The auditory evoked response as an indicator of awareness

The latency of the early cortical wave Nb of the auditory evoked response (AER) was compared with responses to Tunstall's isolated forearm test, while the concentration of nitrous oxide was progressively reduced during light anaesthesia in seven patients. A threshold Nb latency of 44.5 ms was chosen to discriminate between an early cortical AER containing three waves and that with two waves of longer latency. When Nb latency decreased below this threshold, four of the patients has positive responses, indicating awareness. The addition of a volatile anaesthetic abolished any response, and increased Nb latency to more than 44.5 ms. The three wave AER pattern, therefore, is associated with a depth of anaesthesia at which awareness occurs.