Processed Multiparameter Electroencephalogram-Guided General Anesthesia Management Can Reduce Postoperative Delirium
Na Xu1, Li-Xia Li1, Tian-Long Wang1
1Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Insights
Processed electroencephalogram (EEG)-guided anesthesia using patient state index (PSI) and density spectral array (DSA) monitoring significantly reduced postoperative delirium in carotid endarterectomy (CEA) patients. This EEG-guided approach offers a promising strategy for improving patient outcomes after CEA surgery.
Area of Science:
- Anesthesiology
- Neuroscience
- Surgical Outcomes
Background:
- Patients undergoing carotid endarterectomy (CEA) for severe carotid stenosis face a high risk of postoperative delirium, impacting recovery and outcomes.
- Current anesthesia management may not adequately mitigate the risk of intraoperative events leading to delirium.
- Investigating advanced monitoring techniques is crucial for optimizing patient safety during CEA.
Observation:
- A randomized clinical trial involving 255 patients undergoing CEA compared standard anesthesia monitoring with processed electroencephalogram (EEG)-guided management (PSI and DSA).
- Continuous transcranial Doppler ultrasound (TCD) and near-infrared spectroscopy (NIRS) monitored for cerebral hypoperfusion or hyperperfusion.
- EEG suppression time was analyzed across different surgical stages.
Findings:
- The incidence of postoperative delirium was significantly lower in the intervention group (7.87%) compared to the standard group (28.91%) (P < 0.01).
- The intervention group exhibited shorter total EEG suppression time, particularly during critical surgical phases (S2 and S3).
- No significant differences were observed in other neurologic complications or length of hospital stay between the groups.
Implications:
- Processed EEG-guided anesthesia, incorporating PSI and DSA monitoring, effectively reduces postoperative delirium incidence in CEA patients.
- This advanced monitoring strategy may benefit patients with hemodynamic instability or those undergoing procedures affecting cerebral perfusion.
- Optimizing intraoperative EEG management is a key factor in improving neurological outcomes following CEA.
Abstract:
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.
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