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Correlation between burst suppression and postoperative delirium in elderly patients: a prospective study

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Abstract

Objective

To explore the correlation between intraoperative burst suppression (BS) and postoperative delirium (POD) in elderly patients, and provide more ideas for reducing POD in clinical.

Methods

Ninety patients, aged over 60 years, who underwent lumbar internal fixation surgery in our hospital were selected. General information of patients was obtained and informed consent was signed during preoperative visits. Patients were divided into burst suppression (BS) group and non-burst suppression (NBS) group by intraoperative electroencephalogram monitoring. Intraoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded, and the variation and minimum value were obtained by calculating. Hemoglobin (HGB), C-reactive protein (CRP), system immune inflammatory index (SII) at 24 and 72 h after surgery, the incidence of postoperative adverse reactions, postoperative hospital stay, and total cost were recorded after operation. POD assessment was performed using CAM within 7 days after surgery or until discharge. SPSS25.0 was used for statistical analysis.

Results

Compared with the NBS group, the number of elderly patients with high frailty level in BS group was more (P = 0.048). There is correlation between BS and POD (OR: 4.954, 95%CI 1.034–23.736, P = 0.045), and most of the POD patients in BS group behave as hyperactive type.

Conclusion

The occurrence of intraoperative BS is associated with POD, and elderly patients with frailty are more likely to have intraoperative BS. BS can be used as a predictor of POD.

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References

  1. Li M, Wang TL, Wang DX (2020) An overview of Chinese multidisciplinary expert consensus on perioperative brain health in elderly patients. Chin Med J (Engl). 134:5–7. https://doi.org/10.1097/CM9.0000000000001213

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ding X, Gao X, Chen Q et al (2021) Preoperative acute pain is associated with postoperative delirium. Pain Med 22:15–21. https://doi.org/10.1093/pm/pnaa314

    Article  PubMed  Google Scholar 

  3. He Z, Cheng H, Wu H et al (2019) Risk factors for postoperative delirium in patients undergoing microvascular decompression. PLoS One. 14:e0215374. https://doi.org/10.1371/journal.pone.0215374

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Baek W, Kim YM, Lee H (2020) Risk factors of postoperative delirium in older adult spine surgery patients: a meta-analysis. AORN J 112:650–661. https://doi.org/10.1002/aorn.13252

    Article  PubMed  Google Scholar 

  5. Inouye SK, Westendorp RG, Saczynski JS (2014) Delirium in elderly people. Lancet 383:911–922. https://doi.org/10.1016/S0140-6736(13)60688-1

    Article  PubMed  Google Scholar 

  6. O’Gara BP, Mueller A, Gasangwa DVI et al (2020) Prevention of early postoperative decline: a randomized, controlled feasibility trial of perioperative cognitive training. Anesth Analg 130:586–595. https://doi.org/10.1213/ANE.0000000000004469

    Article  PubMed  PubMed Central  Google Scholar 

  7. Brown CH 4th, Neufeld KJ, Tian J et al (2019) Effect of targeting mean arterial pressure during cardiopulmonary bypass by monitoring cerebral autoregulation on postsurgical delirium among older patients: a nested randomized clinical trial. JAMA Surg 154:819–826. https://doi.org/10.1001/jamasurg.2019.1163

    Article  PubMed  PubMed Central  Google Scholar 

  8. Swank RL, Watson CW (1949) Effects of barbiturates and ether on spontaneous electrical activity of dog brain. J Neurophysiol 12:137–160. https://doi.org/10.1152/jn.1949.12.2.137

    Article  CAS  PubMed  Google Scholar 

  9. Phabphal K, Chisurajinda S, Somboon T et al (2018) Does burst-suppression achieve seizure control in refractory status epilepticus? BMC Neurol. 18:46. https://doi.org/10.1186/s12883-018-1050-3

    Article  PubMed  PubMed Central  Google Scholar 

  10. Modica PA, Tempelhoff R (1992) Intracranial pressure during induction of anaesthesia and tracheal intubation with etomidate-induced EEG burst suppression. Can J Anaesth 39:236–241. https://doi.org/10.1007/BF03008783

    Article  CAS  PubMed  Google Scholar 

  11. Besch G, Liu N, Samain E et al (2011) Occurrence of and risk factors for electroencephalogram burst suppression during propofol-remifentanil anaesthesia. Br J Anaesth 107:749–756. https://doi.org/10.1093/bja/aer235

    Article  CAS  PubMed  Google Scholar 

  12. Watson PL, Shintani AK, Tyson R et al (2008) Presence of electroencephalogram burst suppression in sedated, critically ill patients is associated with increased mortality. Crit Care Med 36:3171–3177. https://doi.org/10.1097/CCM.0b013e318186b9ce

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lei H, Xu S, Mao X et al (2021) Systemic Immune-Inflammatory Index as a Predictor of Lymph Node Metastasis in Endometrial Cancer. J Inflamm Res. 14:7131–7142. https://doi.org/10.2147/JIR.S345790

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Church S, Rogers E, Rockwood K et al (2020) A scoping review of the Clinical Frailty Scale. BMC Geriatr. 20:393. https://doi.org/10.1186/s12877-020-01801-7

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wiórek A, Krzych ŁJ (2019) Intraoperative Blood Pressure Variability Predicts Postoperative Mortality in Non-Cardiac Surgery-A Prospective Observational Cohort Study. Int J Environ Res Public Health. 16:4380. https://doi.org/10.3390/ijerph16224380

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sessler CN, Gosnell MS, Grap MJ et al (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344. https://doi.org/10.1164/rccm.2107138

    Article  PubMed  Google Scholar 

  17. Evered LA, Chan MTV, Han R et al (2021) Anaesthetic depth and delirium after major surgery: a randomised clinical trial. Br J Anaesth 127:704–712. https://doi.org/10.1016/j.bja.2021.07.021

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jiang X, Chen D, Lou Y et al (2017) Risk factors for postoperative delirium after spine surgery in middle- and old-aged patients. Aging Clin Exp Res 29:1039–1044. https://doi.org/10.1007/s40520-016-0640-4

    Article  PubMed  Google Scholar 

  19. Morino T, Hino M, Yamaoka S et al (2018) Risk factors for delirium after spine surgery: an age-matched analysis. Asian Spine J 12:703–709. https://doi.org/10.31616/asj.2018.12.4.703

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ching S, Purdon PL, Vijayan S et al (2012) A neurophysiological-metabolic model for burst suppression. Proc Natl Acad Sci U S A 109:3095–3100. https://doi.org/10.1073/pnas.1121461109

    Article  PubMed  PubMed Central  Google Scholar 

  21. Westover MB, Ching S, Shafi MM et al (2013) Real-time segmentation and tracking of brain metabolic state in ICU EEG recordings of burst suppression. Annu Int Conf IEEE Eng Med Biol Soc 2013:7108–7111. https://doi.org/10.1109/EMBC.2013.6611196

    Article  PubMed  Google Scholar 

  22. Liu S, Ching S (2017) Homeostatic dynamics, hysteresis and synchronization in a low-dimensional model of burst suppression. J Math Biol 74:1011–1035. https://doi.org/10.1007/s00285-016-1048-7

    Article  PubMed  Google Scholar 

  23. Berndt N, Kovács R, Schoknecht K et al (2021) Low neuronal metabolism during isoflurane-induced burst suppression is related to synaptic inhibition while neurovascular coupling and mitochondrial function remain intact. J Cereb Blood Flow Metab 41:2640–2655. https://doi.org/10.1177/0271678X211010353

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Westover MB, Ching S, Kumaraswamy VM et al (2015) The human burst suppression electroencephalogram of deep hypothermia. Clin Neurophysiol 126:1901–1914. https://doi.org/10.1016/j.clinph.2014.12.022

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kant IMJ, de Bresser J, van Montfort SJT et al (2018) The association between brain volume, cortical brain infarcts, and physical frailty. Neurobiol Aging 70:247–253. https://doi.org/10.1016/j.neurobiolaging.2018.06.032

    Article  PubMed  PubMed Central  Google Scholar 

  26. Cohen RA, Marsiske MM, Smith GE (2019) Neuropsychology of aging. Handb Clin Neurol 167:149–180. https://doi.org/10.1016/B978-0-12-804766-8.00010-8

    Article  PubMed  Google Scholar 

  27. Wilson JE, Mart MF, Cunningham C, et al. Delirium [published correction appears in Nat Rev Dis Primers. 2020;6(1):94. Nat Rev Dis Primers. 2020;6(1):90. https://doi.org/10.1038/s41572-020-00223-4

  28. Maldonado JR (2013) Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry 21:1190–1222. https://doi.org/10.1016/j.jagp.2013.09.005

    Article  PubMed  Google Scholar 

  29. Wang Y, Shen X (2018) Postoperative delirium in the elderly: the potential neuropathogenesis. Aging Clin Exp Res 30:1287–1295. https://doi.org/10.1007/s40520-018-1008-8

    Article  PubMed  Google Scholar 

  30. Engel GL, Romano J (1959) Delirium, a syndrome of cerebral insufficiency. J Chronic Dis 9:260–277. https://doi.org/10.1016/0021-9681(59)90165-1

    Article  CAS  PubMed  Google Scholar 

  31. Lukatch HS, Kiddoo CE, Maciver MB (2005) Anesthetic-induced burst suppression EEG activity requires glutamate-mediated excitatory synaptic transmission. Cereb Cortex 15:1322–1331. https://doi.org/10.1093/cercor/bhi015

    Article  PubMed  Google Scholar 

  32. Jaramillo S, Montane-Muntane M, Gambus PL et al (2020) Perioperative blood loss: estimation of blood volume loss or haemoglobin mass loss? Blood Transfus 18:20–29. https://doi.org/10.2450/2019.0204-19

    Article  PubMed  PubMed Central  Google Scholar 

  33. Marcos-Pérez D, Sánchez-Flores M, Proietti S et al (2020) Association of inflammatory mediators with frailty status in older adults: results from a systematic review and meta-analysis. Geroscience 42:1451–1473. https://doi.org/10.1007/s11357-020-00247-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Ma O, Crepeau AZ, Dutta A et al (2020) Anticipating postoperative delirium during burst suppression using electroencephalography. IEEE Trans Biomed Eng 67:2659–2668. https://doi.org/10.1109/TBME.2020.2967693

    Article  PubMed  Google Scholar 

  35. Pedemonte JC, Plummer GS, Chamadia S et al (2020) Electroencephalogram burst-suppression during cardiopulmonary bypass in elderly patients mediates postoperative delirium. Anesthesiology 133:280–292. https://doi.org/10.1097/ALN.0000000000003328

    Article  PubMed  Google Scholar 

  36. Koch S, Stegherr AM, Rupp L et al (2019) Emergence delirium in children is not related to intraoperative burst suppression - prospective, observational electrography study. BMC Anesthesiol. 19:146. https://doi.org/10.1186/s12871-019-0819-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Georgii MT, Kreuzer M, Fleischmann A et al (2022) Targeted interventions to increase blood pressure and decrease anaesthetic concentrations reduce intraoperative burst suppression: a randomized, Interventional Clinical Trial. Front Syst Neurosci. 16:786816. https://doi.org/10.3389/fnsys.2022.786816

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Bao Lang.

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This study has been approved by the Ethics Committee of Weifang People's Hospital (2022007).

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Ren, S., Zang, C., Yuan, F. et al. Correlation between burst suppression and postoperative delirium in elderly patients: a prospective study. Aging Clin Exp Res 35, 1873–1879 (2023). https://doi.org/10.1007/s40520-023-02460-5

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  • DOI: https://doi.org/10.1007/s40520-023-02460-5

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