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Association between intraoperative electroencephalographic suppression and postoperative mortality.

M Willingham1, A Ben Abdallah1, S Gradwohl1

  • 1Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA.

British Journal of Anaesthesia
|May 24, 2014
PubMed
Summary

Intraoperative electroencephalogram (EEG) suppression is not an independent predictor of 90-day postoperative mortality. However, EEG suppression combined with low mean arterial pressure significantly increases mortality risk.

Keywords:
anaesthesia, generalcomorbiditydeep sedationelectroencephalographyrisk assessment

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Area of Science:

  • Anesthesiology
  • Neuroscience
  • Critical Care Medicine

Background:

  • Low bispectral index (BIS) values often indicate electroencephalogram (EEG) suppression.
  • EEG suppression has been linked to increased postoperative mortality.
  • This study aimed to clarify the relationship between intraoperative EEG suppression and 90-day mortality.

Purpose of the Study:

  • To determine if intraoperative EEG suppression independently predicts 90-day postoperative mortality.
  • To identify risk factors associated with intraoperative EEG suppression.
  • To explore the interaction between EEG suppression and hemodynamic parameters on mortality.

Main Methods:

  • An observational study of 2662 adults from the B-Unaware and BAG-RECALL trials.
  • Propensity matching created cohorts with >5 minutes (suppressed) and ≤5 minutes (non-suppressed) of EEG suppression.
  • Multivariable logistic regression and zero-inflated mixed effects models were used for analysis.

Main Results:

  • Overall 90-day mortality was 3.9%; 6.3% in the suppressed cohort vs. 3.0% in the non-suppressed cohort.
  • EEG suppression alone was not significantly associated with mortality after adjustment (OR=0.83).
  • A significant interaction was found between EEG suppression and mean arterial pressure <55 mm Hg (OR=2.96).
  • Risk factors for suppression included older age, comorbidities, COPD, and higher anesthetic doses.
  • Factors reducing suppression likelihood included cancer, alcohol/opioid/benzodiazepine use, and nitrous oxide.

Conclusions:

  • Intraoperative EEG suppression is associated with increased anesthetic administration and comorbidities.
  • The hypothesis that EEG suppression predicts mortality is supported only when coincident with low mean arterial pressure.
  • EEG suppression is not an independent predictor of 90-day postoperative mortality.