To determine threshold values, sensitivity and specificity of the spectral edge frequency (SEF) of the electroencephalogram (EEG) that indicate intraoperative movements, we studied 49 patients undergoing, elective laparotomy. Extradural analgesia was used in all patients. To maintain general anaesthesia, patients in group 1 (n = 23) received 0.4-1.2 vol% isoflurane and patients in group 2 (n = 24) propofol 3-5 mg kg-1 h-1 i.v. During operation and emergence from anaesthesia, spontaneous purposeful movements were documented. The EEG was recorded continuously in the awake state until the end of anaesthesia. Power spectral analysis calculated the SEF and power in the delta, theta, alpha and beta bands and the delta ratio. Adequate anaesthesia caused a statistically significant decrease in SEF from 16 to 12 Hz. Power in the beta band decreased and power in the theta band and total power increased compared with the awake state. Before and during movements observed in the intraoperative period or during emergence from general anaesthesia, SEF increased from 12 to 18 Hz, the power in beta band increased and theta power decreased compared with the state of adequate anaesthesia. A threshold value of SEF 14 Hz to predict movements during anaesthesia had a sensitivity of 72% and specificity of 82%.

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We interviewed 45 patients, who answered advertisements (n = 21) or were referred by colleagues (n = 24), about their experience of intraoperative awareness using a standardized questionnaire. Auditory perceptions, hearing sounds or voices were mentioned by all patients (45 of 45): 33 of 45 patients understood and recalled conversations; 21 of 45 patients had visual perceptions; 12 of 21 recognized things or faces; 29 of 45 patients felt being touched; three patients had the sensation of moderate pain; and eight patients were in severe pain. Patients' feelings were mostly related to paralysis (27 of 45), helplessness (28 of 45), anxiety and fear (22 of 45); 18 were in severe panic. All patients (45 of 45) recognized the situation as a real event: 22 of 45 patients experienced unpleasant after effects; 11 suffered from anxiety and nightmares; and three developed post-traumatic stress disorder syndrome and required medical treatment. Twenty of 45 patients were especially attentive to emotionally relevant remarks on their own person, their disease and the course of their operation. The accuracy of sensory perception indicates a very high level of cognitive performance of patients during intraoperative awareness.

We studied mid-latency auditory evoked potentials (MLAEP) during induction of general anaesthesia with ketamine 2 mg kg-1. MLAEP were recorded before, during and after induction of general anaesthesia on the vertex (positive) and mastoid (negative) positions. Latencies of the peak V, Na, Pa, Nb, P1 and amplitudes Na/Pa, Pa/Nb and Nb/P1 were measured. Fast-Fourier transformation was used to calculate power spectra of the MLAEP. In the awake state, MLAEP had large peak-to-peak amplitudes and a periodic waveform. Peak latencies remained within the normal range. Power spectra indicated high energy in the 30-40 Hz frequency range. After induction of general anaesthesia with ketamine, there was no change in latency of peaks V, Na, Pa, Nb, P1 and no apparent reduction in amplitudes Na/Pa, Pa/Nb and Nb/P1. In the power spectra, frequencies in the range of 30-40 Hz retained high energy. Amplitudes and latencies of MLAEP did not change during induction of general anaesthesia with ketamine. Primary processing of auditory stimuli in the primary auditory cortex seemed to be preserved under ketamine. Suppression of sensory (auditory) information processing must take place at a higher cortical level in a dissociative manner.

We have studied dose-dependent effects of alfentanil, fentanyl and morphine on mid-latency auditory evoked potentials (MLAEP). Anaesthesia was induced with alfentanil 100 micrograms kg-1 every 5 min to a total dose of 500 micrograms kg-1 (group I, n = 10), fentanyl 10 micrograms kg-1 every 7 min to a total dose of 50 micrograms kg-1 (group II, n = 10) or morphine 1 mg kg-1 for induction and 0.5 mg kg-1 every 15 min to a total dose of 3 mg kg-1 (group III, n = 10). MLAEP were recorded before and 3-15 min after every opioid dose on vertex (positive) and mastoids on both sides (negative). Latencies of the peaks V, Na, Pa, Nb, P1 (ms) and amplitudes Na/Pa, Pa/Nb and Nb/P1 (microV) were measured. Fast-Fourier transformation was used to calculate power spectra of the AEP. In the awake state, MLAEP had high peak-to-peak amplitudes and a periodic waveform. Power spectra indicated high energy in the 30-40 Hz frequency range. During general anaesthesia with increasing doses of alfentanil, fentanyl and morphine, the brainstem response V was stable. There was a marked increase only in latency and decrease in amplitude of P1. In contrast, for the early cortical potentials Na and Pa, only small increases in latencies and decreases in amplitudes were observed. After the largest doses of alfentanil (500 micrograms kg-1), fentanyl (50 micrograms kg-1) and morphine (3 mg kg-1), Na, Pa and Nb showed a similar pattern as in awake patients.(ABSTRACT TRUNCATED AT 250 WORDS)

SummaryWe studied the effects of increasing end-expiratory concentrations of isoflurane (0.3, 0.6, 0.9, 1.2 vol.%) (n ¼ 12 patients), desflurane (1.5, 3.0, 4.5, 6.0 vol.%) (n ¼ 12 patients) and sevoflurane (0.5, 1.0, 1.5, 2.0 vol.%) (n ¼ 12 patients) on power spectral analysis of the electroencephalogram (EEG). Spectral edge frequency (SEF), total power (TP) and relative power in the delta, theta, alpha and beta band were calculated. EEG changes were very similar within the three groups. SEF decreased, TP and relative power in the delta and theta band increased, power in the beta band decreased in a dose-dependent fashion with comparable regression lines. This indicates that MAC equivalent administration of isoflurane, desflurane and sevoflurane in clinically applied dose ranges is associated with equipotent EEG suppression.

Midlatency auditory evoked potentials (MLAEP) reflect primary cortical processing of auditory stimuli. The effects of benzodiazepines on MLAEP have not yet been studied. We examined the effects of intravenous induction of general anaesthesia using the benzodiazepines midazolam, diazepam and flunitrazepam on MLAEP in 30 patients scheduled for minor gynaecological procedures. Anaesthesia was induced with Group L n = 10), Group II, Group Ill, n = 10 (0, groupe I, n = 10), le diazdpam (0, group II, n = 10) ou le flunitrazepam (0, groupe IlI, n = 10

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