Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

Abstract

Background: Postoperative delirium is associated with an increased risk of morbidity and mortality, especially in the elderly. Delirium in the postanaesthesia care unit (PACU) could predict adverse clinical outcomes. Methods: We investigated a potential link between intraoperative EEG patterns and PACU delirium as well as an association of PACU delirium with perioperative outcomes, readmission and length of hospital stay. The risk factors for PACU delirium were also explored. Data were collected from 626 patients receiving general anaesthesia for procedures that would not interfere with frontal EEG recording. Results: Of the 626 subjects enrolled, 125 tested positive for PACU delirium. Whilst age, renal failure, and pre-existing neurological disease were associated with PACU delirium in the univariable analysis, the multivariable analysis revealed the importance of information derived from the EEG, anaesthetic technique, anaesthesia duration, and history of stroke or neurodegenerative disease. The occurrence of EEG burst suppression during maintenance [odds ratio (OR)¼1.86 (1.13e3.05)] and the type of EEG emergence trajectory may be predictive of PACU delirium. Specifically, EEG emergence trajectories lacking significant spindle power were strongly associated with PACU delirium, especially in cases that involved ketamine or nitrous oxide [OR¼6.51 (3.00e14.12)]. Additionally, subjects with PACU delirium were at an increased risk for readmission [OR¼2.17 (1.13e4.17)] and twice as likely to stay >6 days in the hospital.Conclusions: Specific EEG patterns were associated with PACU delirium. These findings provide valuable information regarding how the brain reacts to surgery and anaesthesia that may lead to strategies to predict PACU delirium and identify key areas of investigation for its prevention.

Postanesthesia care unit delirium following robot‐assisted vs open retropubic radical prostatectomy: A prospective observational study

“…The authors concluded that the type of anesthetic maintenance agent did not affect the incidence of postoperative delirium in elderly patients undergoing noncardiac surgery. In contrast to the aforementioned review, but in accordance with our results, findings from an observational trial suggest an association of propofol infusion with PACU delirium …”

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

“…104,105 Additionally, there is a marked decrease in alpha band power under general anaesthesia in patients >60 yr old, and decreased intraoperative alpha band power has been associated with both preoperative cognitive impairment and recovery room delirium. 104,111,112 However, it is currently unclear whether intraoperative interventions to maximise or maintain alpha band power under general anaesthesia would reduce POD/NCD, and at least one current study is underway to examine this issue. 113 Two major trials inform our understanding of the role of processed EEG monitoring on POD.…”

Effects of Electroencephalogram Guided Anesthesia on Postoperative Delirium: A Systematic Review and Meta-analysis

“…Then, 662 studies were excluded after reviewing the title and abstracts. The full text of the remaining 20 studies were retrieved for evaluations, in which 13 studies were further excluded due to one or more of the following reasons: not RCT (n=2) [30,31] ; review (n=3) [32][33][34] ; non-general anesthesia patients (n=2) [12,13] ; the control group used end-tidal anesthetic concentration (ETAC) as a guide for anesthesia depth rather than routine care (n=1) [35] ; no full-text available (n=1) [36] , or ongoing studies (n=4).…”