1
|
Schwerin S, Schneider G, Kreuzer M, Kratzer S. Impact of Age on the Occurrence of Processed Electroencephalographic Burst Suppression. Anesth Analg 2024:00000539-990000000-00915. [PMID: 39178156 DOI: 10.1213/ane.0000000000007143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
BACKGROUND Patient age is assumed to be an important risk factor for the occurrence of burst suppression, yet this has still to be confirmed by large datasets. METHODS In this single-center retrospective analysis at a university hospital, the electronic patient records of 38,628 patients (≥18 years) receiving general anesthesia between January 2016 and December 2018 were analyzed. Risk factors for burst suppression were evaluated using univariate and multivariable analysis. We measured the incidence of burst suppression as indicated by the burst suppression ratio (BSR) of the Entropy Module, the maximum and mean BSR values, relative burst suppression duration, mean volatile anesthetic concentrations, and mean age-adjusted minimum alveolar concentrations (aaMAC) at burst suppression, and cases of potentially misclassified burst suppression episodes. Analyses were done separately for the total anesthesia period, as well as for the Induction and Maintenance phase. The association with age was evaluated using linear and polynomial fits and by calculating correlation coefficients. RESULTS Of the 54,266 patients analyzed, 38,628 were included, and 19,079 patients exhibited episodes with BSR >0. Patients with BSR >0 were significantly older, and age had the highest predictive power for BSR >0 (area under the receiving operating characteristic [AUROC] = 0.646 [0.638-0.654]) compared to other patient or procedural factors. The probability of BSR >0 increased linearly with patient age (ρ = 0.96-0.99) between 1.9% and 9.8% per year. While maximal and mean BSR showed a nonlinear relationship with age, relative burst suppression duration also increased linearly during maintenance (ρ = 0.83). Further, episodes potentially indicating burst suppression that were not detected by the Entropy BSR algorithm also became more frequent with age. Volatile anesthetic concentrations sufficient to induce BSR >0 were negatively correlated with age (sevoflurane: ρ = -0.71), but remained close to an aaMAC of 1.0. CONCLUSIONS The probability of burst suppression during general anesthesia increases linearly with age in adult patients, while lower anesthetic concentrations induce burst suppression with increasing patient age. Simultaneously, algorithm-based burst suppression detection appears to perform worse in older patients. These findings highlight the necessity to further enhance EEG application and surveillance strategies in anesthesia.
Collapse
Affiliation(s)
- Stefan Schwerin
- From the Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich School of Medicine and Health, Munich, Germany
| | - Gerhard Schneider
- From the Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich School of Medicine and Health, Munich, Germany
| | - Matthias Kreuzer
- From the Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich School of Medicine and Health, Munich, Germany
| | - Stephan Kratzer
- Department of Anesthesia and Intensive Care Medicine, Hessing Foundation, Augsburg, Germany
| |
Collapse
|
2
|
Berger M, Ryu D, Reese M, McGuigan S, Evered LA, Price CC, Scott DA, Westover MB, Eckenhoff R, Bonanni L, Sweeney A, Babiloni C. A Real-Time Neurophysiologic Stress Test for the Aging Brain: Novel Perioperative and ICU Applications of EEG in Older Surgical Patients. Neurotherapeutics 2023; 20:975-1000. [PMID: 37436580 PMCID: PMC10457272 DOI: 10.1007/s13311-023-01401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/13/2023] Open
Abstract
As of 2022, individuals age 65 and older represent approximately 10% of the global population [1], and older adults make up more than one third of anesthesia and surgical cases in developed countries [2, 3]. With approximately > 234 million major surgical procedures performed annually worldwide [4], this suggests that > 70 million surgeries are performed on older adults across the globe each year. The most common postoperative complications seen in these older surgical patients are perioperative neurocognitive disorders including postoperative delirium, which are associated with an increased risk for mortality [5], greater economic burden [6, 7], and greater risk for developing long-term cognitive decline [8] such as Alzheimer's disease and/or related dementias (ADRD). Thus, anesthesia, surgery, and postoperative hospitalization have been viewed as a biological "stress test" for the aging brain, in which postoperative delirium indicates a failed stress test and consequent risk for later cognitive decline (see Fig. 3). Further, it has been hypothesized that interventions that prevent postoperative delirium might reduce the risk of long-term cognitive decline. Recent advances suggest that rather than waiting for the development of postoperative delirium to indicate whether a patient "passed" or "failed" this stress test, the status of the brain can be monitored in real-time via electroencephalography (EEG) in the perioperative period. Beyond the traditional intraoperative use of EEG monitoring for anesthetic titration, perioperative EEG may be a viable tool for identifying waveforms indicative of reduced brain integrity and potential risk for postoperative delirium and long-term cognitive decline. In principle, research incorporating routine perioperative EEG monitoring may provide insight into neuronal patterns of dysfunction associated with risk of postoperative delirium, long-term cognitive decline, or even specific types of aging-related neurodegenerative disease pathology. This research would accelerate our understanding of which waveforms or neuronal patterns necessitate diagnostic workup and intervention in the perioperative period, which could potentially reduce postoperative delirium and/or dementia risk. Thus, here we present recommendations for the use of perioperative EEG as a "predictor" of delirium and perioperative cognitive decline in older surgical patients.
Collapse
Affiliation(s)
- Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone Room 4315B, Box 3094, Durham, NC, 27710, USA.
- Duke Aging Center, Duke University Medical Center, Durham, NC, USA.
- Duke/UNC Alzheimer's Disease Research Center, Duke University Medical Center, Durham, NC, USA.
| | - David Ryu
- School of Medicine, Duke University, Durham, NC, USA
| | - Melody Reese
- Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone Room 4315B, Box 3094, Durham, NC, 27710, USA
- Duke Aging Center, Duke University Medical Center, Durham, NC, USA
| | - Steven McGuigan
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, Australia
| | - Lisbeth A Evered
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, Australia
- Weill Cornell Medicine, New York, NY, USA
| | - Catherine C Price
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - David A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, Australia
| | - M Brandon Westover
- Department of Neurology, Beth Israel Deaconess Hospital, Boston, MA, USA
| | - Roderic Eckenhoff
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Aoife Sweeney
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
- San Raffaele of Cassino, Cassino, FR, Italy
| |
Collapse
|
3
|
Liu X, Nakano M, Yamaguchi A, Bush B, Akiyoshi K, Lee JK, Koehler RC, Hogue CW, Brown CH. The association of bispectral index values and metrics of cerebral perfusion during cardiopulmonary bypass. J Clin Anesth 2021; 74:110395. [PMID: 34147015 DOI: 10.1016/j.jclinane.2021.110395] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE Low bispectral index (BIS) values have been associated with adverse postoperative outcomes. However, trials of optimizing BIS by titrating anesthetic administration have reported conflicting results. One potential explanation is that cerebral perfusion may also affect BIS, but the extent of this relationship is not clear. Therefore, we examined whether BIS would be associated with cerebral perfusion during cardiopulmonary bypass, when anesthetic concentration was constant. DESIGN Observational cohort study. SETTING Cardiac operating room. PATIENTS Seventy-nine patients with cardiopulmonary bypass surgery were included. MEASUREMENTS Continuous BIS, mean arterial blood pressure (MAP), cerebral blood flow velocity (CBFV), and regional cerebral oxygen saturation (rSO2) were monitored, with analysis during a period of constant anesthetic. Mean flow index (Mx) was calculated as Pearson correlation between MAP and CBFV. The lower limit of autoregulation (LLA) was identified as the MAP value at which Mx increased >0.4 with decreasing blood pressure. Postoperative delirium was assessed using the 3D-Confusion Assessment Method. RESULTS Mean BIS was lower during periods of MAP < LLA compared with BIS when MAP>LLA (mean 49.35 ± 10.40 vs. 50.72 ± 10.04, p = 0.002, mean difference = 1.38 [standard error: 0.42]). There was a dose response effect, with the BIS proportionately decreasing as MAP decreased below LLA (β = 0.15, 95% CI for the average slope across all patients 0.07 to 0.23, p < 0.001). In contrast, BIS was relatively unchanged when MAP was above LLA (β = 0.03, 95% CI for the average slope across all patients -0.02 to 0.09, p = 0.22). Additionally, increasing CBFV and rSO2 were associated with increasing BIS. Patients with postoperative delirium had lower mean BIS and higher percentage of time duration with BIS <45 compared to patients without delirium. CONCLUSIONS There was an association of BIS and metrics of cerebral perfusion during a period of constant anesthetic administration, but the absolute magnitude of change in BIS as MAP decreased below the LLA was small.
Collapse
Affiliation(s)
- Xiuyun Liu
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Mitsunori Nakano
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Atsushi Yamaguchi
- Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
| | - Brian Bush
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kei Akiyoshi
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer K Lee
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Raymond C Koehler
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Charles W Hogue
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Charles H Brown
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan.
| |
Collapse
|
4
|
Pandin P, Estruc I, Van Hecke D, Truong HN, Marullo L, Hublet S, Van Obbergh L. Brain Aging and Anesthesia. J Cardiothorac Vasc Anesth 2020; 33 Suppl 1:S58-S66. [PMID: 31279354 DOI: 10.1053/j.jvca.2019.03.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Herein, the authors review the neuroanatomical and the neurophysiological aspects of the normal aging evolution based on the recent literature and briefly describe the difference between physiological and pathological brain aging, with consideration of the currently recommended anesthesia management of older patients. The population of elderly patients is growing drastically with advances in medicine that have prolonged the life span. One of the direct consequence has been a significant increase in the request for anesthesia care for older patients despite the type of surgery (cardiac vs noncardiac and mainly orthopedic). Because the brain of this category of patients undergoes a specific triple influence (immune, metabolic, and inflammatory), some particular physiological, anatomical, and structural modifications must be taken into account because they expose these patients more specifically to postoperative cognitive disturbances. To prevent type of adverse outcome, a better knowledge and understanding of these neurosciences must be promoted. The strategies developed to prevent such adverse outcomes include the determination and detection of significant at-risk patients and improvement in the titration of anesthesia to reduce exposure of anesthesia to these patients through an adapted anesthesia-induced unconsciousness that avoids, as much as possible, the risk of toxic overdose with an overly deep brain depression. To accomplish this, the unprocessed electroencephalogram (EEG) and its spectrogram may represent a significant improvement in monitoring, first by allowing for the rapid recognition of repetitive or persistent EEG suppression by the on-line reading of the raw EEG trace and second by allowing for the accurate determination of the adequate anesthetic-induced state, obtained in general in this category of patients by substantially lowered doses of anesthetic agents. This represents a new methodology for anesthesia titration that is adjusted on a more case-by-case basis and is related to the physiology of individual patients. A better understanding of aging-induced brain transformations remains the key regarding the improvement of the anesthetic management of the always growing population of elderly patients. The promotion of the unprocessed EEG may represent the best method of preventing the risk of anesthetic toxicity, including postoperative cognitive dysfunctions.
Collapse
Affiliation(s)
- Pierre Pandin
- Department of Anesthesia and Critical Care, Erasmus Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Isabel Estruc
- Department of Anesthesia and Critical Care, Erasmus Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Delphine Van Hecke
- Department of Anesthesia and Critical Care, Erasmus Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ha-Nam Truong
- Department of Anesthesia and Critical Care, Erasmus Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Lucia Marullo
- Department of Anesthesia and Critical Care, Erasmus Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Stephane Hublet
- Department of Anesthesia and Critical Care, Erasmus Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luc Van Obbergh
- Department of Anesthesia and Critical Care, Erasmus Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
5
|
Of Parachutes, Speedometers, and EEG: What Evidence Do We Need to Use Devices and Monitors? Anesth Analg 2020; 130:1274-1277. [PMID: 32287134 DOI: 10.1213/ane.0000000000004653] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
6
|
Sieber F, Neufeld K, Oh ES, Gottschalk A, Wang NY. Effect of baseline cognitive impairment on association between predicted propofol effect site concentration and Bispectral index or sedation score. BMC Anesthesiol 2020; 20:129. [PMID: 32466776 PMCID: PMC7254641 DOI: 10.1186/s12871-020-01043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background This study determined whether the relationship between predicted propofol effect site concentration (Ce) and observer’s assessment of alertness/sedation scale (OAA/S) or Bispectral Index (BIS) was similar comparing cognitively intact vs impaired patients undergoing hip fracture repair with spinal anesthesia and sedation. Methods Following informed consent baseline mini-mental status exam (MMSE), Clinical Dementia Rating (CDR) and geriatric depression scale (GDS) were obtained. Intraoperatively OAA/S, BIS, and propofol (timing and exact amounts) administered were recorded. Cerebrospinal fluid was collected for Alzheimer’s (AD) biomarkers. Mean Ce level (AvgCe) during surgery was calculated using the area under the Ce measurement series from incision to closure, divided by surgical time. Average OAA/S (AvgOAA/S), and BIS (AvgBIS) were similarly calculated. Pearson correlations of AvgCe with AvgOAA/S and AvgBIS were calculated overall and by CDR. Nonparametric locally weighted scatterplot smoothing (LOWESS) fits of AvgOAA/S and AvgBIS on AvgCe were produced, stratified by CDR. Multivariable regression incorporating baseline cognitive measurements or AD biomarkers assessed AvgOAA/S or AvgBIS associations with AvgCe. Results In 186 participants AvgBIS and AvgOAA/S correlated with AvgCe (Pearson ρ = − 0.72; p < 0.0001 and Pearson ρ = − 0.81; p < 0.0001, respectively), and remained unchanged across CDR levels. Association patterns of AvgOAA/S or AvgBIS on AvgCe guided by LOWESS fits and modeled through regression, were similar when stratified by CDR (p = 0.16). Multivariable modeling found no independent effect on AvgBIS or AvgOAA/S by MMSE, CDR, GDS, or AD biomarkers after accounting for AvgCe. Conclusions When administering sedation in conjunction with spinal anesthesia, cognitive impairment does not affect the relationship between predicted propofol AvgCe and AvgOAA/S or AvgBIS.
Collapse
Affiliation(s)
- Frederick Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Karin Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, A4Center Suite 457, 4940 Eastern Ave, Baltimore, USA
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Psychiatry and Behavioral Sciences & Neuropathology, Johns Hopkins University School of Medicine, Mason F. Lord Building, Center Tower, 5200 Eastern Avenue, 7th Floor, Baltimore, MD, 21224, USA
| | - Allan Gottschalk
- Departments of Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Nae-Yuh Wang
- Medicine, Biostatistics and Epidemiology, The Johns Hopkins University, 2024 E. Monument Street, Suite 2-500, Baltimore, MD, 21287, USA
| |
Collapse
|
7
|
Kruthiventi SC, Laporta ML, Deljou A, Knopman DS, Petersen RC, Schroeder DR, Sprung J, Weingarten TN. Preoperative cognitive impairment associated with oversedation during recovery from anesthesia. J Anesth 2020; 34:390-396. [PMID: 32222908 DOI: 10.1007/s00540-020-02764-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Our objective was to examine the association between preoperative cognitive status and postoperative recovery from anesthesia. METHODS We included patients (70-91 years old) from the Mayo Clinic Study of Aging who received general anesthesia and were admitted to the postanesthesia care unit from January 1, 2010 through April 30, 2018. Procedures were categorized according to patient's preoperative cognitive status: cognitive impaired (CI) and cognitive unimpaired (CU). Perioperative records were reviewed and analyses were performed with generalized estimating equations. RESULTS A total of 896 procedures from 611 patients were included, with 203 (22.7%) procedures in the CI group. Compared to CU procedures, CI procedures had higher rates of moderate-deep sedation during anesthesia recovery (52 [25.6%] vs. 103 [14.9%]; odds ratio [OR], 1.91; 95% CI, 1.30-2.80; P < 0.01), postoperative pulmonary complications (22 [10.8%] vs. 34 [4.9%]; OR, 2.36[1.22-4.54]; P = 0.01), and postoperative delirium (32 [16.2%] vs. 24 [3.5%]; OR, 5.33 [2.88-9.86]; P < 0.01). When moderate-deep sedation during anesthesia recovery was a covariate, both CI (OR, 3.02[1.60-5.70]; P < 0.01) and moderate-deep sedation (OR, 3.94[2.19-7.11]; P < 0.01) were associated with delirium. In multivariable analysis, postoperative pulmonary complications were associated with moderate-deep sedation (OR, 2.14[1.18-3.87]; P = 0 .01) but not with CI (OR, 1.49 [0.76-2.92]; P = 0 .25). CONCLUSIONS Cognitive impairment was associated with higher rates of moderate-deep residual sedation during anesthesia recovery and delirium, while moderate-deep sedation was associated with higher rates of pulmonary complications and delirium. We speculate that tailoring the anesthetic to facilitate faster emergence for CI patients could improve complication rates.
Collapse
Affiliation(s)
- S Chandralekha Kruthiventi
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Atousa Deljou
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - David S Knopman
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ronald C Petersen
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Darrell R Schroeder
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine (Drs. Kruthiventi, Laporta, Deljou, Sprung, and Weingarten), Department of Neurology (Drs. Knopman and Petersen), and Division of Biomedical Statistics and Informatics (Mr. Schroeder), Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| |
Collapse
|
8
|
Dahaba AA. Benefits and boundaries of processed electroencephalography (pEEG) monitors when they do not concur with standard anesthetic clinical monitoring: lights and shadows. Minerva Anestesiol 2020; 86. [DOI: 10.23736/s0375-9393.19.13959-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
9
|
Berger M, Cooter M, Ni K, Thomas J, Gupta DK, Kertai MD. Response to ‘Correlation between bispectral index and age-adjusted minimal alveolar concentration’ (Br J Anaesth 2020; 124:e8). Br J Anaesth 2020; 124:e38-e39. [DOI: 10.1016/j.bja.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022] Open
|
10
|
Bocskai T, Kovács M, Szakács Z, Gede N, Hegyi P, Varga G, Pap I, Tóth I, Révész P, Szanyi I, Németh A, Gerlinger I, Karádi K, Lujber L. Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis. PLoS One 2020; 15:e0229018. [PMID: 32053678 PMCID: PMC7018011 DOI: 10.1371/journal.pone.0229018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Several studies have suggested that monitoring the depth of anaesthesia might prevent the development of postoperative cognitive decline. We aimed to conduct a meta-analysis to investigate the effects of bispectral index (BIS) monitoring in anaesthesia. METHODS We searched in six major electronic databases. Trials were included if they discussed anaesthesia with and without BIS monitoring or low (<50) and high (≥50) BIS levels and which measured the risk of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD). RESULTS We included fourteen studies in the systematic review, eight of which were eligible for meta-analysis. BIS proved to be protective against POD at 1 day postoperatively in a cohort of 2138 patients (16.1% vs. 22.8% for BIS vs. no BIS groups, respectively; relative risk [RR] 0.71; 95% confidence interval [CI] 0.59 to 0.85, without significant between-study heterogeneity I2 = 0.0%, P = 0.590). The use of BIS was neutral for POCD at 1 week but protective for POCD at 12 weeks (15.8% vs. 18.8% for BIS vs. no BIS groups, respectively; RR = 0.84, CI: 0.66 to 1.08), without significant between-study heterogeneity (I2 = 25.8%, P = 0.260). The neutral association at 1 week proved to be underpowered with trial sequential analysis. In the comparison of low BIS versus high BIS, the incidence of POD at 1 day was similar in the groups. CONCLUSION Our findings suggest a protective effect of BIS compared to not using BIS regarding the incidence of POD at 1 day and POCD at 12 weeks. However, limitations of the evidence warrant further investigation to identify those groups of patients by age, comorbid conditions and other individual variables who would benefit the most from the use of BIS monitoring.
Collapse
Affiliation(s)
- Timea Bocskai
- Department of Anaesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| | - Márton Kovács
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- Hungarian Academy of Sciences–University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
| | - Gábor Varga
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - István Pap
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - István Tóth
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Péter Révész
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - István Szanyi
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Adrienne Németh
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Imre Gerlinger
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| | - Kázmér Karádi
- Institute of Behavioral Sciences, Medical School, University of Pécs, Pécs, Hungary
| | - László Lujber
- Department of Otorhinolaryngology (ENT), Medical School, University of Pécs, Pécs, Hungary
| |
Collapse
|
11
|
Klinger RY, Bottiger B, Berger M. A Plague on Both Your Monitors! Are Bispectral Index and Cerebral Oximetry Useful for Reducing Postoperative Cognitive Impairment? J Cardiothorac Vasc Anesth 2020; 34:1182-1183. [PMID: 32029372 DOI: 10.1053/j.jvca.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/01/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca Y Klinger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Brandi Bottiger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| |
Collapse
|
12
|
Belrose JC, Noppens RR. Anesthesiology and cognitive impairment: a narrative review of current clinical literature. BMC Anesthesiol 2019; 19:241. [PMID: 31881996 PMCID: PMC6933922 DOI: 10.1186/s12871-019-0903-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022] Open
Abstract
Background The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction. Main body This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer’s disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment. Conclusions Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.
Collapse
Affiliation(s)
- Jillian C Belrose
- Department of Anesthesia & Perioperative Medicine, Western University, London Health Sciences Center, 339 Windermere Rd, London, ON, N6A 5A5, Canada
| | - Ruediger R Noppens
- Department of Anesthesia & Perioperative Medicine, Western University, London Health Sciences Center, 339 Windermere Rd, London, ON, N6A 5A5, Canada.
| |
Collapse
|
13
|
Berger M, Schenning KJ, Brown CH, Deiner SG, Whittington RA, Eckenhoff RG. Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg 2018; 127:1406-1413. [PMID: 30303868 PMCID: PMC6309612 DOI: 10.1213/ane.0000000000003841] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks. Thus, the workshop was provider and patient oriented as well as solution focused rather than etiology focused. For those areas in which we determined that there were limited evidence-based recommendations, we identified knowledge gaps and the types of scientific knowledge and investigations needed to direct future best practice. Because concerns about perioperative neurocognitive injury in pediatric patients are already being addressed by the SmartTots initiative, our workshop discussion (and thus this article) focuses specifically on perioperative cognition in older adults. The 2 main perioperative cognitive disorders that have been studied to date are postoperative delirium and cognitive dysfunction. Postoperative delirium is a syndrome of fluctuating changes in attention and level of consciousness that occurs in 20%-40% of patients >60 years of age after major surgery and inpatient hospitalization. Many older surgical patients also develop postoperative cognitive deficits that typically last for weeks to months, thus referred to as postoperative cognitive dysfunction. Because of the heterogeneity of different tools and thresholds used to assess and define these disorders at varying points in time after anesthesia and surgery, a recent article has proposed a new recommended nomenclature for these perioperative neurocognitive disorders. Our discussion about this topic was organized around 4 key issues: preprocedure consent, preoperative cognitive assessment, intraoperative management, and postoperative follow-up. These 4 issues also form the structure of this document. Multiple viewpoints were presented by participants and discussed at this in-person meeting, and the overall group consensus from these discussions was then drafted by a smaller writing group (the 6 primary authors of this article) into this manuscript. Of course, further studies have appeared since the workshop, which the writing group has incorporated where appropriate. All participants from this in-person meeting then had the opportunity to review, edit, and approve this final manuscript; 1 participant did not approve the final manuscript and asked for his/her name to be removed.
Collapse
Affiliation(s)
- Miles Berger
- Anesthesiology Department, Duke University Medical Center, Durham, North Carolina
| | - Katie J. Schenning
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Charles H. Brown
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacie G. Deiner
- Anesthesiology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert A. Whittington
- Department of Anesthesiology, Columbia University Medical Center, New York, New York
| | - Roderic G. Eckenhoff
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | |
Collapse
|
14
|
Higuchi H, Maeda S, Ishii-Maruhama M, Honda-Wakasugi Y, Yabuki-Kawase A, Miyawaki T. Intellectual disability is a risk factor for delayed emergence from total intravenous anaesthesia. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:217-224. [PMID: 29193472 DOI: 10.1111/jir.12448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/28/2017] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Previous studies have suggested that ID influences the depth of general anaesthesia (GA) and delays emergence from GA. In this retrospective cohort study, we investigated whether ID affects the time taken to emerge from GA. METHODS We selected dental patients who underwent GA at the Department of Dental Anaesthesiology, Okayama University Hospital, using predefined inclusion and exclusion criteria, before dividing the selected participants into ID and non-ID (control) groups. Relevant data were collected from electronic anaesthesia records. Emergence time, the time from the discontinuation of propofol and remifentanil to tracheal extubation, was recorded for each patient. We compared the data of the ID group and control group. The association between ID and the emergence time was tested for statistical significance. Multivariate linear regression analysis was used to control for confounders. RESULTS A total of 97 cases (control = 50, ID = 47) were included in the study. The emergence time was significantly longer in the ID group (ID group: 15.8 ± 6.6 min, control group: 10.8 ± 3.6 min). The ID group included more men and lower propofol and remifentanil infusion rates. The treatment time was longer, and the mean bispectral index was lower in the ID group. Sevoflurane inhalation was used only for anaesthesia induction in the ID group. In the multivariate linear regression analysis, ID was found to be significantly associated with a longer emergence time. CONCLUSION Our results suggest that ID is associated with a longer emergence time from GA.
Collapse
Affiliation(s)
- H Higuchi
- Department of Dental Anaesthesiology, Okayama University Hospital, Okayama, Japan
| | - S Maeda
- Department of Dental Anaesthesiology, Okayama University Hospital, Okayama, Japan
| | - M Ishii-Maruhama
- Department of Dental Anaesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Honda-Wakasugi
- Department of Dental Anaesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - A Yabuki-Kawase
- Center for Promotion of Dental Education and International Collaboration, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - T Miyawaki
- Department of Dental Anaesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
15
|
Safavynia SA, Goldstein PA. The Role of Neuroinflammation in Postoperative Cognitive Dysfunction: Moving From Hypothesis to Treatment. Front Psychiatry 2018; 9:752. [PMID: 30705643 PMCID: PMC6345198 DOI: 10.3389/fpsyt.2018.00752] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication of the surgical experience and is common in the elderly and patients with preexisting neurocognitive disorders. Animal and human studies suggest that neuroinflammation from either surgery or anesthesia is a major contributor to the development of POCD. Moreover, a large and growing body of literature has focused on identifying potential risk factors for the development of POCD, as well as identifying candidate treatments based on the neuroinflammatory hypothesis. However, variability in animal models and clinical cohorts makes it difficult to interpret the results of such studies, and represents a barrier for the development of treatment options for POCD. Here, we present a broad topical review of the literature supporting the role of neuroinflammation in POCD. We provide an overview of the cellular and molecular mechanisms underlying the pathogenesis of POCD from pre-clinical and human studies. We offer a brief discussion of the ongoing debate on the root cause of POCD. We conclude with a list of current and hypothesized treatments for POCD, with a focus on recent and current human randomized clinical trials.
Collapse
Affiliation(s)
- Seyed A Safavynia
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States
| | - Peter A Goldstein
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States.,Department of Medicine, Weill Cornell Medical College, New York, NY, United States.,Neuroscience Graduate Program, Weill Cornell Medical College, New York, NY, United States
| |
Collapse
|
16
|
|
17
|
Son YG, Byun SH, Kim JH. The anhepatic phase extended by temporary portocaval shunt does not affect anesthetic sensitivity and postoperative cognitive function: A case-control study. Medicine (Baltimore) 2016; 95:e5654. [PMID: 27930598 PMCID: PMC5266070 DOI: 10.1097/md.0000000000005654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Temporary portocaval shunt (TPCS) prolongs the duration of the anhepatic phase, during which anesthetic sensitivity is highest among the 3 phases of living donor liver transplantation (LDLT). Cognitive dysfunction has been associated with increased anesthetic sensitivity and poor hepatic function. Therefore, we assessed anesthetic sensitivity to desflurane and perioperative cognitive function in patients undergoing LDLT, in whom the duration of the anhepatic phase was extended by TPCS to test the hypothesis that the prolonged anhepatic phase increases anesthetic sensitivity and causes postoperative cognitive decline.This case-control study was conducted in 67 consecutive patients undergoing LDLT from February 2014 to January 2016. Anesthesia was maintained at a 0.6 end-tidal age-adjusted minimum alveolar concentration of desflurane. The bispectral index (BIS) was maintained at less than 60 and averaged at 1-minute intervals. The mini-mental state examination (MMSE-KC) was performed 1 day before and 7 days after the LDLT. All parameters were compared between the patients undergoing TPCS (TPCS group) and the remaining patients (non-TPCS group).TPCS was performed in 16 patients (24%). TPCS prolonged the duration of the anhepatic phase (125.9 ± 29.4 vs 54.9 ± 20.5 minutes [mean ± standard deviation], P < 0.0001). The averaged BIS values during the 3 phases were comparable between the 2 groups. No significant interval changes in the averaged BIS values were observed during the 3 consecutive phases. Similarly, there were no significant differences in MMSE-KC score assessed 1 day before and 7 days after LDLT between the 2 groups. The preoperative MMSE-KC scores were unchanged postoperatively in the 2 groups.The extension of the anhepatic phase did not affect anesthetic sensitivity and postoperative cognitive function.
Collapse
Affiliation(s)
- Young Gon Son
- Docheon-myeon Branch Office of Changnyeong-gun Community Health Center, Changnyeong-gun, Gyeongsangnam-do
| | - Sung Hye Byun
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Jong Hae Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| |
Collapse
|
18
|
Qin JH, Zhang XR, He L, Zhu J, Ma QJ. Effect of sevoflurane and halothane anesthesia on cognitive function and immune function in young rats. Saudi J Biol Sci 2016; 25:47-51. [PMID: 29379356 PMCID: PMC5775091 DOI: 10.1016/j.sjbs.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/13/2016] [Accepted: 08/14/2016] [Indexed: 11/27/2022] Open
Abstract
In the current study, we scrutinized the effect of sevoflurane and halothane on cognitive and immune function in young rats. The rats were divided into following groups: sevoflurane, halothane and sevoflurane + halothane groups, respectively. The rats were regularly treated with the pre-determined treatment. We also scrutinized the serum proinflammatory cytokines including IL-10, IL-4 and IL-2; brain level IL-1β; hippocampal neuronal apoptosis concentration were estimated. The water maze test was performed in rats for the estimation of cognitive ability. During the water maze test, on the 1st day the sevoflurane group showed the latency; sevoflurane and sevoflurane + halothane group demonstrated the declined latency gradually as compared to the control group rats after the 3 days. The latency of the control, halothane, sevoflurane + halothane group rats showed the reduced latency and also showed the reduced crossing circle times. The hippocampal neuron apoptosis was significantly increased in halothane and sevoflurane + halothane group as compared to control group rats, respectively. Control group rats demonstrated the increased neuron apoptosis. The proinflammatory cytokines including IL-10 and IL-4 was significantly higher in sevoflurane, halothane and sevoflurane + halothane group rats after anesthesia and the whole brain IL-1β was significantly decrease in the sevoflurane, halothane and sevoflurane + halothane as compared to control group. Sevoflurane can inhibit the anesthesia effect of halothane on the immune and cognitive function of rats.
Collapse
Affiliation(s)
- Jian-Hua Qin
- Department of Aneshesiology, People's of Hospital of Xinjiang Uygur Autonomous Region, Urumchi 830001, China
| | - Xue-Rong Zhang
- Department of Aneshesiology, People's of Hospital of Xinjiang Uygur Autonomous Region, Urumchi 830001, China
| | - Liang He
- Department of Aneshesiology, People's of Hospital of Xinjiang Uygur Autonomous Region, Urumchi 830001, China
| | - Jun Zhu
- Department of Medical, People's of Hospital of Xinjiang Uygur Autonomous Region, Urumchi 830001, China
| | - Qing-Jun Ma
- Department of Aneshesiology, People's of Hospital of Xinjiang Uygur Autonomous Region, Urumchi 830001, China
| |
Collapse
|
19
|
Depth of anesthesia causality dilemmas: the next generation. Can J Anaesth 2015; 63:142-7. [DOI: 10.1007/s12630-015-0489-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022] Open
|
20
|
Gerstman MD, Merry AF, McIlroy DR, Hannam JA, Mitchell SJ, Myles PS. Acute alcohol intoxication and bispectral index monitoring. Acta Anaesthesiol Scand 2015; 59:1015-21. [PMID: 26040646 DOI: 10.1111/aas.12546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/12/2015] [Accepted: 04/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bispectral index (BIS) monitoring is commonly used to decrease the risk of awareness during anaesthesia. We aimed to determine the relationship between blood alcohol concentration and brain function (as measured by BIS) in healthy adults. METHODS In this prospective observational study, 21 anaesthetic registrars self-regulated alcohol consumption over a 3-h period. Expired alcohol concentration (breathalyser) and BIS measurements were performed hourly for 4 h. A venous blood alcohol sample was taken at the conclusion of the study period. RESULTS The main outcome measures were the correlation between blood alcohol and brain function as measured by BIS and the change in BIS from baseline (∆BIS) at 4 h. The median number of standard drinks consumed was 9.1 (IQR 7.7-12.3), range 5.4-17. At 4 h, there was a moderate inverse correlation between BIS and blood alcohol (r = -0.49, P = 0.029) and between ∆BIS and blood alcohol (r = -0.46, P =0.043). CONCLUSION In healthy young adults, we found a moderate correlation between venous blood alcohol concentration and BIS. This suggests that acute alcohol consumption can decrease BIS. This information may be relevant when providing anaesthesia to intoxicated patients who require urgent or time-critical surgery, although certain limitations of this study should be kept in mind.
Collapse
Affiliation(s)
- M. D. Gerstman
- Department of Anaesthesia and Perioperative Medicine; Alfred Hospital; Melbourne Vic Australia
| | - A. F. Merry
- Department of Anaesthesiology; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - D. R. McIlroy
- Department of Anaesthesia and Perioperative Medicine; Alfred Hospital; Melbourne Vic Australia
- Monash University; Melbourne Australia
| | - J. A. Hannam
- Department of Anaesthesiology; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - S. J. Mitchell
- Department of Anaesthesiology; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - P. S. Myles
- Department of Anaesthesia and Perioperative Medicine; Alfred Hospital; Melbourne Vic Australia
- Monash University; Melbourne Australia
| |
Collapse
|
21
|
Issues in geriatric orthopedic anesthesia. Int Anesthesiol Clin 2015; 52:126-39. [PMID: 25268869 DOI: 10.1097/aia.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
|
23
|
Sugimura M, Kudo C, Hanamoto H, Oyamaguchi A, Morimoto Y, Boku A, Niwa H. Considerations during intravenous sedation in geriatric dental patients with dementia. Clin Oral Investig 2014; 19:1107-14. [PMID: 25346372 DOI: 10.1007/s00784-014-1334-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We retrospectively assessed the usability and precautions required during intravenous sedation (IVS) for dental treatment in geriatric outpatients with dementia. MATERIALS AND METHODS We investigated the intraoperative complications in 65 cases (25 geriatric dental patients with dementia) under IVS, from the standpoint of local anesthesia usage, water usage during treatment, and content of treatment. RESULTS Circulatory complications occurred in 46.2 % and respiratory complications in 52.3 % of all cases (n = 65). Bradycardia occurred in 13.8 % and hypotension in 12.3 % of cases in the former, while coughing spells occurred in 41.5 % and snoring in 16.9 % of cases in the latter. Many of the local anesthesia usage cases did not require water usage, such as during tooth extraction (p < 0.0001). Water usage cases, such as for caries treatment, needed longer sedation and treatment times, resulting in more propofol usage (p < 0.001, p < 0.0001, and p < 0.01, respectively). Many coughing spells developed in the water usage cases (p < 0.05). 81.8 % of snoring and 63.3 % of circulatory complications, such as hypotension and bradycardia, developed in the tooth extraction cases (p < 0.05). CONCLUSIONS All the scheduled dental treatments in dementia patients were smoothly performed under IVS. However, stringent attention should be paid to the prevention of aspiration of fluids retained in the pharynx, airway obstruction due to therapeutic maneuvers, respiratory inhibition by sedatives, and hemodynamic fluctuations caused by invasive procedures under local anesthesia. CLINICAL RELEVANCE In the future, with the growing need for dental procedures in dementia patients, dentists will require training in the general management of such patients.
Collapse
Affiliation(s)
- Mitsutaka Sugimura
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan,
| | | | | | | | | | | | | |
Collapse
|
24
|
Berger M, Burke J, Eckenhoff R, Mathew J. Alzheimer's disease, anesthesia, and surgery: a clinically focused review. J Cardiothorac Vasc Anesth 2014; 28:1609-23. [PMID: 25267693 DOI: 10.1053/j.jvca.2014.04.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Indexed: 02/08/2023]
Affiliation(s)
| | - James Burke
- Neurology, Duke University Medical Center, Durham, NC
| | - Roderick Eckenhoff
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
25
|
Berger M, Nadler J, Mathew JP. Preventing delirium after cardiothoracic surgery: provocative but preliminary evidence for bispectral index monitoring. Anesth Analg 2014; 118:706-7. [PMID: 24651223 DOI: 10.1213/ane.0000000000000130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Miles Berger
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | | | | |
Collapse
|
26
|
Cao YL, Zhang W, Ai YQ, Zhang WX, Li Y. Effect of propofol and ketamine anesthesia on cognitive function and immune function in young rats. ASIAN PAC J TROP MED 2014; 7:407-11. [DOI: 10.1016/s1995-7645(14)60066-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/15/2013] [Accepted: 02/15/2014] [Indexed: 10/25/2022] Open
|
27
|
Perez-Protto S, Geube M, Ontaneda D, Dalton JE, Kurz A, Sessler DI. Sensitivity to volatile anesthetics in patients with dementia: a case-control analysis. Can J Anaesth 2014; 61:611-8. [DOI: 10.1007/s12630-014-0165-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 04/01/2014] [Indexed: 10/25/2022] Open
|
28
|
Abstract
PURPOSE OF REVIEW To review the neurophysiology and neuroanatomy of normal aging and the recent recommendations for the clinical management of general anesthesia and sedation in the elderly. RECENT FINDINGS As the population ages, the number of elderly patients having surgery is likewise increasing and with it, the prevalence of postoperative cognitive disorders. Postoperative cognitive disorders including delirium and postoperative cognitive dysfunction are common postanesthesia complications in elderly patients. Several risk factors for postoperative disorders have been identified, and anesthesiologists commonly adapt their practice habits when taking care of elderly patients to try to mitigate the effects of the anesthetics on postoperative cognitive function. These practices are reasonable and prudent; yet, they are not well supported by an understanding of the aging brain and specifics of how the anesthetic effects on the brain change with age. Through functional imaging and electrophysiological studies, much is being learned about the neurophysiology and the neuroanatomy of normal aging. SUMMARY Our analysis suggests that understanding the neurophysiology and neuroanatomy should be part of the standard working knowledge of anesthesiologists and that this knowledge can guide their use of the electroencephalogram to track more accurately the brain states of elderly patients receiving anesthesia care.
Collapse
|
29
|
|
30
|
Haller CS, Stone WS, Walder B. Small but continuous progress in the research of preoperative and postoperative cognitive dysfunction. Eur J Anaesthesiol 2012; 29:307-308. [PMID: 22694817 DOI: 10.1097/eja.0b013e328355a3f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|