Event-related potential measures of information processing during general anesthesia

To investigate the incidence and manner of auditory information processing during a state of presumed unconsciousness event-related brain potentials (ERPs) were studied in 41 patients undergoing cardiac surgery with propofol/alfentanil anesthesia. The ERPs were recorded during auditory oddball tasks administered before and within several periods of the operation. Mean nasopharyngeal temperature and anesthetic concentrations were determined for each intraoperative ERP recording epoch. During anesthesia ERP waves could still be observed up to 500 ms after stimulus onset indicating that auditory information processing was not suppressed completely by the administered anesthetic agents. Relative to the preoperative recordings, the P1-N1-P2 complex was delayed and more positive going during anesthesia. Comparable changes in ERP morphology have been observed during Stage II–IV sleep, suggesting parallels in the mechanisms underlying early auditory processing in both states of reduced arousal level, possibly related to a selective reduction of a non-specific activity. N1 and P2 peak amplitudes were found to be larger for the deviant tones compared to the standard tones. These amplitude differences most likely reflect automatic detection of stimulus deviance, although it cannot be excluded entirely that they were due to differences in refractoriness. Anesthetic concentrations and nasopharyngeal temperature were found to be of minor significance for ERP control. It is suggested that ERPs could serve as intraoperative reference measures, providing the earliest evidence for auditory processing. This characteristic is important for validation of signals and techniques that are proposed to improve conventional monitoring of anesthesia with respect to detecting unintended awareness.