Effect of electroencephalogram-guided anaesthesia administration on 1-yr mortality: follow-up of a randomised clinical trial

Fritz, Bradley A.; King, Cristi R.; Mickle, Angela; Wildes, Troy S.; Budelier, Thaddeus P.; Oberhaus, Jordan; Park, Daniel; Maybrier, Hannah; Abdallah, Arbi Ben; Kronzer, Alex; McKinnon, Sherry; Torres, Brian A.; Graetz, Thomas J.; Emmert, Daniel A.; Palanca, Ben Julian A.; Stevens, Tracey; Stark, Susan; Lenze, Eric J.; Avidan, Michael S.; Apakama, Ginika; Aranake-Chrisinger, A.; Bolzenius, Jacob D.; Burton, Jamila; Cui, Victoria; Goswami, Shreya; Gupta, Shelly; Jordan, Katherine; Muench, Maxwell; Murphy, Matthew R.; Patel, Aamil; Spencer, James W.; Strutz, Patricia; Tedeschi, Catherine; Trammel, Emma R.; Upadhyayula, Ravi T.; Winter, Anke; Lin, Nan; Jacobsohn, Eric; Fong, Tamara G.; Gallagher, Jackie; Inouye, Sharon K.; Schmitt, Eva M.; Somerville, Emily; Melby, Spencer J.; Tappenden, Jennifer

doi:10.1016/j.bja.2021.04.036

Cited by 8 publications

(3 citation statements)

References 41 publications

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“…82 Given that exploratory end points are intended for hypothesis generation only, and that there was only a very modest difference in median ET MAC of 0.11 between the 2 groups, this particular finding should be interpreted with caution and may represent a type I error. Indeed, a subsequent post hoc analysis by Fritz et al 99 demonstrated no statistically significant difference in 1-year mortality between the pEEG-guided group and the routine care group (adjusted 1-year mortality = 9.6% vs 10.3%; difference = −0.7%; 95% CI, −4.3 to 2.8; P = .70), and this finding is in line with the results from the aforementioned Balanced Anesthesia Study. 89 At present, there is no robust prospective evidence to support that iatrogenic intraoperative burstsuppression, nor the purposeful avoidance of it, has any bearing on perioperative or long-term mortality.…”

Section: Mortalitysupporting

confidence: 66%

Electroencephalographic Burst-Suppression, Perioperative Neuroprotection, Postoperative Cognitive Function, and Mortality: A Focused Narrative Review of the Literature

Ma¹,

Bebawy

2021

Anesthesia &Amp; Analgesia

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Burst-suppression is an electroencephalographic pattern that results from a diverse array of pathophysiological causes and/or metabolic neuronal suppression secondary to the administration of anesthetic medications. The purpose of this review is to provide an overview of the physiological mechanisms that underlie the burst-suppression pattern and to present in a comprehensive way the available evidence both supporting and in opposition to the clinical use of this electroencephalographic pattern as a therapeutic measure in various perioperative settings. (Anesth Analg 2022;135:79-90) GLOSSARY ACNS = American Clinical Neurophysiology Society; ADAPT-2 = Anesthetic Depth and Postoperative Delirium Trial-2; ATP = adenosine triphosphate; [ATP] I = intracellular ATP concentration; BIS = bispectral index; BSR = burst-suppression ratio; CBF = cerebral blood flow; CEA = carotid endarterectomy; CI = confidence interval; CMRO2 = cerebral metabolic rate of oxygen consumption; CPB = cardiopulmonary bypass; CV = cardiovascular; EEG = electroencephalogram; ENGAGES = Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes; ET = end-tidal; GABA = gamma-aminobutyric acid; GOS = Glasgow Outcome Scale; HR = hazard ratio; IAR = intraoperative aneurysm rupture; ICP = intracranial pressure; ICU = intensive care unit; K ATP = ATPgated potassium channels; MAC = minimum alveolar concentration; MAP = mean arterial pressure; OR = odds ratio; PACU = postanesthetic care unit; PD = postoperative delirium; pEEG = processed EEG; POD = postoperative day; RCT = randomized controlled trial; TC = temporary clip Basic, Clinical and Systems Neuroscience

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Section: Mortalitysupporting

confidence: 66%

Electroencephalographic Burst-Suppression, Perioperative Neuroprotection, Postoperative Cognitive Function, and Mortality: A Focused Narrative Review of the Literature

Ma¹,

Bebawy

2021

Anesthesia &Amp; Analgesia

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“…The highly debated question of regional anesthesia reducing metastasis recurrence long-term is difficult to analyze given the plethora of studies that fail to provide clear benefits of using regional anesthesia despite the importance of the question [52][53][54][55][56][57][58][59][60][61][62][63][64]. Remarkably, the depth of anesthesia correlates in some studies with the emergence of postoperative delirium [65][66][67]. The emergence of delirium carries a significant risk of long-term decline, but definitive studies are missing.…”

Section: The Effect Of Anesthesia On Long-term Postoperative Outcomesmentioning

confidence: 99%

Quo Vadis Anesthesiologist? The Value Proposition of Future Anesthesiologists Lies in Preserving or Restoring Presurgical Health after Surgical Insult

Laudański

2022

JCM

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Anesthesiology is an indispensable and ubiquitous field of modern healthcare. Advancements in delivering anesthesia result in a very low rate of anesthesia-related mortality, improved morbidity, and increased patient satisfaction. However, peri-surgical stress may trigger profound and lasting effects on the patient’s physiology, resulting in the emergence of a new allostatic balance. Such a balance may have variable effects on the patient’s recovery. However, in some individuals, the emergence of the new allostatic balance is delayed for years yet ultimately results in a less favorable outcome due to an increased risk of comorbidities. These changes are secondary to a single critical care grade insult such as significant tissue destruction, blood loss, alteration in microbiota with the possible leak of the inflammatory pathogen-associated molecular pattern (PAMP), and the induction of catabolism. Preparing patients for such stress is a novel requirement for anesthesiologists to expand their scope of practice in healthcare delivery by eliminating pre-existing stressors (smoking, obesity, substance abuse) and preconditioning patients to stress using pharmacological and nanotechnology means. Perioperative care should employ a human brain interface for more efficient care delivery and an early warning for excessive damage. Postsurgical care can involve the modification of the immune and metabolic system response. Selected techniques should include utilizing genome expression manipulation, multi-omics analysis, and predictive algorithms. Integration of these techniques into a per-operative recovery data-driven delivery system with the targeted goal of recovering presurgical homeostasis instead of allostatic recovery may represent a perfect nexus for future anesthesiologists.

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“…Recent studies suggested that intraoperative alpha band power was significantly reduced in older adults with preoperative cognitive impairment and postoperative delirium (POD) [ 8 , 9 ]. The optimization of anesthetic exposure based on EEG monitoring was reported to ameliorate postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), while some studies have suggested that this benefit could be controversial [ 10 , 11 , 12 , 13 ]. A possible reason is that these indices of anesthetic depth may not consider the influence of age on neural activity during anesthesia [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Differences in the EEG Power Spectrum and Cross-Frequency Coupling Patterns between Young and Elderly Patients during Sevoflurane Anesthesia

Zhang,

Li,

Wang

et al. 2023

Brain Sciences

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Electroencephalography (EEG) is widely used for monitoring the depth of anesthesia in surgical patients. Distinguishing age-related EEG features under general anesthesia will help to optimize anesthetic depth monitoring during surgery for elderly patients. This retrospective cohort study included 41 patients aged from 18 to 79 years undergoing noncardiac surgery under general anesthesia. We compared the power spectral signatures and phase–amplitude coupling patterns of the young and elderly groups under baseline and surgical anesthetic depth. General anesthesia by sevoflurane significantly increased the spectral power of delta, theta, alpha, and beta bands and strengthened the cross-frequency coupling both in young and elderly patients. However, the variation in EEG power spectral density and the modulation of alpha amplitudes on delta phases was relatively weaker in elderly patients. In conclusion, the EEG under general anesthesia using sevoflurane exhibited similar dynamic features between young and elderly patients, and the weakened alteration of spectral power and cross-frequency coupling patterns could be utilized to precisely quantify the depth of anesthesia in elderly patients.

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Effect of electroencephalogram-guided anaesthesia administration on 1-yr mortality: follow-up of a randomised clinical trial

Cited by 8 publications

References 41 publications

Electroencephalographic Burst-Suppression, Perioperative Neuroprotection, Postoperative Cognitive Function, and Mortality: A Focused Narrative Review of the Literature

Electroencephalographic Burst-Suppression, Perioperative Neuroprotection, Postoperative Cognitive Function, and Mortality: A Focused Narrative Review of the Literature

Quo Vadis Anesthesiologist? The Value Proposition of Future Anesthesiologists Lies in Preserving or Restoring Presurgical Health after Surgical Insult

Differences in the EEG Power Spectrum and Cross-Frequency Coupling Patterns between Young and Elderly Patients during Sevoflurane Anesthesia

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