title: The effects of auditory evoked potential click sounds on bispectral index and entropy.
abstract: BACKGROUND
  The click sounds of auditory evoked potentials (AEP) might have some effect on electroencephalogram indices and Bispectral Index (BIS) but many studies, unconcerned about this effect, have measured both indices simultaneously. In this study, I examined the effects, of AEP click sounds on the BIS, and also on the response entropy (RE) and state entropy (SE) of the entropy monitor.
  
  
  METHODS
  Forty patients aged 40-70 yr and scheduled for surgery of lower extremities under spinal anesthesia were anesthetized with 0.5% bupivacaine or tetracaine. Patients were sedated with midazolam 1 mg followed by propofol infusion started at 1 mg.kg(-1).h(-1). Propofol infusion was controlled to keep BIS or SE at 80, 60, or 40 for several minutes, and then click sounds (65 dB) of the AEP were given for 60 s. The changes in BIS, RE, and SE were observed continuously for 60 s after the click sounds had stopped.
  
  
  RESULTS
  BIS, SE, and RE significantly increased during the click sounds. The longest duration of increase was at BIS or SE 60.
  
  
  CONCLUSIONS
  AEP monitor click sounds transiently increased the simultaneously measured BIS, RE, and SE during different levels of sedation by propofol infusion during spinal anesthesia. Therefore, the effects of the click sounds should be considered when these monitors are used simultaneously in the same patient.
authors.affiliation: Department of Anesthesiology, Ofuna Chuo Hospital, Kanagawa, Japan. nishit-tky@umin.ac.jp
authors.forename: Tomoki
authors.initials: T
authors.lastname: Nishiyama
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000368:Aged; D004569:Electroencephalography; D005072:Evoked Potentials, Auditory; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative