Intraoperative Somatosensory Evoked Potential Monitoring Decreases EEG Burst Suppression Ratio During Deep General Anesthesia

PURPOSE:The burst suppression (BS) EEG patterns induced by general anesthesia can react to somatosensory stimuli. We investigated this reactivity by studying the effect of peripheral nerve stimulation used for routine intraoperative spinal cord monitoring by somatosensory evoked potentials on BS patterns. METHODS:The relative time spent in suppression expressed as BS ratio (BSR) and mean burst duration were measured before (BSRPre), during (BSRStim), and after (BSRPost) a 60-second repetitive electrical ulnar nerve stimulation in nine patients under total intravenous general anesthesia with propofol. The BS reactivity was measured as BSRPre-BSRStim. RESULTS:Overall, 27 trials were included with BSRPre up to 77%, indistinguishable from BSRPost. During stimulation, the mean BSR transiently decreased from 42% to 35%. For each 1% increase in BSRPre, the BS reactivity increased with 0.6%, whereas the burst duration remained approximately 3 seconds. For BSRPre below 30%, the BS reactivity was negligible. CONCLUSIONS:Data from this study show that somatosensory input can evoke bursts, altering the “spontaneous” deep BS patterns (BSRPre >30%). Further studies are necessary to objectively assess the clinical relevance of stimulus-induced BS reactivity during deep general anesthesia.