Desflurane is risk factor for postoperative delirium in older patients’ independent from intraoperative burst suppression duration

Abstract

BackgroundPostoperative Delirium (POD) is the most frequent neurocognitive complication after general anesthesia in older patients. The development of POD is associated with prolonged periods of burst suppression activity in the intraoperative electroencephalogram (EEG). The risk to present burst suppression activity depends not only on the age of the patient but is also more frequent during propofol anesthesia as compared to inhalative anesthesia. The aim of our study is to determine, if the risk to develop POD differs depending on the anesthetic agent given and if this correlates with a longer duration of intraoperative burst suppression.MethodsIn this secondary analysis of the SuDoCo trail [ISRCTN 36437985] 1277 patients, older than 60 years undergoing general anesthesia were included. We preprocessed and analyzed the raw EEG files from each patient and evaluated the intraoperative burst suppression duration. In a logistic regression analysis, we assessed the impact of burst suppression duration and anesthetic agent used for maintenance on the risk to develop POD.Results18.7% of patients developed POD. Burst suppression duration was prolonged in POD patients (POD 27.5 min ± 21.3 min vs. NoPOD 21.4 ± 16.2 min, p < 0.001), for each minute of prolonged intraoperative burst suppression activity the risk to develop POD increased by 1.1% (OR 1.011, CI 95% 1.000–1.022, p = 0.046). Burst suppression duration was prolonged under propofol anesthesia as compared to sevoflurane and desflurane anesthesia (propofol 32.5 ± 20.3 min, sevoflurane 17.1 ± 12.6 min and desflurane 20.1 ± 16.0 min, p < 0.001). However, patients receiving desflurane anesthesia had a 1.8fold higher risk to develop POD, as compared to propofol anesthesia (OR 1.766, CI 95% 1.049–2.974, p = 0.032).ConclusionWe found a significantly increased risk to develop POD after desflurane anesthesia in older patients, even though burst suppression duration was shorter under desflurane anesthesia as compared to propofol anesthesia. Our finding might help to explain some discrepancies in studies analyzing the impact of burst suppression duration and EEG-guided anesthesia on the risk to develop POD.

Electroencephalogram Biomarkers from Anesthesia Induction to Identify Vulnerable Patients at Risk for Postoperative Delirium

“…In our study cohort, anesthesia maintenance with volatile gases was a risk factor for the emergence of POD. This is in line with a previous retrospective study data analysis done by our group 37 and was also shown in a metaanalysis. 38 Hence, prospective studies should examine whether patients presenting the described EEG signatures after LOC would profit from a total intravenous anesthesia with propofol for anesthesia maintenance.…”

Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery

“…It is quite conceivable that the incidence of postoperative delirium in patients may be different when anesthetic agents other than sevoflurane are used. For example, a recent reanalysis of a study in older patients found that desflurane was associated with a higher risk of developing postoperative delirium as compared to propofol or sevoflurane, even though prolonged intraoperative burst suppression activity occurred with propofol [ 38 ]. In another study, older patients with elective lower extremity orthopedic surgery under spinal anesthesia were randomized to receive dexmedetomidine or propofol sedation.…”

Intraoperative electroencephalogram patterns as predictors of postoperative delirium in older patients: a systematic review and meta-analysis

“…After careful reading of the full-text articles, 32 studies were excluded ( Supplementary Table S3 ). Ultimately, this systematic review included 19 studies published between 2015 and 2023 (Soehle et al, 2015 ; Fritz et al, 2016 ; Hesse et al, 2019 ; Momeni et al, 2019 ; Pedemonte et al, 2020 ; Jung et al, 2021 ; Koch et al, 2021 , 2023 ; Lele et al, 2022 ; Li et al, 2022 ; Lutz et al, 2022 ; Röhr et al, 2022 ; Windmann et al, 2022 ; Baron Shahaf et al, 2023 ; Dragovic et al, 2023 ; Khalifa et al, 2023 ; Kinoshita et al, 2023 ; Reese et al, 2023 ; Ostertag et al, 2024 ). Additionally, 10 of these articles were included in the meta-analysis (Soehle et al, 2015 ; Hesse et al, 2019 ; Pedemonte et al, 2020 ; Jung et al, 2021 ; Koch et al, 2021 , 2023 ; Lele et al, 2022 ; Lutz et al, 2022 ; Röhr et al, 2022 ; Ostertag et al, 2024 ).…”

“…Furthermore, it was noted that an increased incidence and duration of BSR and lower BIS values are also predictive of POD development. Nonetheless, several studies have not demonstrated an association between this parameter and POD (Koch et al, 2021 , 2023 ; Lele et al, 2022 ).…”