Association between intraoperative electroencephalographic suppression and postoperative mortality ‡

Abstract

NCT00281489 and NCT00682825.

Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium

“…16 To our knowledge, only two studies have previously examined risk factors for EEG suppression during general anesthesia. [35][36] During propofol-remifentanil anesthesia, older age, history of coronary artery disease, and male sex were associated with an increased probability of having an elevated suppression ratio. 35 None of these characteristics was a risk factor in our study, perhaps because we used inhaled agents rather than total IV anesthesia.…”

Anesthetic depth and long-term survival: an update

“…[10][11][12] Nevertheless, recent research suggests an association between deep general anesthesia and poorer outcomes in surgical patients. 4,5,11,[13][14][15][16][17][18][19][20][21] The dilemma is whether this evidence is strong enough for clinicians to change their practice.…”

“…Intraoperative hypotension has been independently associated with poor outcomes in numerous studies, including many quoted in this review 13,16,17,19,20,26 and has been proposed as a mediator between deep anesthesia and poor outcomes. [39][40][41] The degree and duration of hypotension resulting in harm likely varies from individual to individual, 41,42 but on an empiric basis, a mean arterial pressure (MAP) of \ 55 mmHg has been identified as requiring immediate treatment.…”

Monitoring the brain strikes a discordant note for anesthesiologists

“…There is evidence suggesting that EEG suppression, possibly indicating deep anesthesia, might be associated with adverse outcomes, such as postoperative delirium and even death. [5][6][7][8] In view of this theoretical concern, there are several ongoing major clinical trials seeking to answer the question of whether deep anesthesia is injurious. 9,10 Current indices could be deficient in their ability to reflect deep anesthesia accurately.…”

“…Il existe des données probantes suggérant que la suppression des données EEG, témoignant possiblement d'une anesthésie profonde, pourrait être associée à des complications tels qu'un delirium postopératoire, voire le décès. [5][6][7][8] Devant cette préoccupation théorique, plusieurs essais cliniques sont actuellement en cours pour tenter de répondre à la question de savoir si une anesthésie profonde est source de lésions. 9,10 Les indices actuels pourraient ne pas parvenir à témoigner avec exactitude d'une anesthésie profonde.…”