BIS index monitoring and perioperative neurocognitive disorders in older adults: a systematic review and meta-analysis

Miao, Mengrong; Xu, Yuehua; Sun, Menghong; Chang, Enqiang; Xu, Cong; Zhang, Jiaqiang

doi:10.1007/s40520-019-01433-x

Cited by 16 publications

(14 citation statements)

References 37 publications

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“…PND is a prevalent complication in aged people after major surgery, and it is hard to perform a scaled assessment due to patients’ poor condition and uncooperative behavior [ 32 – 34 ]. Thus, it is essential to find a new and easily accessible biomarker to predict PND occurrence at the early stage.…”

Section: Discussionmentioning

confidence: 99%

Perioperative platelet count in peripheral blood is associated with the early stage of PND after major orthopedic surgery: a prospective observational study

et al. 2022

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Background Perioperative neurocognitive disorders (PND) are common complications of major surgery among elderly patients, remarkably decreasing patients’ life quality. Platelet count has been proved to be an essential factor in inflammation. However, as far as we know, the relationship between platelet count and PND is not clear yet in the orthopedic area. PND could be a long-term disease, which sometimes lasts for several years, and it is meaningful to find a biomarker of PND at the early stage. Thus, we designed this study to find out the association between perioperative platelet count and occurrence of PND, and determine whether preoperative platelet count could be a biomarker of the early stage of PND. Methods A prospective observational study was performed on the patients who would take total knee arthroplasty or total hip arthroplasty. Their peripheral platelets were counted by blood routine examination 1 day before and 3 days after the surgery. And we assessed their neurocognitive functions 1 day before and 3 days after the surgery. These data were recorded and analyzed to find out the relationship between platelet count and the occurrence of PND. Results Eventually, 70 patients finished the whole process, and 14 of them developed PND. The median preoperative platelet count in the PND group was significantly higher than that in the non-PND group (239 vs 168 × 10^9/L, p = 0.009). Preoperative platelet count was an independent risk factor for PND (odds ratio = 1.014, 95% confidence interval [CI] 1.000–1.027, P = 0.043) in the logistic multivariable regression, while the area under the curve of the receiver operating characteristic curve of the prediction model was 0.796 (95% CI 0.676–0.916). Conclusions The higher preoperative and postoperative level of platelet count in the peripheral blood were associated with the early stage of PND, and preoperative platelet count could be a potential predictor of the early stage of PND in patients undergoing major orthopedic surgeries. Trial registration Chinese Clinical Trial Registry: ChiCTR2000033001, registration date: 17 May 2020.

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Section: Discussionmentioning

confidence: 99%

Perioperative platelet count in peripheral blood is associated with the early stage of PND after major orthopedic surgery: a prospective observational study

et al. 2022

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“…The main studies about the incidence of delirium and its association with anaesthetic depth have been conducted by Radtke 19 in Germany, Chan 10 in Hong Kong, who conducted the Cognitive Dysfunction after Anesthesia (CODA) study, Wildes 8 in the U.S.A., who led the major study Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) and the recent study of Evered 7 in 2021. Three important meta-analyses by Miao 9 , Jannsen 11 and Shan 14 should also be noted.…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that a high level of anaesthetic depth measured by the Bispectral Index (BIS) during a long period, as well as high doses of anaesthesia, can be factors predicting the development of postoperative complications 11 . The influence of the anaesthetic plane depth on the presence of some neurological complications, such as delirium, cognitive dysfunction and cerebrovascular accident during follow-up, has been put forward throughout the years 10 , 12 , 13 ; however, the major ENGAGES trial 8 and other recent meta-analyses 9 , 14 have demonstrated some controversy in the relationship between anaesthetic depth and delirium, even going so far as to show that neuromonitoring of anaesthetic depth increases the incidence of delirium 8 .…”

Section: Introductionmentioning

confidence: 99%

Neuromonitoring depth of anesthesia and its association with postoperative delirium

Pérez-Otal

Ramírez-Rodríguez²,

Aragón-Benedí³

et al. 2022

Sci Rep

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Delirium after surgery or Postoperative delirium (POD) is an underdiagnosed entity, despite its severity and high incidence. Patients with delirium require a longer hospital stay and present more postoperative complications, which also increases hospital costs. Given its importance and the lack of specific treatment, multifactorial preventive strategies are evidenced based. Our hypothesis is that using general anaesthesia and avoiding the maximum time in excessively deep anaesthetic planes through BIS neuromonitoring device will reduce the incidence of postoperative delirium in patients over the age of 65 and their hospitalization stay. Patients were randomly assigned to two groups: The visible BIS group and the hidden BIS neuromonitoring group. In the visible BIS group, the depth of anaesthesia was sustained between 40 and 60, while in the other group the depth of anaesthesia was guided by hemodynamic parameters and the Minimum Alveolar Concentration value. Patients were assessed three times a day by research staff fully trained during the 72 h after the surgery to determine the presence of POD, and there was follow-up at 30 days. Patients who developed delirium (n = 69) was significantly lower in the visible BIS group (n = 27; 39.1%) than in the hidden BIS group (n = 42, 60.9%; p = 0.043). There were no differences between the subtypes of delirium in the two groups. Patients in the hidden BIS group were kept for 26.6 ± 14.0 min in BIS values < 40 versus 11.6 ± 10.9 min (p < 0.001) for the patients in the visible BIS group. The hospital stay was lower in the visible BIS group 6.56 ± 6.14 days versus the 9.30 ± 7.11 days (p < 0.001) for the hidden BIS group, as well as mortality; hidden BIS 5.80% versus visible BIS 0% (p = 0.01). A BIS-guided depth of anaesthesia is associated with a lower incidence of delirium. Patients with intraoperative neuromonitoring stayed for a shorter time in excessively deep anaesthetic planes and presented a reduction in hospital stay and mortality.

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“…High EEG delta power is positively associated with glymphatic activity, while beta power is negatively corelated in animal models (Hablitz et al, 2019 ). When bispectral index-guided deep anesthesia is used in geriatric anesthesia, postoperative delirium and cognitive decline in elderly surgical patients are reduced (Deschamps et al, 2019 ; Miao et al, 2019 ). Therefore, intraoperative indicators for monitoring anesthesia depth are clinically significant for research about the relationship between glymphatic function and PND.…”

Section: The Underlying Mechanism Of Altered Glymphatic Function During Intraoperative Anesthesia Managementmentioning

confidence: 99%

Dysfunction of the Glymphatic System as a Potential Mechanism of Perioperative Neurocognitive Disorders

Ren

Liu

Lian

et al. 2021

Front. Aging Neurosci.

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Perioperative neurocognitive disorder (PND) frequently occurs in the elderly as a severe postoperative complication and is characterized by a decline in cognitive function that impairs memory, attention, and other cognitive domains. Currently, the exact pathogenic mechanism of PND is multifaceted and remains unclear. The glymphatic system is a newly discovered glial-dependent perivascular network that subserves a pseudo-lymphatic function in the brain. Recent studies have highlighted the significant role of the glymphatic system in the removal of harmful metabolites in the brain. Dysfunction of the glymphatic system can reduce metabolic waste removal, leading to neuroinflammation and neurological disorders. We speculate that there is a causal relationship between the glymphatic system and symptomatic progression in PND. This paper reviews the current literature on the glymphatic system and some perioperative factors to discuss the role of the glymphatic system in PND.

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BIS index monitoring and perioperative neurocognitive disorders in older adults: a systematic review and meta-analysis

Cited by 16 publications

References 37 publications

Perioperative platelet count in peripheral blood is associated with the early stage of PND after major orthopedic surgery: a prospective observational study

Perioperative platelet count in peripheral blood is associated with the early stage of PND after major orthopedic surgery: a prospective observational study

Neuromonitoring depth of anesthesia and its association with postoperative delirium

Dysfunction of the Glymphatic System as a Potential Mechanism of Perioperative Neurocognitive Disorders

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