Older patients with low pre-operative cognitive performance may inadvertently be receiving a relative overdose during volatile general anaesthesia.

pearl

• Rodrigo G Gutiérrez, José I Egaña, Felipe A Maldonado, Iván A Sáez, Fernando I Reyes, Hugo Soulat, Patrick L Purdon, and Antonello Penna.
• From the Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico, Universidad de Chile, Santiago, Chile.
• Anesth. Analg. 2021 Jul 1; 133 (1): 205-214.

BackgroundPatients with low cognitive performance are thought to have a higher risk of postoperative neurocognitive disorders. Here we analyzed the relationship between preoperative cognition and anesthesia-induced brain dynamics. We hypothesized that patients with low cognitive performance would be more sensitive to anesthetics and would show differences in electroencephalogram (EEG) activity consistent with a brain anesthesia overdose.MethodsThis is a retrospective analysis from a previously reported observational study. We evaluated cognitive performance using the Montreal cognitive assessment (MoCA) test. All patients received general anesthesia maintained with sevoflurane or desflurane during elective major abdominal surgery. We analyzed the EEG using spectral, coherence, and phase-amplitude modulation analyses.ResultsPatients were separated into a low MoCA group (<26 points, n = 12) and a high MoCA group (n = 23). There were no differences in baseline EEG, nor end-tidal age-corrected minimum alveolar concentration (MACage). However, under anesthesia, the low MoCA group had lower α-β power (high MoCA: 2.9 [interquartile range {IQR}: 0.6-5.8 dB] versus low MoCA: -1.2 [IQR: -2.1 to 0.6 dB], difference 4.1 [1.0-5.7]) and a lower α peak frequency (high MoCA: 9.0 [IQR: 8.3-9.8 Hz] versus low MoCA: 7.5 [IQR: 6.3-9.0 Hz], difference 1.5 [0-2.3]) compared to the high MoCA group. The low MoCA group also had a lower α band coherence and a stronger peak-max phase-amplitude coupling (PAC). Finally, patients in the low MoCA group had longer emergence times (high MoCA 663 ± 345 seconds versus low MoCA: 960 ± 352 seconds, difference 297 [15-578]). Multiple linear regression shows up that both age and MoCA scores are independently associated with intraoperative α-β power.ConclusionsAll these EEG features, together with a prolonged emergence time, are consistent with the possibility that older patients with low cognitive performance are receiving a brain anesthesia overdose compare to cognitive normal patients.Copyright © 2020 International Anesthesia Research Society.

This article appears in the collection: Read Articles.

30 keywords...

hide…