Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

Ding, Lin; Chen, Dong Xu; Li, Qian

doi:10.1186/s12871-020-01163-y

Cited by 36 publications

(31 citation statements)

References 69 publications

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“…Our analysis found that cerebral oximetry monitoring-guided intraoperative interventions had a low risk of POD in younger patients (<71.0 years old) and a lower BMI (<25.0), a significant reduction of POCD in patients with a mean age of <63.0 years old compared with control. Ding et al conducted a metaanalysis and found that the intraoperative cerebral oxygenation monitoring could decrease the risk of POCD but have no effect on POD in non-cardiac and cardiac surgeries (41). Our metaregression analysis showed that age was negatively correlated with the reduction in POD and POCD in the intervention group.…”

Section: Discussionmentioning

confidence: 56%

The Effect of Intraoperative Cerebral Oximetry Monitoring on Postoperative Cognitive Dysfunction and ICU Stay in Adult Patients Undergoing Cardiac Surgery: An Updated Systematic Review and Meta-Analysis

Tian

Yuan

Zhou

et al. 2022

Front. Cardiovasc. Med.

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AimDetermining whether intraoperative cerebral oximetry monitoring-guided intervention reduces the risk of postoperative cognitive dysfunction remains controversial. The objective of this study was to conduct an up-to-date meta-analysis to comprehensively assess the effects of regional cerebral oxygen saturation (rSO2) monitoring-guided intervention on cognitive outcomes after cardiac surgery.MethodsPubMed, EMBASE, Ovid, and Cochrane Library databases were systematically searched using the related keywords for cardiac surgical randomized-controlled trials (RCTs) published from their inception to July 31, 2021. The primary outcome was postoperative delirium (POD). The secondary outcomes were postoperative cognitive decline (POCD) and other major postoperative outcomes. The odds ratio (OR) or weighted mean differences (WMDs) with 95% confidence interval (CI) were used to pool the data. The random-effect model was used for the potential clinical inconsistency. We performed meta-regression and subgroup analyses to assess the possible influence of rSO2 monitoring-guided intervention on clinical outcomes.ResultsIn total, 12 RCTs with 1,868 cardiac surgical patients were included. Compared with controls, the incidences of POD (n = 6 trials; OR, 0.28; 95% CI, 0.09–0.84; p = 0.02; I2 = 81%) and POCD (n = 5 trials; OR, 0.38; 95% CI, 0.16–0.93; p = 0.03; I2 = 78%) were significantly lower in the intervention group. Cerebral oximetry desaturation also showed a positive association with the incidence of POD (n = 5 trials; OR, 2.02; 95% CI, 1.25–3.24; p = 0.004; I2 = 81%). The duration of intensive care unit (ICU) stay was markedly shorter in the intervention group than in the control group (n = 10 trials; WMD, −0.22 days; 95% CI, −0.44 to −0.00; p = 0.05; I2 = 74%). Univariate meta-regression analyses showed that the major sources of heterogeneity were age (p = 0.03), body mass index (BMI, p = 0.05), and the proportion of congenital heart disease (CHD, p = 0.02) for POD, age (p = 0.04) for POCD, diabetes mellitus (DM, p = 0.07), cerebrovascular accident (CVA, p = 0.02), and chronic obstructive pulmonary disease (COPD, p = 0.09) for ICU stay. Subsequent subgroup analyses also confirmed these results.ConclusionAvailable evidence from the present study suggests that an intraoperative cerebral oximetry desaturation is associated with an increased POD risk, and the rSO2 monitoring-guided intervention is correlated with a lower risk of POD and POCD, and a shorter ICU stay in adults undergoing cardiac surgery. These clinical benefits may be limited in patients with older age, diabetes status, high BMI, non-CHD, non-COPD, or a previous cardiovascular accident.Systematic Review Registration: [PROSPREO], identifier: [CRD42021252654].

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Section: Discussionmentioning

confidence: 56%

The Effect of Intraoperative Cerebral Oximetry Monitoring on Postoperative Cognitive Dysfunction and ICU Stay in Adult Patients Undergoing Cardiac Surgery: An Updated Systematic Review and Meta-Analysis

Tian

Yuan

Zhou

et al. 2022

Front. Cardiovasc. Med.

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“…Additionally, rSO 2 has a proven ability for the early identification and prediction of the occurrence of perioperative neurological dysfunction in almost all types of surgeries. 22 , 23 Studies have shown that elderly patients were more prone to a decrease in rSO 2 during surgery, and a decrease in intraoperative rSO 2 was significantly correlated with the occurrence of postoperative delirium. 22 Furthermore, rSO 2 values below 50% or a decrease of more than 20% from baseline values indicated cerebral ischemia and the potential presence of blood, as confirmed by the testing of auditory-evoked potentials.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Electroacupuncture Preconditioning on Regional Cerebral Oxygen Saturation Levels in Elderly Patients with Diabetes

Ning¹,

Luo²,

Ding³

et al. 2022

DMSO

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Objective This study aimed to evaluate the effect of electroacupuncture preconditioning on regional cerebral oxygen saturation (rSO 2 ) levels in elderly patients with diabetes. Methods Forty patients undergoing elective diabetic foot surgery were enrolled in this study. All patients were aged 65 years and above and weighed 45–75 kg. All were characterized as class II or III according to the American Society of Anesthesiologists’ physical status classification system. Patients were divided randomly into an electroacupuncture group (group E) and a control group (group C); both groups comprised 20 patients. In group E, the DU20 (Baihui), DU24 (Shenting), and EX-HN1 (Sishencong) acupoints were selected for electroacupuncture 30 min prior to administering anesthesia, while in group C, patients underwent routine anesthesia without electroacupuncture. The patients in both groups were anesthetized using a sciatic nerve block. The number of cases with increased or decreased regional oxygen saturation (rSO 2 ) compared with the baseline as well as rSO 2 variability in the two groups were recorded and compared. Results There was no significant difference in the preoperative rSO 2 values between the two groups (54.4 ± 4.8 (L), 53.9 ± 5.2 (R) [group C] vs 54.1 ± 5.2 (L), 54.5 ± 4.6 (R)[group E]). Compared with group C, the rSO 2 in group E increased (50.3 ± 3.9 [group C] vs 58.4 ± 3.2[group E]), and this difference was statistically significant (P < 0.001). Conclusion Electroacupuncture stimulation can increase rSO 2 levels in patients with diabetes. Clinical Registration Number ChiCTR2100048783 ( http://www.chictr.org.cn ).

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“…Future studies should assess whether perioperative neuromonitoring helps preventing major perioperative neurocognitive disorders. 9…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid and the Risk of Delirium after Off-Pump Surgery

Hulde

Zittermann

Deutsch

et al. 2022

Thorac Cardiovasc Surg

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We investigated whether in patients undergoing off-pump coronary artery bypass grafting surgery a single bolus of 1 g tranexamic acid (TXA) impacts the risk of postoperative delirium using the propensity score matching approach. In 2,757 pairs, the risk of delirium was 4.2% (TXA group) and 5.0% (non-TXA group), with a relative risk in the TXA versus the non-TXA group of 0.83 (95% confidence interval: 0.65–1.07; p = 0.16). There was no significant interaction between TXA administration and renal function on the risk of delirium (p = 0.12). Data indicate that a single bolus of 1 g TXA does not increase the risk of delirium in patients undergoing off-pump surgery.

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Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

Cited by 36 publications

References 69 publications

The Effect of Intraoperative Cerebral Oximetry Monitoring on Postoperative Cognitive Dysfunction and ICU Stay in Adult Patients Undergoing Cardiac Surgery: An Updated Systematic Review and Meta-Analysis

The Effect of Intraoperative Cerebral Oximetry Monitoring on Postoperative Cognitive Dysfunction and ICU Stay in Adult Patients Undergoing Cardiac Surgery: An Updated Systematic Review and Meta-Analysis

The Effect of Electroacupuncture Preconditioning on Regional Cerebral Oxygen Saturation Levels in Elderly Patients with Diabetes

Tranexamic Acid and the Risk of Delirium after Off-Pump Surgery

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