Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction

Radtke, Frank‐Olaf; Franck, Martin; Lendner, Janna D.; Krüger, Stephanie; Wernecke, Klaus D.; Spies, Claudia

doi:10.1093/bja/aet055

Cited by 454 publications

(435 citation statements)

References 25 publications

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“…However, lower values of AAI during volatile anesthesia may indicate that volatile anesthetics were overdosed 27 . Intraoperative monitoring of level of anesthesia can reduce the consequences of neurotoxicity of anesthetics 14,15,43,44 . Clinical parameters during conduction of anesthesia varied, probably as a result of administered doses of anesthetics.…”

Section: Discussionmentioning

confidence: 99%

“…These problems can affect from 4% to 70% of patients up to two years after the traumatic event 5,[7][8][9][10][11] . On the other hand, too deep a level of anesthesia can increase the incidence of postoperative cognitive decline, postoperative delirium, time of hospitalization and accelerate the onset of senile dementia [12][13][14][15] . Analysis of the proper level of anesthesia is based on assessment of clinical parameters, autonomic and somatic reflexes 16 .…”

Section: Introductionmentioning

confidence: 99%

“…Instrumental neuromonitoring was recommended by the international associations of anesthesiologists 24,25 . It was shown that monitoring of brain functions decreases the possibility of both intraoperative awareness and too deep a level of anesthesia 12,14,15 . The costs of hospitalization and the incidence of postoperative nausea and vomiting were also decreased.…”

Section: Introductionmentioning

confidence: 99%

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Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Clinical monitoring is the most common method of adjusting the appropriate level of general anesthesia. However, episodes of intraoperative awareness (AWR) are still reported, suggesting that clinical observations may not be sufficient in some cases. The objective of this study was to compare the efficacy of clinical and instrumental neuromonitoring with auditory evoked potentials (AEP) in an intraoperative analysis of the proper level of general anesthesia. Methods. Patients scheduled for elective surgery were randomly divided into two groups. Subjects in the first group underwent intravenous, in the second group volatile anesthesia. The adequacy of anesthesia was analyzed using clinical parameters. All the participants were instrumentally monitored with the autoregressive AEP index (AAI). After the anesthesia, patients filled out a questionnaire on possible AWR. Results. Data of 208 patients (87 in the first, and 121 in the second group) were analyzed. Before surgery there were no changes in AAI values between groups (80 vs. 78, P=0.5192). The mean values of clinical parameters changed, but five minutes after the nociceptive stimuli. The mean values of AAI at analyzed time points were specific for general anesthesia. In patients under intravenous anesthesia, we found more episodes of too low (46/608 vs.15/847, P<0.000) anesthesia. One case of AWR was found in the TIVA group. Conclusions. AAI index is good indicator of patients' level of consciousness during general anesthesia. Standard clinical monitoring provides appropriate level of the procedure. However, it is insufficient during TIVA and does not prevent episodes of AWR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…In this context, strategies such as minimally invasive surgery, guiding anaesthetic depth with BIS monitoring,93, 94 adequate pain relief, limited use of benzodiazepines95, 96 and opioids, a quiet environment to facilitate sleep and accelerated discharge home have been proposed as effective measures which need to be confirmed in large trials.…”

Section: Surgery and Cognitive Dysfunctionmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

346

198

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BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

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“…3,4 The mechanism(s) of POCD remains elusive, although several contributing factors have been proposed, 1 including the exacerbation of preoperative cognitive impairment, 5 genetic predisposition, cerebral embolism/hypoperfusion, hemodilution, hyperglycemia, anesthetic neurotoxicity, [6][7][8] and perioperative hyperthermia. 9 In addition to these mechanisms, cerebral inflammation in response to embolic and other events during CPB, manifested by transcerebral platelet activation, 10 has also been proposed as a mechanism linking POCD to cardiac surgery.…”

Section: Résumémentioning

confidence: 99%

Effect of intravenous lidocaine on the transcerebral inflammatory response during cardiac surgery: a randomized-controlled trial

Klinger

Cooter

Berger

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Postoperative cognitive dysfunction (POCD) occurs frequently after cardiac surgery. The pathophysiology of POCD remains elusive, but previous work showed that intravenous lidocaine may be protective against POCD, possibly by modulating cerebral inflammation. We hypothesized that intravenous lidocaine would attenuate the cerebral inflammatory response to cardiopulmonary bypass (CPB) by reducing the transcerebral activation gradients of platelets, leukocytes, and/or platelet-leukocyte conjugates. Methods We studied 202 patients undergoing cardiac surgery with CPB in this prospective randomized doubleblinded placebo-controlled trial. Subjects were randomized to receive either intravenous lidocaine (bolus ? 48-hr infusion) or placebo (identical infusion volume and duration). Paired jugular venous and radial arterial blood samples were drawn at several time points and analyzed by fluorescence-activated cell sorting to identify activated platelets and plateletleukocyte conjugates. Transcerebral activation gradients were calculated by subtracting arterial values from venous values and were compared between groups using repeated measures regression models with covariate adjustment for age, sex, surgery type, and CPB duration. Results Beginning after aortic cross-clamp release and peaking ten minutes after the termination of CPB, the mean (SD) transcerebral activation gradient of platelet-monocyte conjugates decreased in lidocaine-treated vs placebo-treated patients [-1.84 (11.47) mean linear fluorescence intensity (MLFI) vs 1.46 (13.88) MLFI, respectively; mean difference, -4.08 MLFI; 95% confidence interval, -7.86 to -0.29; P = 0.03). No difference was seen at any time point for activated platelets or for platelet-neutrophil conjugates. Conclusion While lidocaine did not affect the systemic or transcerebral activation of platelets or leukocytes, we did observe a reduction in the transcerebral activation of platelet-monocyte conjugates after aortic cross-clamp release. This may be a manifestation of reduced cerebral inflammation during cardiopulmonary bypass in response to treatment with lidocaine. This trial was registered at ClinicalTrials.gov (NCT00938964). RésuméObjectif Le dysfonctionnement cognitif postopératoire (DCPO) constitue une complication fréquente après une A list of all members of the Neurologic Outcome Research Group is given in the Appendix.

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Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction

Cited by 454 publications

References 25 publications

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Effect of intravenous lidocaine on the transcerebral inflammatory response during cardiac surgery: a randomized-controlled trial

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