General anesthesia reorganizes cortical morphological networks

Abstract General anesthesia profoundly and reversibly alters global brain state, but whether it reorganizes cortical morphological networks remains unclear. Using paired structural MRI acquired during wakefulness and anesthesia in two independent cohorts receiving propofol or sevoflurane, we characterized between-state differences in undirected and directed cortical morphological networks. In the propofol cohort, anesthesia reduced interregional morphological similarity, especially in transmodal cortex and long-range connections, and decreased nodal efficiency, likewise concentrated in transmodal cortex. Directed analyses revealed increased morphological dependence between unimodal and transmodal systems and within transmodal cortex during anesthesia, with source regions contributing to these increases showing broader, less selective outgoing dependence across transmodal targets. These effects were unrelated to concurrent physiological changes and generalized to sevoflurane. Exploratory analyses linked greater reductions in nodal efficiency to lower normative distributions of dopamine transporter and vesicular monoamine transporter 2. These findings reveal coordinated anesthesia-related reorganization of cortical morphological networks, prominently involving transmodal cortex.