[Auditory evoked potentials].

Abstract

Auditory evoked potentials (AEPs) are an electrical manifestation of the brain response to an auditory stimulus. The waveform represents the passage of electrical activity provoked by auditory stimuli from the cochlea to cortex. The waves represented by I-VII are generated mainly in the brainstem. These waves are called the brain stem auditory evoked potentials (BAEPs) or the auditory brain stem response (ABR). The middle latency AEPs (MLAEP) are generated from the medial geniculate and primary auditory cortex. The long latency AEPs (LLAEP) are generated from the frontal cortex and association areas. The BAEPs appear to be an exquisitely sensitive monitor for pathological events during surgery. Anesthetics and mild hypothermia have minimum effect, if any, on the BAEPs. The BAEPs are useful during the microvascular decompression of the fifth or seventh cranial nerve, resection of acoustic neuroma and posterior fossa operations. Because the auditory pathway occupies a small area in the brainstem, combined use of other evoked potentials such as short latency sensory evoked potentials is recommended. The MLAEPs are most promising evoked responses for monitoring awareness or depth of anesthesia. When the concentration of anesthetics is increased, the amplitudes of the MLAEP's peaks are decreased and their latencies are elongated. Commercially developed A-line AEP monitor or aepEX can extract the AEPs waveform in a short period and automatically analyze the changes in the MLAEPs. These AEP based monitors may be superior to bispectral index (BIS) in detecting the transition from unconsciousness to consciousness.