Influence of Auditory Stimulation Rates on Evoked Potentials during General Anesthesia

Abstract

Background: The auditory middle-latency response (tran-sient) and the 40-Hz auditory steady state response (ASSR) are modulated by anesthetics. However, the quantitative relation between these evoked responses is difficult to obtain because of technical limitations of the recording methods used to obtain transients at high stimulation rates. This study uses continuous-loop averaging deconvolution to fill this technical gap and to study the relation between the transient and ASSR waveform during general anesthesia. Methods: The authors recorded 5-and 40-Hz transients and 40-Hz ASSRs in 13 subjects during general anesthesia. The 5-and 40-Hz transients were used to predict the 40-Hz ASSR by linearly superimposing the transient waveforms. The predicted and re-corded ASSRs were analyzed and compared using phasor and Hotelling T 2 analyses. Results: Grand-averaged recordings revealed differences in the early middle-latency peaks between 5-and 40-Hz transients, e.g., the peak P x was present only in 5-Hz transient. Only the predicted 40-Hz ASSR derived from the 40-Hz transient matched the actual ASSR. Phasor analysis showed that the early peaks contribute significantly to the steady state waveform, and this explains why 5-Hz transient does not predict the 40-Hz ASSR. Oscillations in both the 5-and 40-Hz transients were observed during anesthesia. Discussion: The 40-Hz ASSR represents a composite wave-form and arises when transient waveforms elicited with a 40-Hz stimulation rate are overlapped and superimposed. During gen-eral anesthesia, the morphology of the transient is dependent on the rate of stimulus presentation. The composite nature of the ASSR may explain nonmonotonic anesthetic dose–response relations observed by others.