Auditory Evoked Potentials

A clinical or a research tool?
  • Stefan Schraag
  • Gavin NC Kenny
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 523)


Since one of the earliest systematic observations of the physiologic effects of anaesthetic agents of John Snow in 1847 our interest of measures of the level of anaesthesia has persisted and a variety of approaches and technologies have meanwhile been introduced and utilized. Today, the practice of anaesthesia remains one of the safest and most effective in medicine. So why monitor the central nervous system (CNS)? Like all new technologies, CNS monitoring devices will certainly add something to the cost of delivering anaesthesia. On the other hand, there is no doubt that significant unpredictability and uncertainty still exists in the delivery of anaesthetic drugs. This is reflected in the variety of suggested dosing regimens, especially in intravenous anaesthesia. Some patients still suffer intra-operative awareness and may consecutively develop posttraumatic stress disorder,1 whereas others still have prolonged recovery due to relative overdosing even with otherwise short-acting drugs.


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  1. 1.
    R. Sandin, G. Ennlund, P. Samuelsson, C. Lennmarken, Awareness during anaesthesia: a prospective case study, Lancet 355, 707–711 (2000).PubMedCrossRefGoogle Scholar
  2. 2.
    C. Thornton, R. M. Sharpe, Evoked responses in anaesthesia, Br. J. Anaesth. 81, 771–781 (1998).PubMedCrossRefGoogle Scholar
  3. 3.
    H. Mantzaridis, G. N. C. Kenny, Auditory evoked potential index: A quantitative measure of changes in auditory evoked potentials during general anaesthesia, Anaesthesia 52, 1030–1036 (1997).PubMedCrossRefGoogle Scholar
  4. 4.
    E. W. Jensen, P. Lindholm, S. W. Henneberg, Autoregressive modeling with exogenous input of auditory evoked potentials to produce an online depth of anaesthesia index, Methods Inform. Med. 35, 256–260 (1996).Google Scholar
  5. 5.
    R. C. Dutton, W. D. Smith, I. J. Rampil, B. S. Chortkoff, and E. I. Eger, Forty-hertz midlatency auditory evoked potential activity predicts wakeful response during desflurane and propofol anesthesia in volunteers, Anesthesiology 91, 1209–1220 (1999).PubMedCrossRefGoogle Scholar
  6. 6.
    E. Kochs, G. Stockmanns, C. Thornton, W. Nahm, and C. J. Kalkman, Wavelet analysis of middle latency auditory evoked responses, Anesthesiology 95, 1141–1150 (2001).PubMedCrossRefGoogle Scholar
  7. 7.
    D. Schwender, I. Keller, S. Klasing, and C. Madler, Akustisch evozierte Potentiate mittlerer Latenz (AEPML) unter hochdosierter Opioidanalgesie, Anaesthesisi 39, 299–305 (1990).Google Scholar
  8. 8.
    R. Munglani, J. Andrade, D. J. Sapsford, A. Baddeley, J. G. Jones, A measure of consciousness and memory during isoflurane administration: the coherent frequency, Br. J. Anaesth. 71, 633–641 (1993).PubMedCrossRefGoogle Scholar
  9. 9.
    C. Thornton and D. E. F. Newton, The auditory evoked response: a measure of depth of anaesthesia, Balliere ’s Clinical Anaesthesiology 3, 559–585 (1989).CrossRefGoogle Scholar
  10. 10.
    H. Litvan, E. W. Jensen, M. Revuelta, S. W. Henneberg, P. Paniagua, J. M. Campos, P. Martinez, P. Caminal and J. M. V. Landeira, Comparison of auditory evoked potentials and the A-line ARX index for monitoring the hypnotic level during sevoflurane and propofol induction, Acta Anaesthesiol. Scand. 46, 245–251 (2002).PubMedCrossRefGoogle Scholar
  11. 11.
    C. Thornton, C. P. Heneghan, M. F. M. James and J. G. Jones, Effects of halothane or enflurane with controlled ventilation on auditory evoked potentials, Br. J. Anaesth. 56,315–323 (1984).PubMedCrossRefGoogle Scholar
  12. 12.
    C. Thornton, C. P. Heneghan, M. Navaratnarajah, P. E. Bateman and J. G. Jones, Effect of etomidate on the auditory evoked response in man, Br. J. Anaesth. 57,554–561 (1985).PubMedCrossRefGoogle Scholar
  13. 13.
    F. W. Davies, H. Mantzaridis, G. N. C. Kenny and A. C. Fisher, Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness, Anaesthesia 51,107–113 (1996).PubMedCrossRefGoogle Scholar
  14. 14.
    D. Schwender, T. Rimkus, R. Haesler, S. Klasing, E. PSppel and K. Peter, Effects of increasing doses of alfentanil, fentanyl and morphine on mid-latency auditory evoked potentials, Br. J. Anaesth. 71, 622–628 (1993).PubMedCrossRefGoogle Scholar
  15. 15.
    D. Schwender, M. Daunderer, N. Schnatmann, S. Klasing, S. Finsterer and K. Peter, Midlatency auditory evoked potentials and motor signs of wakefulness during anaesthesia with midazolam, Br. J. Anaesth. 79, 53–58 (1997).PubMedCrossRefGoogle Scholar
  16. 16.
    D. Schwender, S. Klasing, C. Madler, E. Poppel and K. Peter, Effects of benzodiazepins on mid-latency auditory evoked potentials, Can. J. Anaesth. 40,1148–1154 (1993).PubMedCrossRefGoogle Scholar
  17. 17.
    D. Schwender, S. Klasing, C. Madler, E. Poppel and K. Peter, Mid-latency auditory evoked potentials during ketamine anaesthesia in humans, Br. J. Anaesth. 71, 629–632 (1993).PubMedCrossRefGoogle Scholar
  18. 18.
    D. Schwender, A. Kaiser, S. Klasing, K. Peter and E. PGppel, Midlatency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery, Anesthesiology 80, 493–501 (1994).PubMedCrossRefGoogle Scholar
  19. 19.
    C. Thornton, M. P. Barrowcliffe, K. M. Konieczko, P. Ventham, C. J. Dore, D. E. Newton and J. G. Jones, The auditory evoked response as an indicator of awareness, Br. J. Anaesth. 63,113–115 (1989).PubMedCrossRefGoogle Scholar
  20. 20.
    D. E. Newton, C. Thornton, K. M. Konieczko, C. Jordan, N. R. Webster, N. P. Luff, CD. Frith and C. J. Dore Auditory evoked response and awareness: A study in volunteers at sub-MAC concentrations of isoflurane, Br. J. Anaesth. 69,122–129 (1992).PubMedCrossRefGoogle Scholar
  21. 21.
    R. J. Gajraj, M. Doi, H. Mantzaridis and G. N. C. Kenny, Analysis of the EEG bispectrum, auditory evoked potentials and the EEG power spectrum during repeated transitions from consciousness to unconsciousness, Br. J. Anaesth. 80, 46–52 (1998).PubMedCrossRefGoogle Scholar
  22. 22.
    R. J. Gajraj, M. Doi, H. Mantzaridis and G. N. C. Kenny, Comparison of the bispectral EEG analysis and auditory evoked potentials for monitoring depth of anaesthesia during propofol anaesthesia, Br. J. Anaesth. 82, 672–678 (1999).PubMedCrossRefGoogle Scholar
  23. 23.
    S. Schraag, U. Bothner, RJ. Gajraj, G. N. C. Kenny and M. Georgieff, The performance of the electraoencephalogram bispectral index and auditory evoked potential index to predict loss of consciousness during propofol infusion, Anesth. Analg. 89, 1311–1315 (1999).PubMedCrossRefGoogle Scholar
  24. 24.
    V. Bonhomme, G. Plourde, P. Meuret, P. Fiset and S. Backman, Auditory steady-state response and bispectral index for assessing level of consciousness during propofol sedation and hypnosis, Anesth. Analg. 91,1398–1403(2000).Google Scholar
  25. 25.
    I. E. Loveman, J. C. Van Hooff and D. C. Smith, The auditory evoked response as an awareness monitor during anaesthesia, Br. J. Anaesth. 86, 513–518 (2001).PubMedCrossRefGoogle Scholar
  26. 26.
    J. C. Drummond, Monitoring depth of anesthesia. With emphasis on the application of the bispectral index and the middle latency auditory evoked response to the prevention of recall, Anesthesiology 93, 876–882 (2000).PubMedCrossRefGoogle Scholar
  27. 27.
    E. Kochs, CJ. Kalkman, C. Thornton, D. E. Newton, P. Bischoff, H. Kuppe, J. Abke, E. Konecny, W. Nahm and G. Stockmanns, Middle latency auditory evoked responses and electroencephalographic derived variables do not predict movement to noxious stimulation during 1 minimum alveolar anesthetic concentration isoflurane/nitrous oxide anesthesia, Anesth. Analg. 88,1412–1417 (1999).PubMedGoogle Scholar
  28. 28.
    I. T. Kurita, M. Doi, T. Katoh, H. Sano, S. Sato, H. Mantzaridis and G. N. C. Kenny, Auditory evoked potential index predicts the depth of sedation and movement in response to skin incision during sevoflurane anesthesia, Anesthesiology 95, 364–370 (2001).PubMedCrossRefGoogle Scholar
  29. 29.
    M. Doi, RJ. Gajraj, H. Mantzaridis and G. N. C. Kenny, Prediction of movement at laryngeal mask insertion: comparison of auditory evoked potential index, bispectral index, spectral edge frequency and median frequency. Br. J. Anaesth. 82,203–207 (1999).PubMedCrossRefGoogle Scholar
  30. 30.
    LA. Iselin-Chaves, H. E. El Moalem, T. J. Gan, B. Ginsberg and P. S. A. Glass, Changes in the auditory evoked potentials and the bispectral index following propofol or propofol and alfentanil, Anesthesiology 92, 1300–1310(2000).PubMedCrossRefGoogle Scholar
  31. 31.
    I Crabb, C. Thornton, K. M. Konieczko, A. Chan, R. Aquilina, N. Frazer, CJ. Dore* and D. E. Newton, Remifentanil reduces auditory and somatosensory evoked responses during isoflurane anaesthesia in a dose-dependent manner, Br. J. Anaesth. 76, 795–801 (1996).PubMedCrossRefGoogle Scholar
  32. 32.
    R. R. McGregor, L. G. Allan, R. M. Sharpe, C. Thornton and D. E. Newton, Effect of remifentanil on the auditory evoked response and haemodynamic changes after intubation and surgical incision, Br. J. Anaesth. 81, 785–786 (1998).PubMedCrossRefGoogle Scholar
  33. 33.
    G. N. C. Kenny and H. Mantzaridis, Closed loop control of anaesthesia, Br. J. Anaesth. 83, 223–228 (1999).PubMedCrossRefGoogle Scholar
  34. 34.
    R. Allen and D. Smith, Neuro-fuzzy closed-loop control of depth of anaesthesia, Art Intell Med 21, 185–191 (2001).CrossRefGoogle Scholar
  35. 35.
    U. Bothner, S. Milne, G. N. C. Kenny, M. Georgieff and S. Schraag, Bayesian probabilistic network modeling of remifentanil and propofol interaction on wakeup time after closed-loop controlled anesthesia, Int. J. Clin. Monit. 17, 31–36 (2002).CrossRefGoogle Scholar
  36. 36.
    R. A. Veselis, R. A. Reinsel and V. A. Feshchenko, Drug-induced amnesia is a separate phenomenon from sedation. Electrophysiologic evidence, Anesthesiology 95, 896–907 (2001).PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Stefan Schraag
    • 1
  • Gavin NC Kenny
    • 2
  1. 1.Department of AnaesthesiologyUniversity of UlmUlmGermany
  2. 2.Department of AnaesthesiaUniversity of Glasgow, Royal InfirmaryGlasgowUK

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