Article (Scientific journals)
Intra-operative electroencephalogram frontal alpha-band spectral analysis and postoperative delirium in cardiac surgery: A prospective cohort study.
Khalifa, Céline; Lenoir, Cédric; Robert, Annie et al.
2023In European Journal of Anaesthesiology, 40 (10), p. 777 - 787
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Keywords :
Adult; Humans; Prospective Studies; Electroencephalography; Postoperative Complications/diagnosis; Postoperative Complications/epidemiology; Postoperative Complications/etiology; Risk Factors; Emergence Delirium/diagnosis; Emergence Delirium/epidemiology; Emergence Delirium/etiology; Delirium/diagnosis; Delirium/epidemiology; Delirium/etiology; Cardiac Surgical Procedures/adverse effects; Cardiac Surgical Procedures; Delirium; Emergence Delirium; Postoperative Complications; Anesthesiology and Pain Medicine
Abstract :
[en] BACKGROUND: Postoperative delirium (POD) remains a frequent complication after cardiac surgery, with pre-operative cognitive status being one of the main predisposing factors. However, performing complete pre-operative neuropsychological testing is challenging. The magnitude of frontal electroencephalographic (EEG) α oscillations during general anaesthesia has been related to pre-operative cognition and could constitute a functional marker for brain vulnerability. OBJECTIVE: We hypothesised that features of intra-operative α-band activity could predict the occurrence of POD. DESIGN: Single-centre prospective observational study. SETTING: University hospital, from 15 May 2019 to 15 December 2021. PATIENTS: Adult patients undergoing elective cardiac surgery. MAIN OUTCOME MEASURES: Pre-operative cognitive status was assessed by neuropsychological tests and scored as a global z score. A 5-min EEG recording was obtained 30 min after induction of anaesthesia. Anaesthesia was maintained with sevoflurane. Power and peak frequency in the α-band were extracted from the frequency spectra. POD was assessed using the Confusion Assessment Method for Intensive Care Unit, the Confusion Assessment Method and a chart review. RESULTS: Sixty-five (29.5%) of 220 patients developed POD. Delirious patients were significantly older with median [IQR] ages of 74 [64 to 79] years vs. 67 [59 to 74] years; P  < 0.001) and had lower pre-operative cognitive z scores (-0.52 ± 1.14 vs. 0.21 ± 0.84; P  < 0.001). Mean α power (-14.03 ± 4.61 dB vs. -11.59 ± 3.37 dB; P  < 0.001) and maximum α power (-11.36 ± 5.28 dB vs. -8.85 ± 3.90 dB; P  < 0.001) were significantly lower in delirious patients. Intra-operative mean α power was significantly associated with the probability of developing POD (adjusted odds ratio, 0.88; 95% confidence interval (CI), 0.81 to 0.96; P  = 0.007), independently of age and only whenever cognitive status was not considered. CONCLUSION: A lower intra-operative frontal α-band power is associated with a higher incidence of POD after cardiac surgery. Intra-operative measures of α power could constitute a means of identifying patients at risk of this complication. TRIAL REGISTRATION: NCT03706989.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Khalifa, Céline;  UCL Saint-Luc - Cliniques Universitaires Saint-Luc [BE] > Department of Anesthesiology
Lenoir, Cédric;  UCL - Université Catholique de Louvain [BE] > Institute of Neuroscience
Robert, Annie;  UCL - Université Catholique de Louvain [BE] > Institut de Recherche Expérimentale et Clinique
Watremez, Christine;  UCL - Université Catholique de Louvain [BE] > Institut de Recherche Expérimentale et Clinique
Kahn, David;  UCL Saint-Luc - Cliniques Universitaires Saint-Luc [BE] > Department of Anaesthesiology
Mastrobuoni, Stefano;  UCL - Université Catholique de Louvain [BE] > Département de Recherche Expériementale et Clinique
Aphram, Gaby;  UCL - Université Catholique de Louvain [BE] > Département de Recherche Expérimentale et Clinique
Ivanoiu, Adrian;  UCL - Université Catholique de Louvain [BE] > Department of Neuroscience
Bonhomme, Vincent  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service d'anesthésie - réanimation
Mouraux, André;  UCL - Université Catholique de Louvain [BE] > Department of Neuroscience
Momeni, Mona;  UCL Saint-Luc - Cliniques Universitaires Saint-Luc [BE] > Department of Anaesthesiology
Language :
English
Title :
Intra-operative electroencephalogram frontal alpha-band spectral analysis and postoperative delirium in cardiac surgery: A prospective cohort study.
Publication date :
01 October 2023
Journal title :
European Journal of Anaesthesiology
ISSN :
0265-0215
eISSN :
1365-2346
Publisher :
NLM (Medline), England
Volume :
40
Issue :
10
Pages :
777 - 787
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 23 November 2023

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