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ANESTHETIC PHARMACOLOGY

A Combination of Electroencephalogram and Auditory Evoked Potentials Separates Different Levels of Anesthesia in Volunteers

Bettina Horn, MD^*, Stefanie Pilge, MD^*, Eberhard F. Kochs, MD^*, Gudrun Stockmanns, PhD, Andreas Hock, MSc^*, and Gerhard Schneider, MD^*

From the *Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich; and Institute of Information Logistics, Department of Computer Science and Applied Cognitive Science, University of Duisburg-Essen, Germany.

Address correspondence and reprint requests to Dr. Gerhard Schneider, Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger St. 22, 81675 Munich, Germany. Address e-mail to g.schneider{at}lrz.tum.de.

BACKGROUND: It has been shown that the combination of electroencephalogram (EEG) and auditory evoked potentials (AEP) allows a good separation of consciousness from unconsciousness. In the present study, we sought a combined EEG/AEP indicator that allows both separation of consciousness from unconsciousness and discrimination among different levels of sedation and hypnosis over a wider range of anesthesia.

METHODS: Fifteen unpremedicated volunteers received mono-anesthesia with sevoflurane or propofol in a randomized crossover design in two consecutive sessions. Loss of consciousness (LOC) and EEG burst suppression (BSP) defined end-points from the upper and lower range of general anesthesia. In addition to those two extremes, the difference between anesthetic concentration at BSP and LOC was divided into three equal intervals, resulting in two intermediate levels which divided the concentration from LOC (minimum) to BSP (maximum) into three equal steps. This data set was used to test whether a previously described combined EEG/AEP indicator "detector of consciousness" can also discriminate among degrees of anesthetic effects from the awake state to BSP. Furthermore, a new improved combined EEG/AEP indicator was developed on the basis of the data from the current study, and subsequently this new indicator was tested for its ability to separate consciousness from unconsciousness with the patient data set.

RESULTS: The former "detector of consciousness" showed a prediction probability (P_K) of 0.77 to separate different levels of anesthesia from the current study, whereas for the new combined EEG/AEP indicator, P_K was 0.94. The new indicator was further applied to the previous study and achieved a P_K of 0.89.

CONCLUSIONS: These results show that with the new indicator presented here, a combination of EEG and AEP parameters can be used to differentiate degrees of anesthetic effects over a wide range of hypnosis, from the conscious state to deep anesthesia (i.e., BSP).

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