Dynamics of MLAEP changes in midazolam-induced sedation |
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| Institution: | 1. Department of Biomedical Engineering, City College of the City University of New York, New York, NY 10031, USA;2. Laboratory for Intelligent Imaging and Neural Computing, Columbia University, New York, NY 10027, USA;3. Machine Learning Department, Technische Universität Berlin, 10587, Berlin, Germany;1. Departments of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA;2. Departments of Pharmacology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA;3. Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 3620 Hamilton Walk, 305 John Morgan, Philadelphia, PA 19104, USA;4. Department of Anaesthesia, Harvard Medical School, GRB 444, 55 Fruit St., Boston, MA 02114, USA;5. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA;6. Departments of Anesthesia and Physiology, Room 3318 Medical Sciences Building, University of Toronto, Toronto, Ontario M5S 1A8, Canada;7. Departments of Medicine, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA;1. School of Physics, Harbin Institute of Technology, Harbin 150080, China;2. School of Physics, Beijing Institute of Technology, Beijing 100081, China;3. China Center for Information Industry Development, Beijing 100048, China |
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| Abstract: | This study aimed at assessing the effects of midazolam (MDZ) sedation on auditory brainstem (BAEP) and middle latency (MLAEP) evoked potentials in intensive care conditions. Ten ventilated comatose patients were receiving an intravenous MDZ bolus dose (0.2 mg/kg) followed by a 2 h continuous infusion (0.1 mg/kg/h). MLAEPs and BAEPs elicited by clicks (90 dB HL+masking) were simultaneously and continuously monitored during the first 6 h and for 30 min the next morning. We found no effect of MDZ sedation on BAEPs. Only MLAEP components were modified. However, none of the patients presented any total abolition of the MLAEPs. Bolus injection led to very early alteration of cortical responses, beginning after 5 min and lasting almost 1 h (maximum Pa latency increase, 3.1 ms; maximum Pa-Nb amplitude decrease, 46%). During continuous infusion, MLAEPs remained slightly, although significantly, altered (Pa latency, +1.3 ms; Pa-Nb amplitude, 27%). The Nb wave seemed to be modified earlier and to return to normality later than the Pa wave. These findings incite a careful interpretation of MLAEP tracings acquired during the first hour following MDZ bolus injection. If possible, MDZ should be administered as continuous infusion for reliable interpretation of evoked potential changes in intensive care unit, or during surgery. |
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