[Perioperative EEG monitoring: studies of the electrophysiological arousal mechanism].

Electroencephalogram recordings have been advocated for assessment of changes in cerebral function during anaesthesia. Controversy exists on the specificity of EEG parameters indicating depth of anaesthesia, because cortical electrical activity is modulated not only by drugs but also by a variety of exogenous and endogenous stimuli. In clinical practice, EEG measures often fail to accurately predict anaesthetic depth since the effects of nociceptive stimulation on the EEG are still not well defined. Previous reports indicate that in anaesthetised patients sensory stimulation may induce a shift to a dominant EEG frequency with faster waves similar to patterns seen during emergence from anaesthesia under certain circumstances. This electrophysiological arousal (EEG desynchronisation) may be associated with clinical arousal phenomena such as movement and increases in haemodynamic and respiratory activity. However, the mechanism of arousal during emergence from anaesthesia may be quite different from arousal reactions induced by noxious stimulation. Recent studies indicate that surgical stimulation can induce increases in slow wave EEG-activity ("reverse" or "paradoxical" arousal) associated with clinical arousal phenomena. Stimulus related delta patterns also were observed after acoustical or painful stimulation in head injured patients. The occurrence of slow EEG wave patterns may be related to functional blockade of the ascending activating system of the brain stem. In contrast, slowing of the EEG is comparable to EEG changes seen with increasing concentrations of anaesthetics. This indicates the difficulty to discriminate arousal phenomena from drug effects using EEG monitoring alone.(ABSTRACT TRUNCATED AT 250 WORDS)