Comparison of Bispectral Index-Guided Individualized Anesthesia with Standard General Anesthesia on Inadequate Emergence and Postoperative Delirium in Elderly Patients Undergoing Esophagectomy: A Retrospective Study at a Single Center

Yang, Yichen; Song, Chengjun; Song, Chengwei; Li, Cheng‐Wen

doi:10.12659/msm.925314

Cited by 3 publications

(3 citation statements)

References 46 publications

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“…We found that BIS values at LOC were on average ∼18 points higher for patients older than 65 years. Our results are consistent with previous works ( Zohar et al, 2006 ; Lysakowski et al, 2009 ; Besch et al, 2011 ; Ni et al, 2019 ; Yang et al, 2020 ) that suggested that BIS has an age bias, specifically underestimating depth of anesthesia in patients older than 65 years of age. This population became behaviorally unconscious at higher BIS score when compared to younger patients.…”

Section: Discussionsupporting

confidence: 93%

“…However, currently commercially available monitors, like the Bispectral Index (BIS) monitor, do not consider the natural changes in a person’s EEG throughout their life ( Purdon et al, 2015a ), and thus may be misreading elderly patients’ depth of hypnosis. In fact, the efficacy of EEG monitors has been questioned in geriatric patients, as they have not shown advantages compared to standard treatment in some settings ( Zohar et al, 2006 ; Yang et al, 2020 ). Lysakowski et al (2009) showed that, at the time of loss of consciousness (LOC), geriatric patients presented significantly higher BIS and spectral entropy values than younger patients.…”

Section: Introductionmentioning

confidence: 99%

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The effect of age on electroencephalogram measures of anesthesia hypnosis: A comparison of BIS, Alpha Power, Lempel-Ziv complexity and permutation entropy during propofol induction

Biggs

Boncompte

Pedemonte

et al. 2022

Front. Aging Neurosci.

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BackgroundImproving anesthesia administration for elderly population is of particular importance because they undergo considerably more surgical procedures and are at the most risk of suffering from anesthesia-related complications. Intraoperative brain monitors electroencephalogram (EEG) have proved useful in the general population, however, in elderly subjects this is contentious. Probably because these monitors do not account for the natural differences in EEG signals between young and older patients. In this study we attempted to systematically characterize the age-dependence of different EEG measures of anesthesia hypnosis.MethodsWe recorded EEG from 30 patients with a wide age range (19–99 years old) and analyzed four different proposed indexes of depth of hypnosis before, during and after loss of behavioral response due to slow propofol infusion during anesthetic induction. We analyzed Bispectral Index (BIS), Alpha Power and two entropy-related EEG measures, Lempel-Ziv complexity (LZc), and permutation entropy (PE) using mixed-effect analysis of variances (ANOVAs). We evaluated their possible age biases and their trajectories during propofol induction.ResultsAll measures were dependent on anesthesia stages. BIS, LZc, and PE presented lower values at increasing anesthetic dosage. Inversely, Alpha Power increased with increasing propofol at low doses, however this relation was reversed at greater effect-site propofol concentrations. Significant group differences between elderly patients (>65 years) and young patients were observed for BIS, Alpha Power, and LZc, but not for PE.ConclusionBIS, Alpha Power, and LZc show important age-related biases during slow propofol induction. These should be considered when interpreting and designing EEG monitors for clinical settings. Interestingly, PE did not present significant age differences, which makes it a promising candidate as an age-independent measure of hypnotic depth to be used in future monitor development.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

The effect of age on electroencephalogram measures of anesthesia hypnosis: A comparison of BIS, Alpha Power, Lempel-Ziv complexity and permutation entropy during propofol induction

Biggs

Boncompte

Pedemonte

et al. 2022

Front. Aging Neurosci.

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show abstract

“…Enhanced recovery after surgery (ERAS) programmes strongly recommend BIS use during esophagectomy (88). However, Yang and colleagues in the specific context of esophagectomy found that BIS-guided individualized anesthesia did not reduce inadequate emergence or POD (89). We suggest titrating anesthesia depth with the help of a monitor rather than going blind.…”

Section: Depth Of Anesthesia Monitoringmentioning

confidence: 89%

Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint

Deana¹,

Vetrugno²,

Bignami³

et al. 2021

J Thorac Dis

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Objective: This review summarizes the peri-operative anesthesiological approaches to esophagectomy considering the best up-to-date, evidence-based medicine, discussed from the anesthesiologist's standpoint. Background: Esophagectomy is the only curative therapy for esophageal cancer. Despite the many advancements made in the surgical treatment of this tumour, esophagectomy still carries a morbidity rate reaching 60%. Patients undergoing esophagectomy should be referred to high volume centres where they can receive a multidisciplinary approach to treatment, associated with better outcomes. The anesthesiologist is the key figure who should guide the peri-operative phase, from diagnosis through to post-surgery rehabilitation. We performed an updated narrative review devoted to the study of anesthesia management for esophagectomy in cancer patients. Methods: We searched MEDLINE, Scopus and Google Scholar databases from inception to May 2021. We used the following terms: "esophagectomy", "esophagectomy AND pre-operative evaluation", "esophagectomy AND protective lung ventilation", "esophagectomy AND hemodynamic monitoring" and "esophagectomy AND analgesia". We considered only articles with abstract written in English and available to the reader. We excluded single case-reports. Conclusions: Pre-operative anesthesiological evaluation is mandatory in order to stratify and optimize any medical condition. During surgery, protective ventilation and judicious fluid management are the cornerstones of intraoperative "protective anesthesia". Post-operative care should be provided by an intensive care unit or high-dependency unit depending on the patient's condition, the type of surgery endured and the availability of local resources. The provision of adequate post-operative analgesia favours early mobilization and rapid recovery. Anesthesiologist has an important role during the peri-operative care for esophagectomy.However, there are still some topics that need to be further studied to improve the outcome of these patients.

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Electroencephalographic Measures of Delirium in the Perioperative Setting: A Systematic Review

Bruzzone,

Chapin,

Walker

et al. 2024

Anesthesia &Amp; Analgesia

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Postoperative delirium (POD) is frequent in older adults and is associated with adverse cognitive and functional outcomes. In the last several decades, there has been an increased interest in exploring tools that easily allow the early recognition of patients at risk of developing POD. The electroencephalogram (EEG) is a widely available tool used to understand delirium pathophysiology, and its use in the perioperative setting has grown exponentially, particularly to predict and detect POD. We performed a systematic review to investigate the use of EEG in the pre-, intra-, and postoperative settings. We identified 371 studies, and 56 met the inclusion criteria. A range of techniques was used to obtain EEG data, from limited 1-4 channel setups to complex 256-channel systems. Power spectra were often measured preoperatively, yet the outcomes were inconsistent. During surgery, the emphasis was primarily on burst suppression (BS) metrics and power spectra, with a link between the frequency and timing of BS, and POD. The EEG patterns observed in POD aligned with those noted in delirium in different contexts, suggesting a reduction in EEG activity. Further research is required to investigate preoperative EEG indicators that may predict susceptibility to delirium.

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Comparison of Bispectral Index-Guided Individualized Anesthesia with Standard General Anesthesia on Inadequate Emergence and Postoperative Delirium in Elderly Patients Undergoing Esophagectomy: A Retrospective Study at a Single Center

Cited by 3 publications

References 46 publications

The effect of age on electroencephalogram measures of anesthesia hypnosis: A comparison of BIS, Alpha Power, Lempel-Ziv complexity and permutation entropy during propofol induction

The effect of age on electroencephalogram measures of anesthesia hypnosis: A comparison of BIS, Alpha Power, Lempel-Ziv complexity and permutation entropy during propofol induction

Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint

Electroencephalographic Measures of Delirium in the Perioperative Setting: A Systematic Review

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