Predicting postoperative delirium and postoperative cognitive decline with combined intraoperative electroencephalogram monitoring and cerebral near-infrared spectroscopy in patients undergoing cardiac interventions
Studies have associated electroencephalogram (EEG) suppression with postoperative delirium (POD) and postoperative cognitive decline (POCD). Otherwise, improving cerebral tissue oxygen saturation (rScO2) seems beneficial. No study has evaluated the impact of EEG suppression and decreased rScO2 on the incidence of POD and POCD when the intraoperative management of patients is performed with a depth-of-anesthesia (DOA) monitor and a cerebral oximetry. In this prospective study patients undergoing cardiac interventions were monitored with the NeuroSENSE® DOA monitor and bilateral cerebral oximetry. An algorithm was used to optimize cerebral oxygenation. EEG suppression was presented as total area under the curve (AUC) of suppression ratio (SR) > 0 s (AUCEEGSR>0s). Cerebral desaturation was defined as AUC of 25% drop of oximetry values as compared to baseline. POD was evaluated by the chart review method. POCD was defined as a Z-score ≤ 2 based on Mini Mental State Examination at baseline and day 5 or if the patient reported any cognitive decline at 3 and at 6 months postoperatively. Among the 1616 patients, 1513 underwent normothermic surgery and were further analyzed. POD and POCD were respectively evaluated in 1504 and 1350 patients of whom 303 (20%) and 270 (20%) were respectively diagnosed positive. Having experienced high magnitudes of EEG suppression (fourth quartile of AUCEEGSR>0s) was significantly associated with POD (OR = 2.247; 95% CI = 1.414–3.571; P = 0.001). Low rScO2 at the end of surgery was statistically associated with POCD (OR = 0.981; 95% CI = 0.965–0.997; P = 0.018). The results of our study show that the degree of intraoperative EEG suppression on one hand, and low rScO2 at the end of procedure on the other hand, are associated with respectively POD and POCD in patients undergoing cardiac interventions.
KeywordsBurst suppression Depth-of-anesthesia monitor Cerebral oximetry Postoperative delirium Postoperative cognitive decline
The authors would like to thank Prof. Zech for his advise regarding the statistical analyses.
This study has received a Grant from “The Belgian Society of Anesthesiology and Reanimation” and a research Grant from “The Sorin Group”. This work was supported as well by the Department of Anesthesiology of Cliniques Universitaires Saint Luc, Brussels, Belgium.
Compliance with ethical standards
Conflict of interest
Mona Momeni has received speaker’s fees from Medtronic. The other authors declare no conflict of interest.
Ethical approval for this study (2013/07NOV/508–B403201318880) was provided by Le Comité d’Ethique Hospitalo-Facultaire des Cliniques universitaires Saint Luc, Brussels, Belgium (Chairperson Prof. JM Maloteaux) on 25 November 2013. The trial was registered prior to patient enrollment at Clinicaltrials.gov (NCT02006212; Date of registration: 04/12/2013).
Written informed consent was obtained from all subjects.
Research involving human participants
This study was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinhi declaration and its later amendments or comparable ethical standards.
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