Effects of anesthetics on nociceptive sensory evoked potentials by intraepidermal noxious electrical stimulation of A-d fibers

Purpose Generation of nociceptive sensory evoked potentials (NEPs) by selective stimulation of nociceptive intraepidermal nerve fibers is a simple technique which could be used as intraoperative nociception monitor. We evaluated the effects of remifentanil, propofol and sevoflurane on NEPs by this technique.Methods Patients undergoing general anesthesia were assigned to groups in two studies. A-d fiber selective NEPs were recorded. Study 1: NEPs were recorded at control, under anesthetics administration: remifentanil at an effect-site concentration (Ce) of 1.0 ng/mL (n = 10), propofol at Ce of 0.5 i.tg/mL (n = 10), or sevoflurane at 0.2 minimum alveolar concentration (MAC) (n = 10), and recovery from the anesthetics. Study 2: NEPs were recorded at control and under administration of higher dose anesthetics: propofol at Ce of 0.5 and 1.0 i.tg/mL (n = 10) or sevoflurane at 0.2 and 0.5 MAC (n = 10). A P-value < 0.016 was considered statistically significant in multiple analyses.Results Study 1: Remifentanil at Ce of 1.0 ng/mL significantly suppressed the amplitude of NEPs (mean amplitude (standard deviation) of control vs. remifentanil administration: 16.8 i.tV (3.8) vs. 10.1 i.tV (2.5), P < 0.001). Propofol and sevoflurane did not suppress the amplitude significantly. Study 2: Propofol at Ce of 0.5 and 1.0 i.tg/mL and sevoflurane at 0.2 and 0.5 MAC did not suppress the amplitude significantly.Conclusion The amplitude of A-d fiber selective NEPs was suppressed by remifentanil but not propofol or sevoflurane. NEPs with intraepidermal electrical stimulation can assess the analgesic effect of anesthetics.

Automated summary

The study evaluated the effects of remifentanil, propofol, and sevoflurane on nociceptive evoked potentials (NEPs) generated by selective stimulation of nociceptive intraepidermal nerve fibers. The results showed that remifentanil significantly suppressed the amplitude of NEPs, while propofol and sevoflurane did not have a significant effect.