title: Block-dependent sedation during epidural anaesthesia is associated with delayed brainstem conduction.
abstract: BACKGROUND
  Neuraxial anaesthesia produces a sedative and anaesthetic-sparing effect. Recent evidence suggests that spinal cord anaesthesia modifies reticulo-thalamo-cortical arousal by decreasing afferent sensory transmission. We hypothesized that epidural anaesthesia produces sensory deafferentation-dependent sedation that is associated with impairment of brainstem transmission. We used brainstem auditory evoked potentials (BAEP) to evaluate reticular function in 11 volunteers.
  
  
  METHODS
  Epidural anaesthesia was induced with 2-chloroprocaine 2%. Haemodynamic and respiratory responses, sensory block level, sedation depth and BAEP were assessed throughout induction and resolution of epidural anaesthesia. Sedation was evaluated using verbal rating score (VRS), observer's assessment alertness/sedation (OAA/S) score, and bispectral index score (BIS). Prediction probability (PK) was used to associate sensory block with sedation, as well as BIS with other sedation measures. Spearman's rank order correlation was used to associate block level and sedation with the absolute and interpeak BAEP latencies.
  
  
  RESULTS
  Sensory block level significantly predicted VRS (PK=0.747), OAA/S score (PK=0.748) and BIS. BIS predicted VRS and OAA/S score (PK=0.728). The latency of wave III of BAEP significantly correlated with sedation level (rho=0.335, P<0.01) and sensory block (rho=0.394, P<0.01). The other BAEP parameters did not change during epidural anaesthesia. Haemodynamic and respiratory responses remained stable throughout the study.
  
  
  CONCLUSIONS
  Sedation during epidural anaesthesia depends on sensory block level and is associated with detectable block-dependent alterations in the brainstem auditory evoked responses. Sensory deafferentation may reduce CNS alertness through mechanisms related to brainstem neural activity.
authors.affiliation: Outcomes Research Institute and Department of Anesthesiology, University of Louisville, KY 40202, USA. agdoufas@louisville.edu
authors.forename: A G
authors.initials: AG
authors.lastname: Doufas
authors.forename: A
authors.initials: A
authors.lastname: Wadhwa
authors.forename: Y M
authors.initials: YM
authors.lastname: Shah
authors.forename: C-M
authors.initials: CM
authors.lastname: Lin
authors.forename: G S
authors.initials: GS
authors.lastname: Haugh
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D001364:Awareness; D016292:Procedural Sedation / Q000379:methods*; D004569:Electroencephalography; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011930:Reaction Time; D012119:Respiration