In Reply

Purdon, Patrick L.; Akeju, Oluwaseun; Brown, Emery N.

doi:10.1097/aln.0000000000000794

Cited by 4 publications

(2 citation statements)

References 29 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…117 Older patients might uniquely benefit from the individualised realtime feedback of anaesthetic brain state provided by the EEG spectrogram or raw waveform pattens. 104,118,119 Avoiding cerebral hypoperfusion is another area of investigation in preventing PND. Appropriate cerebral perfusion in older patients is complicated by the fact that many older patients have hypertension, which can shift cerebral pressure autoregulation.…”

Section: Preventionmentioning

confidence: 99%

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

Mahanna‐Gabrielli

Schenning

Eriksson

et al. 2019

British Journal of Anaesthesia

149

187

View full text Add to dashboard Cite

Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.

show abstract

Section: Preventionmentioning

confidence: 99%

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

Mahanna‐Gabrielli

Schenning

Eriksson

et al. 2019

British Journal of Anaesthesia

149

187

View full text Add to dashboard Cite

show abstract

“…It was observed that using the PSI alone did not result in as good outcomes and BS avoidance, possibly due to underestimation of EEG suppression using the monitoring (56). Patients may have benefited from BSR and PSI monitoring, visual tracking of the EEG, and the individualized real-time feedback of an anesthetic cerebral state provided by the EEG spectrogram or raw waveform patterns (70)(71)(72), thereby achieving superior anesthesia depth monitoring and reducing POD risk. Anesthesiologists may be able to manage patients' anesthetic cerebral state better by monitoring multiple EEG parameters.…”

Section: Discussionmentioning

confidence: 99%

Processed Multiparameter Electroencephalogram-Guided General Anesthesia Management Can Reduce Postoperative Delirium Following Carotid Endarterectomy: A Randomized Clinical Trial

Wang

et al. 2021

Front. Neurol.

View full text Add to dashboard Cite

Background: Patients undergoing carotid endarterectomy (CEA) for severe carotid stenosis are vulnerable to postoperative delirium, a complication frequently associated with poor outcome. This study investigated the impact of processed electroencephalogram (EEG)-guided anesthesia management on the incidence of postoperative delirium in patients undergoing CEA.Methods: This single-center, prospective, randomized clinical trial on 255 patients receiving CEA under general anesthesia compared the outcomes of patient state index (PSI) monitoring [SEDLine Brain Function Monitor (Masimo, Inc, Irvine, CA)] (standard group, n = 128) with PSI combined with density spectral array(DSA) -guided monitoring (intervention group, n = 127) to reduce the risk of intraoperative EEG burst suppression. All patients were monitored by continuous transcranial Doppler ultrasound (TCD) and near-infrared spectroscopy (NIRS) to avoid perioperative cerebral hypoperfusion or hyperperfusion. According to the surgical process, EEG suppression time was calculated separately for three stages: S1 (from anesthesia induction to carotid artery clamping), S2 (from clamping to declamping), and S3 (from declamping to the end of surgery). The primary outcome was incidence of postoperative delirium according to the Confusion Assessment Method algorithm during the first 3 days post-surgery, and secondary outcomes were other neurologic complications and length of hospital stay.Results: There were no episodes of cerebral hypoperfusion or hyperperfusion according to TCD and NIRS monitoring in either group during surgery. The incidence of postoperative delirium within 3 days post-surgery was significantly lower in the intervention group than the standard group (7.87 vs. 28.91%, P < 0.01). In the intervention group, the total EEG suppression time and the EEG suppression time during S2 and S3 were shorter (Total, 0 “0” vs. 0 “1.17” min, P = 0.04; S2, 0 “0” vs. 0 “0.1” min, P < 0.01; S3, 0 “0” vs. 0 “0” min, P = 0.02). There were no group differences in incidence of neurologic complications and length of postoperative hospital stay.Conclusion: Processed electroencephalogram-guided general anesthesia management, consisting of PSI combined with DSA monitoring, can significantly reduce the risk of postoperative delirium in patients undergoing CEA. Patients, especially those exhibiting hemodynamic fluctuations or receiving surgical procedures that disrupt cerebral perfusion, may benefit from the monitoring of multiple EEG parameters during surgery.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03622515.

show abstract

A Prospective Study of Age-dependent Changes in Propofol-induced Electroencephalogram Oscillations in Children

et al. 2017

View full text Add to dashboard Cite

Background In adults, frontal electroencephalogram patterns observed during propofol-induced unconsciousness consist of slow oscillations (0.1 to 1 Hz) and coherent alpha oscillations (8 to 13 Hz). Given that the nervous system undergoes significant changes during development, anesthesia-induced electroencephalogram oscillations in children may differ from those observed in adults. Therefore, we investigated age-related changes in frontal electroencephalogram power spectra and coherence during propofol-induced unconsciousness. Methods We analyzed electroencephalogram data recorded during propofol-induced unconsciousness in patients between 0 and 21 yr of age (n = 97), using multitaper spectral and coherence methods. We characterized power and coherence as a function of age using multiple linear regression analysis and within four age groups: 4 months to 1 yr old (n = 4), greater than 1 to 7 yr old (n = 16), greater than 7 to 14 yr old (n = 30), and greater than 14 to 21 yr old (n = 47). Results Total electroencephalogram power (0.1 to 40 Hz) peaked at approximately 8 yr old and subsequently declined with increasing age. For patients greater than 1 yr old, the propofol-induced electroencephalogram structure was qualitatively similar regardless of age, featuring slow and coherent alpha oscillations. For patients under 1 yr of age, frontal alpha oscillations were not coherent. Conclusions Neurodevelopmental processes that occur throughout childhood, including thalamocortical development, may underlie age-dependent changes in electroencephalogram power and coherence during anesthesia. These age-dependent anesthesia-induced electroencephalogram oscillations suggest a more principled approach to monitoring brain states in pediatric patients.

show abstract

In Reply

Cited by 4 publications

References 29 publications

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

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

Processed Multiparameter Electroencephalogram-Guided General Anesthesia Management Can Reduce Postoperative Delirium Following Carotid Endarterectomy: A Randomized Clinical Trial

A Prospective Study of Age-dependent Changes in Propofol-induced Electroencephalogram Oscillations in Children

Contact Info

Product

Resources

About