Intraoperative Optimization of Both Depth of Anesthesia and Cerebral Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery—A Randomized Controlled Pilot Trial

Kunst, Gudrun; Gauge, Nathan; Salaunkey, Kiran; Spazzapan, Martina; Amoako, Derek; Ferreira, Nicola; Green, David W.; Ballard, Clive

doi:10.1053/j.jvca.2019.10.054

Cited by 33 publications

(87 citation statements)

References 55 publications

(73 reference statements)

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“…Therefore, further and larger multi-center RCTs are needed to confirm our conclusions. In our meta-analysis, there were two studies evaluated the effects of the combination of combined use of EEG monitoring and regional cerebral saturation monitoring on reducing PND [44,45]. The RCT conducted by Ballard and colleagues showed that the use of EEG and rSO 2 monitor can significantly reduce the incidence of POCD at1, 12 and 52 weeks postoperatively [44].…”

Section: Regional Cerebral Oxygenation Monitoringmentioning

confidence: 99%

“…Reviewing the reference lists of the retrieved studies did not identify any new eligible study. Finally, 22 RCTs were included in the present this review [18,19,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. A flow diagram illustrating the literature search and trials screening process was shown in Fig.…”

Section: Literature Searchmentioning

confidence: 99%

“…As listed in Table 1, a total number of 6356 patients included in the 22 RCTs were enrolled in this meta-analysis [18,19,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. Among these 22 RCTs, 10 studies used EEG as the guide for anesthesia depth [18,[26][27][28][29][30][31][32][33][34], 10 studies evaluated the effects of rSO 2 monitoring on PND [19,[35][36][37][38][39][40][41][42][43] and the last 2 trials deployed both of the two monitoring [44,45]. Ten out of the 22 trials included patients who underwent cardiac surgery [18, 19, 27, 36, 38-41, 43, 45], whereas the other 12 studies were conducted in among patients undergoing non-cardiac major surgery, including abdominal surgery, ENT surgery, hip fracture repa...…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

Ding

Chen

2020

BMC Anesthesiol

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Background Perioperative neurocognitive disorders (PND) is a common postoperative complication including postoperative delirium (POD), postoperative cognitive decline (POCD) or delayed neurocognitive recovery. It is still controversial whether the use of intraoperative cerebral function monitoring can decrease the incidence of PND. The purpose of this study was to evaluate the effects of different cerebral function monitoring (electroencephalography (EEG) and regional cerebral oxygen saturation (rSO2) monitoring) on PND based on the data from randomized controlled trials (RCTs). Methods The electronic databases of Ovid MEDLINE, PubMed, EMBASE, Cochrane Library database were systematically searched using the indicated keywords from their inception to April 2020. The odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were employed to analyze the data. Heterogeneity across analyzed studies was assessed with chi-square test and I2 test. Results Twenty two RCTs with 6356 patients were included in the final analysis. Data from 12 studies including 4976 patients were analyzed to assess the association between the EEG-guided anesthesia and PND. The results showed that EEG-guided anesthesia could reduce the incidence of POD in patients undergoing non-cardiac surgery (OR: 0.73; 95% CI: 0.57–0.95; P = 0.02), but had no effect on patients undergoing cardiac surgery (OR: 0.44; 95% CI: 0.05–3.54; P = 0.44). The use of intraoperative EEG monitoring reduced the incidence of POCD up to 3 months after the surgery (OR: 0.69; 95% CI: 0.49–0.96; P = 0.03), but the incidence of early POCD remained unaffected (OR: 0.61; 95% CI: 0.35–1.07; P = 0.09). The remaining 10 studies compared the effect of rSO2 monitoring to routine care in a total of 1380 participants on the incidence of PND. The results indicated that intraoperative monitoring of rSO2 could reduce the incidence of POCD (OR 0.53, 95% CI 0.39–0.73; P < 0.0001), whereas no significant difference was found regarding the incidence of POD (OR: 0.74; 95% CI: 0.48–1.14; P = 0.17). Conclusions The findings in the present study indicated that intraoperative use of EEG or/and rSO2 monitor could decrease the risk of PND. Trial registration PROSPREO registration number: CRD42019130512.

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Section: Regional Cerebral Oxygenation Monitoringmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

Ding

Chen

2020

BMC Anesthesiol

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“…Both processed electroencephalogram (EEG) monitoring to titrate anesthetic dosage and regional cerebral oxygen saturation (rScO 2 ) monitoring to improve cerebral oxygen delivery have been proposed as methods to reduce perioperative neurocognitive disorders, with mixed results. In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Kunst et al 3 report on a pilot randomized control trial evaluating the combined use of processed EEG monitoring (using the bispectral index [BIS]) and regional cerebral saturation monitoring to reduce perioperative neurocognitive disorders in elderly patients undergoing coronary artery bypass graft surgery. Importantly, for patients in the control group, anesthesiologists were blinded to the results of the BIS and rScO 2 monitors.…”

mentioning

confidence: 99%

“…This combined intervention also was associated with a small but statistically significant increase in BIS values in the intervention group versus the control group, yet there was no significant difference in cerebral oximetry desaturation parameters between groups. 3 Because individual clinicians use data from intraoperative monitors to make different clinical care decisions, interpreting these results is difficult. Despite general knowledge that the minimum alveolar concentration (MAC) of inhaled anesthetics declines with age 4 and the intuition that reducing anesthetic dosage in older patients might reduce subsequent neurocognitive dysfunction, the clinical picture is not so simple.…”

mentioning

confidence: 99%

A Plague on Both Your Monitors! Are Bispectral Index and Cerebral Oximetry Useful for Reducing Postoperative Cognitive Impairment?

Klinger

Bottiger

Berger

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk?

Pecorella,

De Rosa,

Licchelli

et al. 2024

Intl J Gynecology & Obste

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Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age‐related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk–benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post‐surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.

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Intraoperative Optimization of Both Depth of Anesthesia and Cerebral Oxygenation in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery—A Randomized Controlled Pilot Trial

Cited by 33 publications

References 55 publications

Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

A Plague on Both Your Monitors! Are Bispectral Index and Cerebral Oximetry Useful for Reducing Postoperative Cognitive Impairment?

Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk?

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