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Auditory-evoked potentials in bispectral index-guided anaesthesia for cardiac surgery

Published online by Cambridge University Press:  01 July 2007

T. Musialowicz ,
M. Niskanen ,
H. Yppärilä-Wolters ,
M. Pöyhönen ,
O. Pitkänen  and
M. Hynynen
T. Musialowicz*
Affiliation:
Kuopio University Hospital, Anaesthesiology and Intensive Care Department, Kuopio, Finland
M. Niskanen
Affiliation:
Kuopio University Hospital, Anaesthesiology and Intensive Care Department, Kuopio, Finland
H. Yppärilä-Wolters
Affiliation:
Kuopio University Hospital, Department of Neurophysiology, Kuopio, Finland
M. Pöyhönen
Affiliation:
Kuopio University Hospital, Anaesthesiology and Intensive Care Department, Kuopio, Finland
O. Pitkänen
Affiliation:
Kuopio University Hospital, Anaesthesiology and Intensive Care Department, Kuopio, Finland
M. Hynynen
Affiliation:
Helsinki University Hospital, Jorvi Hospital – Department of Anaesthesiology and Intensive Care, Espoo, Finland
*
Correspondence to: Tadeusz Musialowicz, Anaesthesiology and IntensiveCare Department, Kuopio University Hospital, Puijonlaaksontie 2, P. O. Box 1777, Kuopio 70211, Finland. E-mail: tadeusz.musialowicz@kuh.fi; Tel: +35817173351; Fax: +35817173351
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Summary

Background and objective

Midlatency auditory-evoked potentials, as measures of the anaesthetic state, were evaluated at similar levels of bispectral index in cardiac surgical patients maintained with either propofol or isoflurane anaesthesia.

Methods

Twenty-four patients were randomly allocated to anaesthesia with propofol (n = 12) or isoflurane (n = 12). Bispectral index was maintained below 60 during surgery. Auditory-evoked potentials were collected before induction of anaesthesia, 10 min after intubation, 30 min after sternotomy, during cardiopulmonary bypass at the time of cross-clamping of the aorta and during stable mild hypothermia, after de-clamping of the aorta, and after the operation.

Results

At the pre-determined time points, bispectral index values showed comparable depth of hypnosis in both groups. The latency of the Nb component of midlatency auditory-evoked potentials was significantly increased in the isoflurane group after intubation (P < 0.001) and that of both the Nb and the Pa components after sternotomy (P < 0.001) compared with the propofol group. No differences between the groups were detected with respect to haemodynamic variables. No patient reported recall of intraoperative events.

Conclusion

After intubation and surgical stimulation, when bispectral index was at a constant level, there was a difference in the Nb and Pa components of the midlatency auditory-evoked potentials between the two anaesthetic regimens, indicating a distinction in the state of anaesthesia. Our results suggest that the parallel use of these two electrophysiological methods can show differences in the components of anaesthesia between various anaesthesia methods in cardiac surgical patients.

Keywords

ANAESTHESIA, inhalation, intravenousCARDIOPULMONARY BYPASSAUDITORY EVOKED POTENTIALSELECTROENCEPHALOGRAPHY, bispectral index
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 7 , July 2007 , pp. 571 - 579
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Thornton, C. Evoked potentials in anaesthesia. Eur J Anaesthesiol 1991; 8: 89–107.Google ScholarPubMed
2.Hammarén, E, Yli-Hankala, A, Rosenberg, PH, Hynynen, M. Cardiopulmonary bypass-induced changes in plasma concentrations of propofol and in auditory evoked potentials. Br J Anaesth 1996; 77: 360–364.CrossRefGoogle ScholarPubMed
3.Palm, S, Linstedt, U, Petry, A, Wulf, H. Dose-response relationship of propofol on mid-latency auditory evoked potentials (MLAEP) in cardiac surgery. Acta Anaesthesiol Scand 2001; 45: 1006–1010.CrossRefGoogle ScholarPubMed
4.Struys, M, Jensen, EW, Smith, W et al. . Performance of the ARX-derivered auditory evoked potential index as an indicator of anesthetic depth. Anesthesiology 2002; 96: 803–816.CrossRefGoogle ScholarPubMed
5.Drummond, JC. Monitoring depth of anesthesia with emphasis on the application of the bispectral index and middle latency auditory evoked response to the prevention of recall. Anesthesiology 2000; 93: 876–882.CrossRefGoogle Scholar
6.Myles, PS, Leslie, K, McNeil, J, Forbes, A, Chan, MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 2004; 363: 1757–1763.CrossRefGoogle ScholarPubMed
7.Ekman, A, Lindholm, ML, Lennmarken, C, Sandin, R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 2004; 48: 20–26.CrossRefGoogle ScholarPubMed
8.Heck, M, Kumle, B, Boldt, J, Lang, J, Lehmann, A, Saggau, W. Electroencephalogram bispectral index predicts hemodynamic and arousal reactions during induction of anesthesia in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2000; 14: 693–697.CrossRefGoogle ScholarPubMed
9.Doi, M, Gajraj, RJ, Mantzaridis, H, Kenny, GN. Relationship between calculated blood concentrations of propofol and electrophysiological variables during emergence from anesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. Br J Anaesth 1997; 78: 180–184.CrossRefGoogle ScholarPubMed
10.Iselin-Chaves, IA, El Moalem, HE, Gan, T, Ginsberg, B, Glass, PS. Changes in the auditory evoked potentials and the bispectral index following propofol or propofol and alfentanil. Anesthesiology 2000; 92: 1300–1310.CrossRefGoogle ScholarPubMed
11.Tiren, C, Anderson, RE, Barr, G, Öwall, A, Jakobsson, JG. Clinical comparison of three different anaesthetic depth monitors during cardiopulmonary bypass. Anaesthesia 2005; 60: 189–193.CrossRefGoogle ScholarPubMed
12.Doi, M, Gajraj, RJ, Mantzaridis, H, Kenny, GN. Effects of cardiopulmonary bypass and hypothermia on electroencephalographic variables. Anaesthesia 1997; 52: 1048–1055.CrossRefGoogle ScholarPubMed
13.Edmonds, HL, Rodriguez, RA, Audenaert, SM, Austin, EH, Pollock, SB, Ganzel, BL. The role of neuromonitoring in cardiovascular surgery. J Cardiothorac Vasc Anesth 1996; 10: 15–23.CrossRefGoogle ScholarPubMed
14.Ahonen, J, Olkkola, KT, Hynynen, M et al. . Comparison of alfentanil, fentanyl and sufentanil for total intravenous anaesthesia with propofol in patients undergoing coronary artery bypass surgery. Br J Anaesth 2000; 85: 533–540.CrossRefGoogle ScholarPubMed
15.Johansen, JW, Sebel, PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology 2000; 93: 1336–1344.CrossRefGoogle ScholarPubMed
16.Musialowicz, T, Hynynen, M, Yppärilä, H, Pölönen, P, Ruokonen, E, Jakob, SM. Midlatency auditory-evoked potentials in the assessment of sedation in cardiac surgery patients. J Cardiothorac Vasc Anesth 2004; 18: 559–562.CrossRefGoogle ScholarPubMed
17.Shinner, G, Sharpe, RM, Thornton, C, Dore, CJ, Brunner, MD. Effect of bolus dose of alfentanil on the arousal response to intubation, as assessed by the auditory evoked response. Br J Anaesth 1999; 82: 925–928.CrossRefGoogle ScholarPubMed
18.Ranta, SO-V, Herranen, P, Hynynen, M. Patients’ conscious recollections from cardiac anesthesia. J Cardiothorac Vasc Anesth 2002; 16: 426–430.CrossRefGoogle ScholarPubMed
19.Liu, EHC, Wong, HK, Chia, CP, Lim, HJ, Chen, ZY, Lee, TL. Effects of isoflurane and propofol on cortical somatosensory evoked potentials during comparable depth of anaesthesia as guided by bispectral index. Br J Anaesth 2005; 94: 193–197.CrossRefGoogle ScholarPubMed
20.Iselin-Chaves, IA, Flaishon, R, Sebel, PS et al. . The effect of the interaction of propofol and alfentanil on recall, loss of consciousness, and the bispectral index. Anesth Analg 1998; 87: 949–955.CrossRefGoogle ScholarPubMed
21.Glass, PS, Bloom, M, Kearse, L, Rosow, C, Sebel, P, Man berg, P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.CrossRefGoogle ScholarPubMed
22.Olofsen, E, Dahan, A. The dynamic relationship between end-tidal sevoflurane and isoflurane concentrations and bispectral index and spectral edge frequency of the electroencephalogram. Anesthesiology 1999; 90: 1345–1353.CrossRefGoogle ScholarPubMed
23.Glass, PS. Pharmacokinetic and pharmacodynamic principles in providing ‘fast track’ recovery. J Cardiothorac Vasc Anesth 1995; 9: 16–20.Google ScholarPubMed
24.Thornton, C, Konieczko, K, Jones, JG, Jordan, C, Dore, CJ, Heneghan, CP. Effect of surgical stimulation on the auditory evoked response. Br J Anaesth 1988; 60: 372–378.CrossRefGoogle ScholarPubMed
25.De Beer, NA, Van Hooff, JC, Cluitmans, PJ, Korsten, HH, Beneken, JE. Haemodynamic responses to incision and sternotomy in relation to the auditory evoked potentials and spontaneous EEG. Br J Anaesth 1996; 76: 685–693.CrossRefGoogle Scholar
26.Bonhomme, V, Llabres, V, Dewandre, PY, Brichant, JF, Hans, P. Combined use of bispectral index and A-line autoregressive index to assess anti-nociceptive component of balanced anaesthesia during lumbar arthrodesis. Br J Anaesth 2006; 93: 353–360.CrossRefGoogle Scholar
27.Mi, WD, Sakai, T, Takahashi, S, Matsuki, A. Haemodynamic and electroencephalograph responses to intubation during induction with propofol and profofol/fentanyl. Can J Anaesth 1998; 45: 19–22.CrossRefGoogle Scholar
28.Kaisti, KK, Metsahonkala, L, Teras, M et al. . Effects of surgical levels of propofol and sevoflurane anesthesia on cerebral blood flow in healthy subjects studied with positron emission tomography. Anesthesiology 2002; 96: 1358–1370.CrossRefGoogle ScholarPubMed
29.Jeong, YB, Kim, JS, Jeong, SM, Park, JW, Choi, IC. Comparison of the effects of sevoflurane and propofol anaesthesia on regional cerebral glucose metabolism in humans using positron emission tomography. J Int Med Res 2006; 34: 374–384.CrossRefGoogle ScholarPubMed