Use of processed-EEG monitoring to guide anaesthesia depth is associated with a 38% odds reduction of developing postoperative delirium.

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• Kristen K MacKenzie, Angelitta M Britt-Spells, Laura P Sands, and Jacqueline M Leung.
• From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California (K.K.M., J.M.L.) Department of Kinesiology, University of Indianapolis, Indianapolis, Indiana (A.M.B.-S.) Virginia Polytechnic Institute and State University, Center for Gerontology, Blacksburg, Virginia (L.P.S.).
• Anesthesiology. 2018 Sep 1; 129 (3): 417-427.

What We Already Know About This TopicWHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction.MethodsA systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs.ResultsThirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76).ConclusionsProcessed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.

This article appears in the collections: Does anesthesia cause post-operative delirium and post-operative cognitive decline? and Postoperative mortality and intraoperative anesthetic depth.

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