Cognitive Impairment Is Associated with Absolute Intraoperative Frontal α-Band Power but Not with Baseline α-Band Power: A Pilot Study

Koch, Susanne; Feinkohl, Insa; Chakravarty, S.; Windmann, Victoria; Lichtner, Gregor; Pischon, Tobias; Brown, Emery N.; Spies, Claudia

doi:10.1159/000502950

Cited by 28 publications

(36 citation statements)

References 41 publications

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“…The association between low alpha-band and cognitive impairment are consistent with recent work from Koch and colleagues (Koch et al, 2019). The analysis of the average AP effect (average marginal effect Figure 2A) showed a significant association with CD.…”

Section: Discussionsupporting

confidence: 90%

“…Some authors proposed a new complementary use of peroperative EEG aimed at predicting CD, or even more generally peri operative neurocognitive disorder, using patterns such as the intra operative Burst Suppression (BS) (Wildes et al, 2019). Recently, the decrease of power spectral density in the alpha band (8-13Hz), collected on the frontal EEG under general anesthesia has been associated not only to chronological age but also to preoperative CD (Koch et al, 2019). On the other hand, it is also recognized that the effective dosage of hypnotics under general anesthesia decreases with age (Schnider model and MAC) but also with preoperative cognitive status (Laalou et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Propofol Requirement and EEG Alpha Band Power During General Anesthesia Provide Complementary Views on Preoperative Cognitive Decline

Touchard¹,

Cartailler

Levé³

et al. 2020

Front. Aging Neurosci.

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Background: Although cognitive decline (CD) is associated with increased post-operative morbidity and mortality, routinely screening patients remains difficult. The main objective of this prospective study is to use the EEG response to a Propofol-based general anesthesia (GA) to reveal CD.Methods: 42 patients with collected EEG and Propofol target concentration infusion (TCI) during GA had a preoperative cognitive assessment using MoCA. We evaluated the performance of three variables to detect CD (MoCA < 25 points): age, Propofol requirement to induce unconsciousness (TCI at SEF95: 8–13 Hz) and the frontal alpha band power (AP at SEF95: 8–13 Hz).Results: The 17 patients (40%) with CD were significantly older (p < 0.001), had lower TCI (p < 0.001), and AP (p < 0.001). We found using logistic models that TCI and AP were the best set of variables associated with CD (AUC: 0.89) and performed better than age (p < 0.05). Propofol TCI had a greater impact on CD probability compared to AP, although both were complementary in detecting CD.Conclusion: TCI and AP contribute additively to reveal patient with preoperative cognitive decline. Further research on post-operative cognitive trajectory are necessary to confirm the interest of intra operative variables in addition or as a substitute to cognitive evaluation.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Propofol Requirement and EEG Alpha Band Power During General Anesthesia Provide Complementary Views on Preoperative Cognitive Decline

Touchard¹,

Cartailler

Levé³

et al. 2020

Front. Aging Neurosci.

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“…Ein weiterer Risikofaktor für das Auftreten eines postoperativen Delirs v. a. bei älteren Patienten sind präoperative kognitive Einschränkungen [25]. Diese sind ebenfalls mit einer geringeren intraoperativen α-Power assoziiert [35,36].Wie bereits erwähnt, führt das Auftreten eines postoperativen Delirs wiederum zu einem erhöhten Risiko für langanhaltende postoperative kognitive Defizite [26]. Eine EEG-gesteuerte Narkose kann das Risiko für das Auftreten dieser Langzeitfolgen verringern [24,37].…”

Section: Reduktion Von Postoperativen Kognitiven Defizitenunclassified

“…Eine EEG-gesteuerte Narkose kann das Risiko für das Auftreten dieser Langzeitfolgen verringern [24,37]. Auch bei Patienten mit präoperativen kognitiven Einschränkungen zeigt sich eine intraoperativ geringere α-Power [25,35,36], was auch hier den Einfluss einer prädisponierenden Vulnerabilität bestätigt.…”

Section: Reduktion Von Postoperativen Kognitiven Defizitenunclassified

Intraoperatives Neuromonitoring: Elektroenzephalografie

Windmann¹,

Koch²

2021

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungIntraoperatives Neuromonitoring mittels Elektroenzephalografie (EEG) ermöglicht eine Überwachung der Narkosetiefe und soll das Auftreten intraoperativer Wachheit, eines postoperativen Delirs und postoperativer kognitiver Defizite verhindern sowie Prozesszeiten im OP verkürzen. Der Beitrag zeigt, wie Roh-EEG, Spektrogramme und prozessierte Indizes für unterschiedliche Altersgruppen und Anästhetika zu interpretieren sind und welcher klinische Nutzen sich daraus ergibt.

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“…Postoperative delirium is a common complication in older surgical patients and has been associated with increased length of stay, functional decline, and increased 1 year postoperative mortality rates. 1-3 Recent guidelines call for 1,4 or at least encourage 5,6 EEG-based anesthetic management to reduce delirium rates, and intraoperative anesthetized raw EEG features such as burst suppression and alpha band power have been associated with postoperative delirium 7-10 and preoperative cognitive impairment, 11,12 respectively. Fritz et al demonstrated that increased anesthetic sensitivity (as indicated by EEG burst suppression at lower anesthetic dosage) is associated with increased postoperative delirium risk.…”

Section: Introductionmentioning

confidence: 99%

A Processed EEG based Brain Anesthetic Resistance Index Predicts Postoperative Delirium in Older Adults: A Dual Center Study

Cooter

Bunning

Eleswarpu

et al. 2021

Preprint

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BackgroundSome older adults show exaggerated responses to drugs that act on the brain, such as increased delirium risk in response to anticholinergic drugs. The brain’s response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG based-measure of the brain’s neurophysiologic resistance to anesthetic dose-related changes, and hypothesized that it would predict postoperative delirium.MethodsWe defined the Duke Anesthesia Resistance Scale (DARS) as the average BIS index divided by the quantity 2.5 minus the average age-adjusted end-tidal MAC (aaMAC) inhaled anesthetic fraction. The relationship between DARS and postoperative delirium was analyzed in derivation (Duke; N=69), validation (Mt Sinai; N=70), and combined estimation cohorts (N=139) of older surgical patients (age ≥65). In the derivation cohort, we identified a threshold relationship between DARS and for delirium and identified an optimal cut point for prediction.ResultsIn the derivation cohort, the optimal DARS threshold for predicting delirium was 27.0. The delirium rate was 11/49 (22.5%) vs 11/20 (55.0%) and 7/57 (12.3%) vs 6/13 (46.2%) for those with DARS ≥ 27 vs those with DARS < 27 in the derivation and validation cohorts respectively. In the combined estimation cohort, multivariable analysis found a significant association of DARS <27.0 with postoperative delirium (OR=4.7; 95% CI: 1.87, 12.0; p=0.001). In the derivation cohort, the DARS had an AUC of 0.63 with sensitivity of 50%, specificity of 81%, positive predictive value of 0.55, and negative predictive value of 0.78. The DARS remained a significant predictor of delirium after accounting for opioid, midazolam, propofol, non-depolarizing neuromuscular blocker, phenylephrine and ketamine dosage, and for nitrous oxide and epidural usage.ConclusionsThese results suggest than an intraoperative processed EEG-based measure of lower brain anesthetic resistance (i.e. DARS <27) could be used in older surgical patients as an independent predictor of postoperative delirium risk.

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Cognitive Impairment Is Associated with Absolute Intraoperative Frontal α-Band Power but Not with Baseline α-Band Power: A Pilot Study

Abstract: Background: Cognitive abilities decline with aging, leading to a higher risk for the development of postoperative delirium or postoperative neurocognitive disorders after general anesthesia. Since frontal α-band power is known to be highly correlated with cognitive function in general, we

Cited by 28 publications

References 41 publications

Propofol Requirement and EEG Alpha Band Power During General Anesthesia Provide Complementary Views on Preoperative Cognitive Decline

Propofol Requirement and EEG Alpha Band Power During General Anesthesia Provide Complementary Views on Preoperative Cognitive Decline

Intraoperatives Neuromonitoring: Elektroenzephalografie

A Processed EEG based Brain Anesthetic Resistance Index Predicts Postoperative Delirium in Older Adults: A Dual Center Study

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