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Midlatency auditory evoked potentials do not allow the prediction of recovery from general anesthesia with isoflurane

[Les potentiels évoqués auditifs de milatence ne permettent pas de prédire la récupération après une anesthésie générale à l'isoflurane]

Ingrid Rundshagen, MD^*, Kai Schnabel and Jochen Schulte am Esch, MD

^* From the Department of Anesthesiology, University Hospital Charité, Humboldt University of Berlin, Campus Charité Mitte, Berlin, Germany;
the Department of Psychology, University of Michigan, Ann Arbor, USA; and
the Department of Anesthesiology, University-Hospital Eppendorf, Hamburg, Germany.

Dr. Ingrid Rundshagen, Department of Anesthesiology, University Hospital Charité, Campus Charité Mitte, Schumannstr. 20/21, D-10117 Berlin, Germany. Phone: 49-30-450 531 012; Fax: 49-30-450 531 911; E-mail: ingrid.rundshagen{at}charite.de

Purpose: To investigate midlatency auditory evoked potentials (MLAEP) waveforms during recovery from anesthesia. The hypothesis was that MLAEP are sensitive variables to discriminate between states of consciousness and unconsciousness during emergence from anesthesia.

Methods: MLAEP were recorded in the awake state and during the wake-up phase from isoflurane anesthesia in 22 female patients undergoing ophthalmologic surgery. During emergence from anesthesia the changes in latency and amplitude of MLAEP components Na, Pa and Nb were compared with the awake level. The next day the patients were asked for explicit memory for the recovery period.

Results: In 72% of the patients the MLAEP waveforms were completely suppressed during isoflurane anesthesia. When the patients responded and opened their eyes spontaneously 38 ± 12 min after anesthesia, the latencies of Na (18.3 ± 1.2 vs 17.6 ± 1.3; P = 0.013) and Nb (47.4 vs 7.1 vs 44.7 ± 7.8; P = 0.048) remained prolonged compared with awake values. In contrast, the amplitudes NaPa and PaNb had regained baseline level. Nine patients had explicit memory for the immediate recovery period. However, there was no difference for any MLAEP component between patients with and without memory at any time.

Conclusions: The persistent changes of MLAEP latency components Na and Nb indicated impaired auditory signal processing 38 min after isoflurane anesthesia. There was a marked intra- and inter-individual variability during reversal of the anesthetic induced MLAEP changes. This limits the prediction of recovery of consciousness in the individual patient during emergence from anesthesia.