The Effects of Bispectral Index–Guided Anesthesia on Postoperative Delirium in Elderly Patients: A Systematic Review and Meta-Analysis

Shan, Weifeng; Chen, Bingquan; Zhou, Yanfeng

doi:10.1016/j.wneu.2020.11.110

Cited by 17 publications

(8 citation statements)

References 23 publications

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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%

See 1 more Smart Citation

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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Section: Discussionmentioning

confidence: 99%

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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“…Nine meta-analyses [32][33][34][35][36][37][38][39][40] were found studying the effect of BIS monitoring on postoperative delirium and postoperative cognitive dysfunction, but our study has included more randomized controlled trials than most of them and included the most recent RCT of Evered et al [13] while being more stringent on patient population and intervention of study. Bocskai et al [32] also showed protective effects of BIS monitoring on POD on day 1 and POCD at 12 weeks, but relatively fewer studies were included, and younger patients with lower risk for POD and POCD were also included.…”

Section: Discussionmentioning

confidence: 99%

Effect of Anaesthesia Depth on Postoperative Delirium and Postoperative Cognitive Dysfunction in High-Risk Patients: A Systematic Review and Meta-Analysis

Ling¹,

Yang²,

Lee³

2022

Cureus

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Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) pose increased morbidity and mortality, especially to elderly patients. The effect of anesthesia is debatable. The databases of PubMed, EMBASE, Google Scholar, Cochrane Library and Web of Science were searched from inception until 24 February 2022 to identify randomized-controlled trials (RCTs) studying the effect of depth of anesthesia on POD and POCD primarily. Data on length of hospital stay and mortality were also extracted. Trial sequential analysis was also performed. Seventeen studies were eligible for systematic review and 15 studies of 5392 patients were eligible for meta-analysis. High bispectral index (BIS) favored a reduction in POD and POCD at three months. We found no significant difference between High BIS and Low BIS for mini-mental state exam (MMSE) score and POCD on day 7. However, this did not translate to a significant difference in length of stay and mortality. The data was also underpowered and heterogeneous. Future RCTs should focus on highrisk patients. A standardized methodology of reporting postoperative delirium and cognitive dysfunction is needed to improve comparisons across trials.

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“…141,168,169 The most recent reviews and meta-analyses have demonstrated contrasting findings in the ability of EEG-guided anesthesia to reduce POD and POCD. [170][171][172] Nevertheless, pEEG-guided anesthesia still may prove appealing to clinicians, with other objective clinical signs being unreliable during CPB. 173 Aside from specifically guiding depth of anesthesia, pEEG devices can be used to detect cortical burst suppression, which is associated with POD in cardiac surgery patients.…”

Section: Processed Eegmentioning

confidence: 99%

Neuromonitoring and Neurocognitive Outcomes in Cardiac Surgery: A Narrative Review

Milne

Gilbey

Gautel

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Neurocognitive dysfunction after cardiac surgery can present with diverse clinical phenotypes, which include postoperative delirium, postoperative cognitive dysfunction, and stroke, and it presents a significant healthcare burden for both patients and providers. Neurologic monitoring during cardiac surgery includes several modalities assessing cerebral perfusion and oxygenation (near-infrared spectroscopy, transcranial Doppler and jugular venous bulb saturation monitoring) and those that measure cerebral function (processed and unprocessed electroencephalogram), reflecting an absence of a single, definitive neuromonitor. This narrative review briefly describes the technologic basis of these neuromonitoring modalities, before exploring their use in clinical practice, both as tools to predict neurocognitive dysfunction, and with a bundle of interventions designed to optimize cerebral oxygen supply, with the aim of reducing postoperative delirium and cognitive dysfunction following cardiac surgery.

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The Effects of Bispectral Index–Guided Anesthesia on Postoperative Delirium in Elderly Patients: A Systematic Review and Meta-Analysis

Cited by 17 publications

References 23 publications

Neuromonitoring depth of anesthesia and its association with postoperative delirium

Neuromonitoring depth of anesthesia and its association with postoperative delirium

Effect of Anaesthesia Depth on Postoperative Delirium and Postoperative Cognitive Dysfunction in High-Risk Patients: A Systematic Review and Meta-Analysis

Neuromonitoring and Neurocognitive Outcomes in Cardiac Surgery: A Narrative Review

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