Anesthetic effects on electrophysiologic recordings

With the increased use of intraoperative monitoring of the central nervous system (CNS) has come a need for better understanding of the effects of anesthetic agents on intraoperative recordings. The commonly used anesthetic agents and their effects on intraoperative electroencephalography (EEG) and evoked potentials (EP) are discussed. Halogenated inhalational anesthetics produce dose-related reduction in EEG amplitude and frequency after an initial activation. They also produce dose-related decreases in amplitude and increases in latency of sensory evoked potentials (SEP) that are most marked in cortically generated components. Subcortical, spinal, and peripheral evoked responses are less affected. Responses in the motor pathways are recordable in the epidural space; however, the relative contributions of sensory and motor tracts may be changed when both are present. Muscle responses are easily suppressed after spinal and motor cortex stimulation, probably by anesthetic effect at the anterior horn cells of the spinal cord. Intravenous analgesic agents (opioids, ketamine) are associated with less marked changes in EEG and evoked responses, with some increases in amplitude of cortically generated SEP caused by ketamine. Intravenous sedative-hypnotic drugs (droperidol, barbiturates, benzodiazepines, etomidate, propofol) produce dose-related depression of the EEG after initial activation and dose-related depression of evoked responses to a lesser extent than do the inhalation agents. Etomidate is associated with amplitude enhancement of EEG and cortically generated SEP. Muscle relaxants have minimal effect on the EEG and SEP. Their use, however, may alter muscle recordings from motor tract stimulation. These effects and their relevance to the choice of agents for specific monitoring techniques are discussed.