Date of Award

January 2022

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Benjamin F. Gruenbaum

Second Advisor

Helene Benveniste


AbstractCONSCIOUSNESS: MECHANISMS AND NEUROPSYCHIATRIC OUTCOMES. Benjamin Gruenbaum, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL. (Sponsored by Helene Benveniste, Department of Anesthesiology, Yale University, School of Medicine).

In this thesis, we describe three studies that probe aspects of consciousness to demonstrate the relationship between neuropathology and consciousness in diverse clinical scenarios.1–4 The first study specifically investigates the mechanisms of so-called loss of consciousness during focal limbic seizures.1 The aim of the second study2,3 is to determine whether intraoperative ketamine infusion influences the risk of development of postoperative delirium (POD) after complex spinal fusion involving ≥5 levels. In the third study,4 we conducted a systematic literature review of both human and animal studies that evaluated depression and anxiety in absence seizures (AS). In the first study, we discover slow-wave Up/Down states in cortical electrophysiology that resemble those found in slow-wave sleep and deep anesthesia.1 In the retrospective study of patients undergoing spine complex deformity correction surgery involving ≥5 fusion levels, our study demonstrates that the use of intra-operative ketamine is an independent predictor for POD.2,3 Our systematic review of the literature presents evidence describing a robust association between AS and depression and anxiety.4 The present work constitutes an interdisciplinary survey of consciousness via three examples of the author’s work, providing mechanistic and epidemiological evidence of the bidirectional relationships between neuropathology and different states of consciousness.


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