Reducing Perioperative Neurocognitive Disorders (PND) Through Depth of Anesthesia Monitoring: A Critical Review

International Journal of General Medicine, Journal Year: 2021, Volume and Issue: Volume 14, P. 153 - 162

Published: Jan. 1, 2021

Abstract: General anesthesia has been administered for over 150 years, and in that time, become progressively safer. Improvements outcomes have driven by multiple advances, including the use of non-invasive monitors to assess cardiovascular respiratory status. More recent advances included development measure neurologic status means "processed" electroencephalography (pEEG), wherein frontal EEG signal is analyzed proprietary algorithms produce a dimensionless number (scaled from 0 100), low values are associated with deepening levels sedation progresses loss consciousness. Such shown enable anesthetic titration so as expedite emergence early recovery, their advocated prevention intraoperative awareness setting administration total intravenous neuromuscular blockade. Whether can minimize, or prevent, longer term adverse events matter debate. In this narrative review most literature, we provide an assessment on pEEG notable, important, postoperative outcome – delirium elderly patients. As will discuss, existing data do not support its routine this, any other, patient population. Keywords: delirium, outcome, postoperative, EEG,

Language: Английский

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Postoperative Delirium Severity and Recovery Correlate With Electroencephalogram Spectral Features

Anesthesia & Analgesia, Journal Year: 2022, Volume and Issue: unknown

Published: May 13, 2022

BACKGROUND: Delirium is an acute syndrome characterized by inattention, disorganized thinking, and altered level of consciousness. A reliable biomarker for tracking delirium does not exist, but oscillations in the electroencephalogram (EEG) could address this need. We evaluated whether frequencies EEG are associated with onset, severity, recovery postoperative period. METHODS: Twenty-six adults enrolled Electroencephalography Guidance Anesthesia to Alleviate Geriatric Syndromes (ENGAGES; ClinicalTrials.gov NCT02241655) study underwent major surgery requiring general anesthesia, provided longitudinal recordings prespecified substudy. The presence severity were confusion assessment method (CAM) or CAM-intensive care unit. data obtained during awake eyes-open eyes-closed states yielded relative power delta (1–4 Hz), theta (4–8 alpha (8–13 Hz) bands. Discriminability was c-statistics. To account correlation among repeated measures within patients, mixed-effects models generated assess relationships between: (1) (ordinal), (2) time (linear). Slopes ordinal linear reported as change score/change power, power/time (days), respectively. Bonferroni correction applied confidence intervals (CIs) multiple comparisons. RESULTS: Occipital offered moderate discriminability (c-statistic, 0.75; 98% CI, 0.58–0.87), varying inversely (slope, –0.67; –1.36 –0.01; P = .01) inattention –1.44; –2.30 –0.58; .002). correlated directly 1.28; 0.12–2.44; .007), 2.00; 0.48–3.54; .01), thinking 3.15; 0.66–5.65; .01). Corresponding frontal recapitulated these degrees. Severity consciousness 11.52; 6.33–16.71; < .001). Frontal –0.05; –0.12 –0.04; CONCLUSIONS: Presence, core features covary spectral EEG. cost accessibility facilitate translation findings future mechanistic interventional trials.

Language: Английский

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Age-Related Perioperative Neurocognitive Disorders: Experimental Models and Druggable Targets

The Annual Review of Pharmacology and Toxicology, Journal Year: 2022, Volume and Issue: 63(1), P. 321 - 340

Published: Sept. 13, 2022

With the worldwide increase in life span, surgical patients are becoming older and have a greater propensity for postoperative cognitive impairment, either new onset or through deterioration of an existing condition; both conditions, knowledge patient's preoperative function trajectory is imperative. We describe clinical utility tablet-based technique rapid assessment memory attentiveness domains required executive function. The pathogenic mechanisms perioperative neurocognitive disorders been investigated animal models which excessive and/or prolonged neuroinflammation has emerged as likely contender. cellular molecular species involved putative targets future therapeutic interventions that efficacious do not interfere with healing process.

Language: Английский

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Preoperative electroencephalographic alpha-power changes with eyes opening are associated with postoperative attention impairment and inattention-related delirium severity

British Journal of Anaesthesia, Journal Year: 2023, Volume and Issue: 132(1), P. 154 - 163

Published: Dec. 12, 2023

BackgroundIn the eyes-closed, awake condition, EEG oscillatory power in alpha band (7–13 Hz) dominates human spectral activity. With eyes open, however, substantially decreases. Less attenuation with opening has been associated inattention; thus, we analysed whether reduced preoperative is postoperative inattention, a delirium-defining feature.MethodsPreoperative 32-channel was recorded open and closed 71 non-neurological, noncardiac surgery patients aged ≥ 60 years. Inattention other delirium features were assessed before twice daily after until discharge. Eyes-opening alpha-attenuation magnitude for associations primarily, severity, secondarily, using multivariate age- Mini-Mental Status Examination (MMSE)-adjusted logistic proportional-odds regression analyses.ResultsPreoperative inversely inattention (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.57, 0.94; P=0.038). Sensitivity analyses showed an inverse relationship between chronicity, defined as 'never', 'newly', or 'chronically' inattentive (OR 0.76, CI: 0.62, 0.93; P=0.019). In addition, severity 0.79, 0.65, 0.95; P=0.040), predominantly result of feature.ConclusionsPreoperative awake, resting, might represent neural biomarker risk attentional impairment. Further, eyes-opening could provide insight into mechanisms underlying risk.

Language: Английский

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Permutation Entropy Does Not Track the Electroencephalogram-Related Manifestations of Paradoxical Excitation During Propofol-Induced Loss of Responsiveness: Results From a Prospective Observational Cohort Study

Anesthesia & Analgesia, Journal Year: 2024, Volume and Issue: unknown

Published: Feb. 27, 2024

During the anesthetic-induced loss of responsiveness (LOR), a "paradoxical excitation" with activation β-frequencies in electroencephalogram (EEG) can be observed. Thus, spectral parameters-as widely used commercial anesthesia monitoring devices-may mistakenly indicate that patients are awake when they actually losing responsiveness. Nonlinear time-domain parameters such as permutation entropy (PeEn) may analyze additional EEG information and appropriately reflect change cognitive state during transition. Determining which correctly track level is essential for designing algorithms but also give valuable insight regarding signal characteristics transitions.

Language: Английский

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