The Effects of Propofol Anaesthesia on Molecular-enriched Networks During Resting-state and Naturalistic Stimulation

Placing a patient in a state of anaesthesia is crucial for modern surgical practice. However, the mechanisms by which anaesthetic drugs, such as propofol, impart their effects on consciousness remain poorly understood. Propofol potentiates GABAergic transmission, which purportedly has direct actions on cortex as well as indirect actions via ascending neuromodulatory systems. Functional imaging studies to date have been limited in their ability to unravel how these effects on neurotransmission impact system-level dynamics of the brain. Here, we leveraged advances in multi-modal imaging, Receptor-Enriched Analysis of functional Connectivity by Targets (REACT), to investigate how different levels of propofol-induced sedation alters neurotransmission-related functional connectivity (FC), both at rest and when individuals are exposed to naturalistic auditory stimulation. Propofol increased GABA-A- and noradrenaline transporter-enriched FC within occipital and somatosensory regions respectively. Additionally, during auditory stimulation, the network related to the vesicular acetylcholine transporter showed reduced FC within the right superior temporal gyrus, regardless of level of anaesthesia, and a spatial configuration correlating with a broad range of meta-analytic measures of audition- and emotion-related cognition. In bringing together these micro- and macro-scale systems, we provide support for both direct GABAergic and indirect noradrenergic-related network changes under anaesthesia and describe a cognition-related reconfiguration of the cholinergic network, highlighting the utility of REACT to explore the molecular substrates consciousness and cognition.