Occurrence of and risk factors for electroencephalogram burst suppression during propofol–remifentanil anaesthesia

Besch, Guillaume; Liu, N.; Samain, Emmanuel; Pericard, C.; Boichut, N.; Mercier, Mariette; Chazot, Thierry; Pili-Floury, Sébastien

doi:10.1093/bja/aer235

Cited by 83 publications

(71 citation statements)

References 47 publications

(19 reference statements)

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“…16 To our knowledge, only two studies have previously examined risk factors for EEG suppression during general anesthesia. [35][36] During propofol-remifentanil anesthesia, older age, history of coronary artery disease, and male sex were associated with an increased probability of having an elevated suppression ratio. 35 None of these characteristics was a risk factor in our study, perhaps because we used inhaled agents rather than total IV anesthesia.…”

Section: Discussionmentioning

confidence: 97%

“…[35][36] During propofol-remifentanil anesthesia, older age, history of coronary artery disease, and male sex were associated with an increased probability of having an elevated suppression ratio. 35 None of these characteristics was a risk factor in our study, perhaps because we used inhaled agents rather than total IV anesthesia. In a study of general anesthesia with volatile agents, many risk factors for EEG suppression were identified, including high end-tidal anesthetic concentration and high intraoperative opioid dose.…”

Section: Discussionmentioning

confidence: 97%

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Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium

Fritz

Kalarickal

Maybrier

et al. 2016

Survey of Anesthesiology

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium

Fritz

Kalarickal

Maybrier

et al. 2016

Survey of Anesthesiology

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“…23,48 It can be produced by anesthetic agents, hypothermia, and a range of cerebral ischemic insults, and it is associated with long-term cerebral damage. 51 In the context of general anesthesia, the onset of burst suppression often represents unnecessarily deep anesthesia, 23 although care should be taken to rule out the other more sinister causes.…”

mentioning

confidence: 99%

Anesthetic depth and long-term survival: an update

Leslie

Short

2015

Can J Anesth/J Can Anesth

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Purpose The purpose of this paper is to review the current evidence relating anesthetic depth to long-term survival after surgery. Source Using PubMed as the principal source, this review included published studies in all languages comparing mortality in patients with low-and highprocessed electro-encephalo-graphic index values. Principal findings All published studies used the bispectral index (BIS) monitor to measure anesthetic depth. The majority of the published observational studies were post hoc analyses of studies undertaken for other purposes. Most of these studies report a statistically significant association between deep general anesthesia (i.e., BIS values\45) and death. Some studies also suggest an association between deep general anesthesia and myocardial infarction or postoperative cognitive decline. The combination of low BIS values and low delivered anesthetic concentrations (thus defining increased anesthetic sensitivity) may identify patients at particularly high risk. One of the three available randomized controlled trials reports worse outcomes in the BIS = 50 group compared with the BIS[80 group, and two report no difference in mortality between the BIS = 35 and BIS = 50-55 groups. Conclusions The available evidence on anesthetic depth and long-term survival is inconclusive. Randomized controlled trials with carefully controlled arterial blood pressure are required.

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“…Low bispectral index values (less than 40 to 30) typically occur when there is electroencephalographic burst suppression. 11,12 Unlike many other electroencephalographic features seen during general anesthesia, such as spindles and slow delta waves, burst suppression is not a physiologically normal rhythm. Burst suppression appears more frequently during general anesthesia in patients who have coronary artery disease 11 and has been implicated as a harbinger of 6-month mortality in medical intensive care unit patients.…”

mentioning

confidence: 99%

“…11,12 Unlike many other electroencephalographic features seen during general anesthesia, such as spindles and slow delta waves, burst suppression is not a physiologically normal rhythm. Burst suppression appears more frequently during general anesthesia in patients who have coronary artery disease 11 and has been implicated as a harbinger of 6-month mortality in medical intensive care unit patients. 13 It is hypothesized that prolonged burst suppression might precipitate neurologic injury.…”

mentioning

confidence: 99%