Impact of propofol on mid-latency auditory-evoked potentials in children

Kuhnle, G. E. H.; Hornuß, Cyrill; Lenk, Mustafa Koray; Salam, Alex P.; Wiepcke, D.; Edelmann-Gahr, V.; Flake, G.; Daunderer, M; Oberhauser, M.; Müller, Hans‐Helge; Feuerecker, Matthias

doi:10.1093/bja/aet002

Cited by 13 publications

(14 citation statements)

References 25 publications

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“…This study has shown that AEP latency exhibited similar changes in different subjects and at different acoustic intensities during anesthesia ( Figs 2e , 3a ), corroborating previous studies 36 37 38 39 40 . However, AEP amplitude changed with greater variability during anesthesia ( Figs 2g , 3d ), consistent with other reports 14 41 .…”

Section: Discussionsupporting

confidence: 91%

Latency of auditory evoked potential monitoring the effects of general anesthetics on nerve fibers and synapses

Huang

Liang

Zhong

et al. 2015

Sci Rep

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Auditory evoked potential (AEP) is an effective index for the effects of general anesthetics. However, it’s unknown if AEP can differentiate the effects of general anesthetics on nerve fibers and synapses. Presently, we investigated AEP latency and amplitude changes to different acoustic intensities during pentobarbital anesthesia. Latency more regularly changed than amplitude during anesthesia. AEP Latency monotonically decreased with acoustic intensity increase (i.e., latency-intensity curve) and could be fitted to an exponential decay equation, which showed two components, the theoretical minimum latency and stimulus-dependent delay. From the latency-intensity curves, the changes of these two components (∆L and ∆I) were extracted during anesthesia. ∆L and ∆I monitored the effect of pentobarbital on nerve fibers and synapses. Pentobarbital can induce anesthesia, and two side effects, hypoxemia and hypothermia. The hypoxemia was not related with ∆L and ∆I. However, ∆L was changed by the hypothermia, whereas ∆I was changed by the hypothermia and anesthesia. Therefore, we conclude that, AEP latency is superior to amplitude for the effects of general anesthetics, ∆L monitors the effect of hypothermia on nerve fibers, and ∆I monitors a combined effect of anesthesia and hypothermia on synapses. When eliminating the temperature factor, ∆I monitors the anesthesia effect on synapses.

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Section: Discussionsupporting

confidence: 91%

Latency of auditory evoked potential monitoring the effects of general anesthetics on nerve fibers and synapses

Huang

Liang

Zhong

et al. 2015

Sci Rep

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“…In addition, ABRs are used in combination with evoked potentials from other modalities to monitor coma prognosis (Guérit 2005;Fischer et al 2006; see below), or in isolation to corroborate brain death (Machado et al 1991). In the surgical theatre, MLR is used to monitor the depth of anaesthesia in adults (Bell et al 2004) and children (Kuhnle et al 2013). It has been recently shown that, compared with the traditional clinical assessment of depth of anaesthesia, MLR monitoring led to a reduction in a) the amount anaesthetic drug requirement, b) the use of vasopressors to manage hypotension, and c) consequential cognitive impairment (Jildenstål et al 2011).…”

Section: Utility Of Aerp For Clinical Practicementioning

confidence: 99%

Auditory Event-Related Potentials

Winkler

Denham

Escera

2015

Encyclopedia of Computational Neuroscience

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Auditory event-related potential (AERP), auditory evoked potential (AEP), auditory evoked field (AEF)• DEFINITION Auditory event-related potentials are electric potentials (AERP, AEP) and magnetic fields (AEF) generated by the synchronous activity of large neural populations in the brain, which are time-locked to some actual or expected sound event (cf. the definition of ERP in EEG/MEG Evoked/Spontaneous Activity).• DETAILED DESCRIPTION Measurement and Derivation of AERPs/AEFsAERPs are derived from the continuous electro-/magnetoencephalogram (EEG/MEG, see EEG/MEG Evoked/Spontaneous Activity) by extracting segments of the signal (epochs) time-locked to some actual or expected acoustic event. AERPs were first recorded by Hallowell and Pauline A. Davis in 1935-36 (Davis 1939;Davis et al. 1939). Because EEG/MEG is typically recorded non-invasively (outside the brain, e.g., from/around the scalp), these measures only reflect synchronous activity of large neural populations (for measuring methods and instrumentation, see EEG/MEG Evoked/Spontaneous Activity). Consequently, the acoustic events eliciting detectable AERPs consist of relatively large changes of spectral energy occurring within a relatively short time period, such as abrupt sound onsets, offsets, and changes within a continuous sound, because large acoustic changes affect many neurons within the auditory system and the short transition period synchronizes the responses of individual neurons ( The anatomical inset (left panel) highlights the main stages of the auditory pathway: "bn", brainstem nuclei (including the cochlear nucleus, the superior olivary nucleus, the nucleus of the lateral lemniscus); "IC", inferior colliculus; "MGB", the medial geniculate body in the thalamus; "AC", auditory cortex. The main assumed brain sources of the different AERPs are marked by colored circles: the ascending auditory pathway of the brainstem for ABRs (green); the thalamo-cortical loops and parts of auditory cortex for MLRs (blue); the auditory cortex for LLRs (red). AERPs can be broken down into a series of waves (see the naming convention in the main text). Figure 1 illustrates the progression of stimulus-related neuronal activity through the auditory system and the corresponding series of positive and negative waveforms observable in the AERP response. The earliest detectable responses (< ca. 10 ms after the acoustic event) originate from subcortical brain 4 structures and are termed the Auditory Brainstem Response (ABR; cf. Auditory Evoked Brainstem Responses). These are followed by AERP responses of thalamo-cortical origin (mainly from the primary auditory cortex), termed the Middle-Latency Response (MLR), elicited during the ca. 10-50 ms post-event latency range. The waveforms following are called Long-Latency Responses (LLR) and they originate largely from auditory cortex, but may also include contributions from parietal and frontal areas.

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“…Six studies described MLAEP during propofol anesthesia 20,21,24,27,29,32 . The effect of propofol on the components of the unprocessed MLAEP in children (with a mean age of 8.6 years) has been described by Kuhnle et al 21 They observed a dose related increase of latencies (Na, Pa, Nb and P1) and decreasing amplitudes.…”

Section: Resultsmentioning

confidence: 97%

“…For these four studies, the risk of bias in the reference standard were rated as unclear. Two studies were rated unclear for their risk of bias in the domain of “Flow and Timing”, because one study was terminated prematurely due to change in the anesthesia practice 18 and the other failed to generate data from 4 of the 14 patients 21 . Seven studies allowed premedication for their patients and were therefore rated as “unclear” for applicability concerns of patient selection 17,18,20–24 .…”

Section: Resultsmentioning

confidence: 99%

Midlatency auditory evoked potentials during anesthesia in children: A narrative review

Cheung

Heer

Stolker

et al. 2021

Pediatric Anesthesia

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The relationship between anesthesia and the electrical activity of the brain has been described as early as in the 1940's. 1 Development in this field has been extended to the investigation of the relationship between the brain activity and depth of anesthesia. 2 Research of the brain activity as a surrogate to monitor the depth of hypnosis during anesthesia has mostly focused on the spontaneous electroencephalogram (EEG). However, the spontaneous EEG does not mature before adult age, which could influence its reliability in children. 3 Although Mid-Latency auditory evoked potentials (MLAEP) are electrical brain activity, they are fundamentally different from the spontaneous EEG. These potentials are electric responses of the brain to an auditive stimulus.They occur at about 8-50 ms after the stimulus, which is after the auditory brainstem response (0-8 ms) and before the late cortical response (>50 ms). Needless to say, an impaired auditory pathway and/or inadequate delivery of the acoustic stimulus (poor fit of the earbuds in children) will make the recording of a MLAEP unreliable or even impossible.A typical MLAEP waveform consists of 3 troughs (labelled with N for negative polarity) and 2 peaks (labelled with P for positive polarity) of a few microvolts (Figure 1). To put in perspective, the EEG is about ten times stronger and the ECG is about 100 times stronger. The weak signal of the MLAEP makes it susceptible to noise and diminishes its signal quality. The peaks and troughs are commonly labeled as N 0 , P 0 , Na, Pa and Nb and occur, in the awake adult, at about 9 ms, 12 ms, 16 ms, 25 ms and 36 ms, respectively, after the application of an auditive stimulus. 4 The MLAEP is believed to be generated from the medial geniculate body and primary auditory cortex. 5 In anesthetized adult patients, the peaks and troughs decrease in amplitude and the interval when they occur, which are called latencies, increases. [5][6][7][8][9] Myelination of the brain in de developing child strongly influences evoked potentials, this makes it difficult to elicit these in infants having an age of less than 1 year and very difficult in infants less than 6 months of age.MLAEP mature after the first decade of life, around 10-12 years. [10][11][12][13] Mid-Latency auditory evoked potentials could be a parameter to measure the depth of hypnosis in anesthetized children. This narrative review summarizes the current literature concerning the use of MLAEP and its implications in anesthetized children. | ME THODSThis study adheres to the Preferred Reporting Items for Systematic Reviews and MetaAnalysis (PRISMA) guidelines, since it was initiated

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Impact of propofol on mid-latency auditory-evoked potentials in children

Abstract: Propofol affects MLAEP latencies and amplitudes in children in a dose-dependent manner. MLAEP measurement might therefore be a useful tool for monitoring depth of propofol anaesthesia in children.

Cited by 13 publications

References 25 publications

Latency of auditory evoked potential monitoring the effects of general anesthetics on nerve fibers and synapses

Latency of auditory evoked potential monitoring the effects of general anesthetics on nerve fibers and synapses

Auditory Event-Related Potentials

Midlatency auditory evoked potentials during anesthesia in children: A narrative review

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