every year, but the regulatory mechanism of general anesthesia still needs to be elucidated
.
General anesthesia is different from sleep, but there are many similarities
.
The EEG features of general anesthesia and sleep state are different and drug-specific, and both can show characteristic changes such as slow wave activity and delta wave oscillation, but both can cause a decrease in the level of consciousness and accompanied by
changes in limb behavior and autonomic nerves.
Therefore, exploring how sleep-wake neural circuits are involved in the induction and awakening of general anesthesia has become a research hotspot
in this field.

In recent years, Professor Huang Zhili's research group has successively identified the nucleus accumbens, ventral globus pallidus, dorsal striatum, paraventricular nucleus of hypothalamus, medial nucleus of the snout, and dorsal part of the deep midbrain as new nuclei
for sleep-wake regulation.
At the same time, it was found that neural mechanisms such as pro-awakening parabrachial nucleus glutamatergic neurons, nucleus accumbens, dopamine D1 receptor-positive neurons, and paraventricular nucleus regulated the induction and awakening
of general anesthesia.

Combined with the research results of the research group and the current research status at home and abroad, on January 10, 2023, Huang Zhili and Miao Changhong's research group published an online publication entitled "Understanding the neural mechanisms of general anesthesia from interaction" in the journal Pharmacological Reviews (IF: 18.
923, with an average annual publication volume of about 27 articles per year in the past five years).
with sleep-wake state: a decade of discovery" (23 pages + 4 schedules).

This paper reviews more than 200 important research results in this field in the past 10 years, and analyzes how sleep-wake neural circuits interact to regulate the induction and awakening
of general anesthesia.
This paper further strengthens people's understanding of the mechanisms of general anesthesia and sleep-wakefulness, and provides many enlightenments
for further exploring the interaction mechanism of sleep-wake and general anesthesia.

Fig.
1.
In the induction regulation of general anesthesia of halogenated inhalation anesthetics, glutamatergic neurons in the lateral rein nucleus (LHb) and γ-aminobutyric acid neuron in the medial nucleus of the kiss (RMTg) promoted anesthesia induction.
Inhibition induction of nucleus accumbens (NAc) dopamine D1 receptor-positive neurons, paraventricular nucleus (PVT) glutamatergic neurons, etc.
; The ventral tegmental area (VTA) and the preoptic area (POA) of the hypothalamus play a dual regulatory role
of promoting and inhibiting induction due to the differences of neuronal type and subregion.

Fig.
2: In the regulation of propofol general anesthesia awakening, the lateral rein nucleus (LHb) glutamatergic neurons and the ventrolateral preoptic area (VLPO) of the hypothalamus inhibited awakening.
Parabrachial nucleus (PB) glutamatergic neurons, basal forebrain (BF) cholinergic neurons, etc.
promote awakening; The thalamic reticular nucleus (TRN) plays a dual regulatory role
in promoting and inhibiting awakening.

Professor Huang Zhili and Professor Miao Changhong of the Department of Anesthesiology, Zhongshan Hospital Affiliated to Fudan University are co-corresponding authors, Dr.
Bao Jiaojiao, an anesthesiologist at Zhongshan Hospital, and Jiang Shan, a graduate student of the Department of Pharmacology of the School of Basic Medical Sciences, are co-first authors, Professor Qu Weimin of the School of Basic Medical Sciences of Fudan University and Professor Li Wenwen of the Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital of Fudan University are co-authors
.
This work is supported
by the major projects of the China Brain Program of the Ministry of Science and Technology, the key and key national cooperation projects of the National Natural Science Foundation of China, and the Shanghai Natural Science Foundation.

References:

Bao WW*, Jiang S*, Qu WM, Li WX, Miao CH#, Huang ZL# .
Understanding the neural mechanisms of general anesthesia from interaction with sleep-wake state: a decade of discovery.
Pharmacological Reviews，2023.
doi: 10.
1124/pharmrev.
122.
000717.