The effects of propofol on the 40-Hz auditory steady-state response and on the electroencephalogram in humans.

The auditory steady-state response (ASSR) is a nearly sinusoidal electrical response of the brain to auditory stimuli delivered at fast rates. The amplitude of the response is largest for stimulus rates near 40/s, hence the label 40-Hz ASSR. We have studied the effects of propofol (1.5 mg/kg) on the 40-Hz ASSR in 14 patients. The spectral edge frequency (SEF) and median frequency (MDF) of the electroencephalogram were recorded for comparison. The study was limited to 6 min after the injection of propofol. Recordings were obtained every minute. Consciousness, defined as responsiveness to verbal command, was assessed in all patients within 1 min. Nine patients, regained consciousness before the end of the study. Propofol caused disappearance of the 40-Hz ASSR for 2 min. Th 40-Hz ASSR reappeared afterward, reaching, at the end of the study period, an amplitude of about 65% of baseline. Recovery of the 40-Hz ASSR occurred whether or not consciousness was regained during the study, but the amplitude tended to be larger in patients who had regained consciousness compared with patients still unconscious during the same recording. The SEF was reduced by 24% within 2 min and recovered more quickly than the 40-Hz ASSR, reaching 91% of baseline within 4 min. The SEF tended to be higher in patients who had regained consciousness. The MDF was reduced by 27% within 2 min, and exceeded baseline values by 25% during recovery. The MDF was not higher in patients who had regained consciousness. We conclude that propofol transiently abolishes the 40-Hz ASSR. Recovery of the 40-Hz ASSR occurs whether or not consciousness is regained, but the 40-Hz ASSR tends to be larger after the return of consciousness. An association between higher amplitude 40-Hz ASSR and the return of consciousness could not be conclusively established, perhaps because of low signal-to-noise ratio in three patients. The 40-Hz ASSR did not offer any clear advantage over the SEF in predicting the return of consciousness.