Exploring the associations between intraoperative electroencephalographic depression mediated by different
Fei Sun1, Fangming Shen2, Weiwei Cai1
1Department of Anaesthesiology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing City , Jiangsu Province, 210008, China.
Insights
This study explores how intraoperative electroencephalogram (EEG) patterns affect negative postoperative behavioral changes in children undergoing day surgery. Findings aim to improve discharge assessments and postoperative care quality for pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Neuroscience
Background:
- Negative postoperative behavioral changes (NPOBCs) are common after pediatric anesthesia.
- Previous research linked EEG suppression to early recovery delirium, not distant NPOBCs.
- This gap is critical for pediatric day surgery patients discharged same-day.
Purpose of the Study:
- To investigate the mediating effects of intraoperative EEG patterns on NPOBCs in pediatric day surgery.
- To explore the mechanisms underlying NPOBCs in pediatric anesthesia.
- To develop a predictive model for NPOBCs to enhance discharge assessments.
Main Methods:
- Two-center, prospective, randomized, single-blind, controlled trial of 854 pediatric patients.
- Comparison of propofol (Group T) versus sevoflurane (Group S) anesthesia.
- Intraoperative EEG monitoring and analysis, with NPOBCs assessed up to 28 days postoperatively.
Main Results:
- The study aims to identify correlations between specific intraoperative EEG patterns and the incidence of NPOBCs.
- Analysis will determine if anesthetic type (propofol vs. sevoflurane) influences EEG patterns and subsequent behavioral changes.
- The study will evaluate NPOBC incidence at multiple postoperative time points (3 days, 1, 7, and 28 days).
Conclusions:
- Intraoperative EEG patterns may mediate NPOBCs in pediatric day surgery.
- Current discharge assessments may not adequately predict NPOBCs.
- A predictive model based on EEG could improve pediatric postoperative care and rehabilitation.
Background:
Negative postoperative behavioural changes (NPOBCs) are among the most common complications of paediatric anaesthesia. The association between electroencephalogram (EEG) suppression and postoperative outcomes in previous clinical studies has been limited to delirium occurring early in the anaesthesia recovery room, and there are no reports of associations with negative postoperative behavioural changes in the distant postoperative period. However, this has important implications for children undergoing day surgery who are discharged on the same day after surgery.
Methods:
The objective of this study is to investigate the mediating effects of intraoperative EEG patterns and negative postoperative behavioural changes in children undergoing paediatric day surgery. This study is a two-centre, prospective, randomised, single-blind, controlled trial involving 854 paediatric patients undergoing day surgery at the Children's Hospital of Nanjing Medical University and Zhongda Hospital of Southeast University; these patients are randomly assigned into two groups: the propofol intravenous anaesthesia, which is induced and maintained with propofol, group (Group T) and the sevoflurane inhalation anaesthesia, which is induced and maintained with sevoflurane, group (Group S). The depth of anaesthesia is monitored for both groups of children, and the EEG characteristics of the children are extracted. The primary outcome measure is the incidence of negative behavioural changes during the first three days after surgery. The secondary outcomes include evaluating the incidence of negative behavioural changes at 1, 7, and 28 days postoperatively and investigating the relationship between intraoperative EEG patterns and NPOBCs. The study flow diagram is presented in Fig. 1.
Discussion:
The aim of this clinical trial is to prospectively observe the mediating effects of intraoperative EEG forms and negative postoperative behavioural changes in children undergoing paediatric day surgery and to further explore the possible mechanisms of negative postoperative behavioural changes in paediatric anaesthesia. Moreover, in paediatric day surgery, the postoperative discharge assessment of children still lacks the ability to predict negative postoperative behavioural changes, and this study will construct a prediction model of negative postoperative behavioural changes to help anaesthesiologists more comprehensively assess whether children meet the criteria for discharge and to improve the quality of postoperative rehabilitation of children.
Trial Registration:
The study protocol was registered with the China Clinical Trial Registry ( http://www.chictr.org.cn ) on 1 July 2024 under the registration number ChiCTR2400086403. This trial is retrospectively registered.
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