Awareness detection during Caesarean section under general anaesthesia using EEG spectrum analysis

This study examined the relationship between the EEG (spectral edge frequency 90 - SEF90) and the occurrence of awareness defined for the purpose of this study as responsiveness to verbal commands. Fifty women undergoing general anaesthesia for elective Caesarean section were examined. Responsiveness to verbal commands was detected every minute in the period from the induction of anaesthesia to the delivery of the newborn using the Tunstall isolated forearm technique and correlated with the SEF90 value. The patients were assigned by a randomized code to receive either thiopentone (4 mg · kg^{- 1}) or ketamine (1 mg · kg^{- 1})for induction of anaesthesia. Before the administration of succinylcholine a tourniquet was applied to the free arm, and inflated to 200 mmHg, to maintain motor function to one arm. The EEG recordings started five minutes before induction and were recorded throughout anaesthesia. The incidence of responsiveness to verbal commands was lower in the ketamine group (24%) where the average SEF90 was 12.0 ± 3 Hz, than in the thiopentone group (52%), where the average SEF90 was 18.09 ± 3 Hz(P = 0.01). The results suggest that SEF values of ≤ 8.6 Hz were sufficient to avoid responsiveness to verbal commands.