EEG evidence for shunt requirement during carotid endarterectomy: optimal EEG derivations with respect to frequency bands and anesthetic regimen.

Currently there is no consensus on the derivations that should be used for EEG monitoring during carotid endarterectomy (CEA). The aim of this study was to determine which derivations distinguish the best between patients requiring a shunt and patients who do not need a shunt. Four predefined frequency bands and two regimens for general anesthesia (isoflurane versus propofol) were used. EEG data (16 channels) were obtained from 152 EEGs recorded during carotid endarterectomy. Analog EEG signals of preclamp and clamp periods of 100 seconds were digitized to compute power spectra. Changes in power during clamping were calculated for all possible derivations in four predefined frequency bands and were expressed as Z-scores. For each derivation, the area under the receiver operating characteristics curve was calculated. Derivations with the greatest area under the receiver operating characteristics curve were considered to distinguish the best between the shunt and the nonshunt groups formed in retrospect on the basis of consensus between three independent and experienced board-certified electroencephalographers. The two different anesthetic regimens resulted in different patterns of EEG changes because of clamping. The optimal derivations to differentiate between the shunt and the nonshunt groups also differed for the two anesthetic regimens, although for both conditions, anterior head regions were especially preferred. The optimal derivations are given for each anesthetic regimen.

Comparing signal to noise ratios of amplitude modulation following responses from four EEG derivations in awake normally hearing adults.

Amplitude modulation following responses (AMFR) or steady-state evoked potentials (SSEPs) can be used for the objective and frequency-specific estimation of hearing thresholds in awake and sleeping subjects. To be useful as a clinical tool, a high signal to noise ratio (SNR) is required for a minimal testing time. Four EEG derivations were compared in six relaxed, cooperative awake normally hearing adults to compare the SNRs. Stimuli comprised a 1 kHz carrier wave, amplitude modulated at 39 Hz and 90 Hz. They were presented for about 4.4 min in one ear at a level slightly above the behavioural threshold (10 dB SL). In the 39 Hz condition, the SNRs from the different derivations did not differ significantly. However, in the 90 Hz condition one novel derivation (Cz-inion with ground at Pz) yielded a significantly lower noise level, about 60 per cent of the noise level of the other derivations. The SNR of this derivation was about 50 per cent larger than from other derivations. Such an increase of the SNR implies that testing time is reduced by about 56 per cent as compared to conventional derivations in these subjects.