Analysis of the EEG bispectrum, auditory evoked potentials and the EEG power spectrum during repeated transitions from consciousness to unconsciousness

• Published in: British journal of anaesthesia : BJA Vol. 80; no. 1; pp. 46 - 52
• Main Authors: Gajraj, R J, Doi, M, Mantzaridis, H, Kenny, G N
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-01-1998; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Anesthesia; Anesthesia, General; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous; Arthroplasty, Replacement; Biological and medical sciences; Consciousness - physiology; Electroencephalography; Evoked Potentials, Auditory; Female; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative - methods; Propofol; Sensitivity and Specificity; Unconsciousness - physiopathology; Human; Electrodiagnosis; Vigilance; Auditory evoked potential; Electrophysiology; General anesthesia; Electroencephalography; Monitoring; Depth
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/80.1.46

We have compared the auditory evoked potential (AEP) index (a numerical index derived from the AEP), 95% spectral edge frequency (SEF), median frequency (MF) and the bispectral index (BIS) during alternating periods of consciousness and unconsciousness produced by target-controlled infusions of propofol. We studied 12 patients undergoing hip or knee replacement under spinal anaesthesia. During periods of consciousness and unconsciousness, respective mean values for the four measurements were: AEP index, 60.8 (SD 13.7) and 37.6 (6.5); BIS, 85.1 (8.2) and 66.8 (10.5); SEF, 24.2 (2.2) and 18.7 (2.1); and MF, 10.9 (3.3) and 8.8 (2.0). Threshold values with a specificity of 100% for a state of unconsciousness were: AEP index, 37 (sensitivity 52%); BIS, 55 (sensitivity 15%); and SEF, 16.0 (sensitivity 9%). There was no recorded value for MF that was 100% specific for unconsciousness. Of the four measurements, only AEP index demonstrated a significant difference (P < 0.05) between all mean values 1 min before recovery of consciousness and all mean values 1 min after recovery of consciousness. Our findings suggest that of the four electrophysiological variables, AEP index was best at distinguishing the transition from unconsciousness to consciousness.