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Electroencephalographic Monitoring in the Recovery Room for Identification of Patients at Risk for Postoperative
Maximilian Markus1, Sandra Widmann2, Julia Jansche3
1Maximilian Markus, M.D.: Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
Background:
Electroencephalography (EEG), especially the assessment of alpha oscillations (8 to 12 Hz), has gained attention as a noninvasive marker of neural network integrity, with reduced alpha power linked to thalamocortical disconnectivity and increased vulnerability to postoperative delirium (POD) in elderly patients. Recent studies have demonstrated that altered EEG dynamics in the alpha-band frequencies during anesthesia emergence in the postanesthesia care unit are associated with POD. However, EEG data postoperatively from the recovery room are scarce.
Methods:
This prospective observational study (2019 to 2022) at Charité-Universitätsmedizin Berlin investigates frontal EEG signatures and POD in older adults undergoing surgery. Postoperative POD screening was performed in the recovery room and twice daily for 5 days. While the overall study collected pre- and intraoperative EEGs, this study focused on frontal EEG files recorded in the recovery room while patients were awake. Spectral-domain EEG features and monitor-derived indices were compared by multivariable regression analysis between those who developed POD and those who did not.
Results:
A total of 184 patients had sufficient EEG data for analysis; 57 (31%) developed POD. Recovery-room recordings showed significantly reduced alpha- and beta-band power in patients with POD versus those without POD, with cumulative 10- to 20-Hz power providing the best discrimination (area under the receiver operating characteristic, 0.69; 95% CI, 0.60 to 0.77). Patients without POD exhibited increases in alpha- and beta-band power (8 to 20 Hz) relative to preoperative baseline, with the highest augmentation at approximately 16 Hz, whereas POD patients retained spectral patterns comparable to baseline across all frequency bands.
Conclusions:
These data suggest that frontal EEG monitoring in the recovery room can help identify a "vulnerable brain" phenotype associated with increased POD risk. Integrating this monitoring into postoperative care may support risk stratification and more individualized management.
