Abstract
Auditory evoked potentials (AEPs) have been used as a measure of the depth of anesthesia during the intra-operative process. AEPs are classically divided, on the basis of their latency, into first, fast, middle, slow, and late components. The use of auditory evoked potential has been advocated for the assessment of Intra-operative awareness (IOA), but has not been considered seriously enough to universalize it. It is because we have not explored enough the impact of auditory perception and auditory processing on the IOA phenomena as well as on the subsequent psychological impact of IOA on the patient. More importantly, we have seldom tried to look at the phenomena of IOP from the perspective of consciousness itself. This perspective is especially important because many of IOA phenomena exist in the subconscious domain than they do in the conscious domain of explicit recall. Two important forms of these subconscious manifestations of IOA are the implicit recall phenomena and post-operative dreams related to the operation. Here, we present an integrated auditory consciousness-based model of IOA. We start with a brief description of auditory awareness and the factors affecting it. Further, we proceed to the evaluation of conscious and subconscious information processing by auditory modality and how they interact during and after intra-operative period. Further, we show that both conscious and subconscious auditory processing affect the IOA experience and both have serious psychological implications on the patient subsequently. These effects could be prevented by using auditory evoked potential during monitoring of anesthesia, especially the mid-latency auditory evoked potentials (MLAERs). To conclude our model with present hypothesis, we propose that the use of auditory evoked potential should be universal with general anesthesia use in order to prevent the occurrences of distressing outcomes resulting from both conscious and subconscious auditory processing during anesthesia.
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Myles, P. S., Leslie, K., McNeil, J., Forbes, A., & Chan, M. T. (2004). Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet, 363, 1457–1763.
Ghoneim, M. M., Block, R. I., Haffarnan, M., & Mathews, M. J. (2009). Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesthesia and Analgesia, 108, 527–535.
Schwender, D., Kunze-Kronawitter, H., Dietrich, P., Klasing, S., Forst, H., & Madler, C. (1998). Conscious awareness during general anaesthesia: patients’ perceptions, emotions, cognition and reactions. British Journal of Anaesthesia, 80, 133–139.
Alexandrov, Y. I., Klucharev, V., & Sams, M. (2007). Effect of emotional context in auditory-cortex processing. International Journal of Psychophysiology, 65, 261–271.
Yu, F., & J. Y. Luo, Y. J. (2009). Auditory-induced emotion modulates processes of response inhibition: an event-related potential study. NeuroReport, 2009(20), 25–30.
Plourde, G., Belin, P., Chartrand, D., Fiset, P., Backman, S. B., Xie, G., et al. (2006). Cortical processing of complex auditory stimuli during alterations of consciousness with the general anesthetic propofol. Anesthesiology, 104, 448–457.
Rosen, M Lu J N. (1987). Awareness: clinical aspects, consciousness, awareness and pain in general anaesthesia. London: Butterworths.
Sandhu, K., & Dash, H. (2009). Awareness during anaesthesia. Indian Journal of Anaesthesia, 53, 148–157.
Samuelsson, P., Brudin, L., & Sandin, R. H. (2008). Intraoperative dreams reported after general anaesthesia are not early interpretations of delayed awareness. Acta Anaesthesiologica Scandinavica, 52, 805–809.
Leslie, K. H. S., Paech, M. J., Kurowski, I., & Whybrow, T. (2007). Dreaming during anesthesia and anesthetic depth in elective surgery patients: a prospective cohort study. Anesthesiology, 2007(106), 33–42.
Franks, N. P. (2008). General anaesthesia: from molecular targets to neuronal pathways of sleep and arousal. Nature Reviews Neuroscience, 2008(9), 370–386.
John, E. R., & Prichep, L. S. (2005). The anesthetic cascade: a theory of how anesthesia suppresses consciousness. Anesthesiology, 2005(105), 447–471.
Lydic, R., & Baghdoyan, H. A. (2005). Sleep, anesthesiology, and the neurobiology of arousal state control. Anesthesiology, 2005(103), 1268–1295.
Alkire, M. T., & Miller, J. (2005). General anesthesia and the neural correlates of consciousness. Progress in Brain Research, 2005(150), 229–244.
Alkire, M. T., Hudetz, A. G., & Tononi, G. (2008). Consciousness and anesthesia. Science, 322, 876–880.
Koelsch, S., Heinke, W., Sammler, D., & Olthoff, D. (2006). Auditory processing during deep propofol sedation and recovery from unconsciousness. Clinical Neurophysiology, 117, 1746–1759.
Heinke, W., Kenntner, R., Gunter, T. C., Sammler, D., Olthoff, D., & Koelsch, S. (2004). Sequential effects of increasing propofol sedation on frontal and temporal cortices as indexed by auditory event-related potentials. Anesthesiology, 100, 617–625.
Ypparila, H., Karhu, J., Westeren-Punnonen, S., Musialowicz, T., & Partanen, J. (2002). Evidence of auditory processing during postoperative propofol sedation. Clinical Neurophysiology, 113, 1357–1364.
Simpson, T. P., Manara, A. R., Kane, N. M., Barton, R. L., Rowlands, C. A., & Butler, S. R. (2002). Effect of propofol anaesthesia on the event-related potential mismatch negativity and the auditory-evoked potential N1. British Journal of Anaesthesia, 89, 382–388.
Heinke, W., & Koelsch, S. (2005). The effects of anesthetics on brain activity and cognitive function. Current Opinion in Anaesthesiology, 18, 625–631.
Reinsel, R. A., Veselis, R. A., Dnistrian, A. M., Feshchenko, V. A., Beattie, B. J., & Duff, M. R. (2000). Midazolam decreases cerebral blood flow in the left prefrontal cortex in a dose-dependent fashion. International Journal of Neuropsychopharmacology, 117, 117–127.
Aceto, P., Valente, A., Gorgoglione, M., Adducci, E., & De Cosmo, G. (2003). Relationship between awareness and middle latency auditory evoked responses during surgical anaesthesia. British Journal of Anaesthesia, 90, 630–635.
Griefahn, B., Scheuch, K., Jansen, G., & Spreng, M. (2004). Protection goals for residents in the vicinity of civil airports. Noise Health, 6, 51–62.
Muzet, A. (2007). Environmental noise, sleep and health. Sleep Medicine Reviews, 11, 135–142.
Nordby, H., Hugdahl, K., Stickgold, R., Bronnick, K. S., & Hobson, J. A. (1996). Event-related potentials (ERPs) to deviant auditory stimuli during sleep and waking. NeuroReport, 10, 1082–1086.
Karakas, S., Cakmak, E. D., Bekci, B., & Aydin, H. (2007). Oscillatory responses representing differential auditory processing in sleep. International Journal of Psychophysiology, 65, 40–50.
Bastuji, H., Garcia-Larrea, L., Franc, C., & Mauguiere, F. (1995). Brain processing of stimulus deviance during slow-wave and paradoxical sleep: a study of human auditory evoked responses using the oddball paradigm. Journal of Clinical Neurophysiology, 12, 155–167.
Perrin, F., Garcia-Larrea, L., Mauguiere, F., & Bastuji, H. (1999). A differential brain response to the subject’s own name persists during sleep. Clinical Neurophysiology, 110, 2153–2164.
Portas, C. M., Krakow, K., Allen, P., Josephs, O., Armony, J. L., & Frith, C. D. (2000). Auditory processing across the sleep-wake cycle: simultaneous EEG and fMRI monitoring in humans. Neuron, 28, 991–999.
Ranta, S. O., Laurila, R., Saario, J., Ali-Melkkila, T., & Hynynen, M. (1998). Awareness with recall during general anesthesia: incidence and risk factors. Anesthesia and Analgesia, 86, 1084–1089.
Osterman, J. E., Hopper, J., Heran, W. J., Keane, T. M., & van der Kolk, B. A. (2001). Awareness under anesthesia and the development of posttraumatic stress disorder. General Hospital Psychiatry, 23, 198–204.
Schacter, D. L., & Church, B. (1995). Implicit memory in amnesic patients: when is auditory priming spared? Journal of the International Neuropsychological Society, 1995(1), 434–442.
Jacobson, G. P., Kraus, N., & McGee, T. J. (1997). Hearing as reflected by middle and long latency event-related potentials. Advances in Oto-Rhino-Laryngology, 53, 46–84.
Deiber, M. P., Ibanez, V., Fischer, C., Perrin, F., & Mauguiere, F. (1988). Sequential mapping favours the hypothesis of distinct generators for Na and Pa middle latency auditory evoked potentials. Electroencephalography and Clinical Neurophysiology, 71, 187–197.
Pockett, S. (1999). Anesthesia and the electrophysiology of auditory consciousness. Consciousness and Cognition, 8, 45–61.
Zatorre, R. J., Evans, A. C., Meyer, E., & Gjedde, A. (1992). Lateralization of phonetic and pitch discrimination in speech processing. Science, 256, 846–849.
Kraus N, N., & McGee, T. (1995). The middle latency response generating system. Electroencephalography and Clinical Neurophysiology. Supplement, 44, 93–101.
Merikle, P. M., & Daneman, M. (1996). Memory for events during anaesthesia: a meta-analysis. In B. Bonke, J. G. Bovill, & N. Moergan (Eds.), Memory and Awareness in Anaesthesia III (pp. 108–121). The Netherlands: Van Gorgum.
Schwender, D., Kaiser, A., Klasing, S., Peter, K., & Poppel, E. (1994). Midlatency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery. Anesthesiology, 80, 493–501.
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Dong, X., Suo, P., Yuan, X. et al. Use of Auditory Evoked Potentials for Intra-Operative Awareness in Anesthesia: A Consciousness-Based Conceptual Model. Cell Biochem Biophys 71, 441–447 (2015). https://doi.org/10.1007/s12013-014-0221-0
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DOI: https://doi.org/10.1007/s12013-014-0221-0