An assessment of the variability of early scalp-components of the somatosensory evoked response in uncomplicated, unshunted carotid endarterectomy.

Abstract

Although many publications deal with the usefulness of the SER in CEAs, the criteria of calling a SER abnormal during a CEA are largely arbitrary. One way to define the limits of normalcy for SERs during the CEA will be to analyze the SER tracings obtained during unshunted and uncomplicated (intra- and postoperative) CEAs. In 23 such CEAs (10 right, 13 left; clamptime 10-23 mins.), data analysis at the ipsilateral parietal electrode, on stimulation of the contralateral median nerve (square pulse -5.1/sec, 10-30 V, 200 microseconds; bandpass-30-3000 Hz trials-500 stimuli), revealed that (1) latency fluctuations of the N20 (21.4 msec) were narrowest, being less than 1.5 msec different during and after clamping compared to the preclamp latency in all 23 CEAs, whereas those of P25 (27.4 msec) and N35 (38.5 msec) were greater than 2.0 msec different from the preclamp latency in 3 and 8 CEAs respectively, and (2) the amplitudes of N20, P25 and N35 measured from the preceding peak of opposite polarity, fell to less than 75% of the preclamp value on 3, 4 and 7 CEAs respectively. It is concluded that N20 was the most stable of the first three short-latency components in the SER and should perhaps be most relied upon to predict abnormality of the SER during CEAs.