Effect of Electroencephalography Spectral Edge Frequency (SEF) and Patient State Index (PSI)-Guided Propofol-Remifentanil Anesthesia on Delirium After Laparoscopic Surgery: The eMODIPOD Randomized Controlled Trial.

IF 2.3 2区医学 Q2 ANESTHESIOLOGY

Journal of neurosurgical anesthesiology Pub Date : 2022-04-01 DOI:10.1097/ANA.0000000000000823

E Wang, Lu Wang, Chunyan Ye, Ning Luo, Yanrong Zhang, Yugui Zhong, Maoen Zhu, Yu Zou, Qian Li, Longyan Li, Zongbin Song, Hui Luo, Feng Dai, Hong Liu, Adrian W Gelb, Qulian Guo, Lingzhong Meng

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引用次数: 9

Abstract

Background: The effect of SedLine electroencephalography (EEG)-guided anesthetic care on postoperative delirium (POD) has not been studied.

Methods: This single-center randomized EEG Monitoring tO Decrease the Incidence of Post-Operative Delirium (eMODIPOD) trial involved 1560 patients aged 50 years or above undergoing laparoscopic surgery. Propofol-remifentanil anesthesia was guided either by SedLine (EEG-guided care, n=779) or not (usual care, n=781). The goal of EEG-guided care was to maintain spectral edge frequency between 10 and 15 and patient state index (PSI) between 25 and 50. The primary outcome was the incidence of POD on postoperative days 1 to 5. The secondary outcomes included emergence delirium, composite moderate-to-severe complications, length of hospital stay, intensive care unit admission, 30-day hospital readmission and all-cause mortality, and intraoperative awareness.

Results: Of the 1560 randomized patients, 1545 were included in the modified intention-to-treat analysis. The median propofol administered for anesthesia maintenance was 900 mg and 1000 mg in the EEG-guided and usual care groups, respectively (P=0.21). POD occurred in 1.0% (8/771) and 1.2% (9/774) of patients in the EEG-guided and usual care groups, respectively (risk ratio: 0.89; 95% confidence interval: 0.35-2.30). There were no between-group differences in all secondary outcome measures. Emergence delirium occurred in 11.8% (91/771) and 13.2% (102/774) of the EEG-guided care and usual care groups, respectively (risk ratio: 0.90; 95% confidence interval: 0.69-1.17; P=0.41). Three patients from each group reported intraoperative awareness.

Conclusions: Compared with usual care, SedLine spectral edge frequency-guided and patient state index-guided propofol-remifentanil anesthetic care neither alters anesthetic delivery nor decreases the unexpected low incidence of POD in relatively young Chinese patients undergoing laparoscopic surgery.

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脑电图谱边频率(SEF)和患者状态指数(PSI)引导异丙酚-瑞芬太尼麻醉对腹腔镜术后谵妄的影响:eMODIPOD随机对照试验。

背景:SedLine脑电图(EEG)引导麻醉护理对术后谵妄(POD)的影响尚未研究。方法:这项单中心随机脑电图监测降低术后谵妄发生率(eMODIPOD)试验纳入1560例50岁及以上接受腹腔镜手术的患者。异丙酚-瑞芬太尼麻醉采用SedLine(脑电图引导护理，n=779)或不采用SedLine(常规护理，n=781)。脑电图引导护理的目标是保持频谱边缘频率在10到15之间，患者状态指数(PSI)在25到50之间。主要观察指标为术后第1 ~ 5天POD的发生率。次要结局包括出现性谵妄、复合中重度并发症、住院时间、重症监护病房入院、30天再入院和全因死亡率以及术中意识。结果:在1560例随机患者中，1545例纳入改良意向治疗分析。脑电图引导组和常规护理组用于麻醉维持的中位异丙酚分别为900 mg和1000 mg (P=0.21)。脑电图引导组和常规护理组的POD发生率分别为1.0%(8/771)和1.2%(9/774)(风险比:0.89;95%置信区间:0.35-2.30)。在所有次要结果测量中，组间无差异。在脑电图引导护理组和常规护理组中，出现性谵妄的发生率分别为11.8%(91/771)和13.2%(102/774)(风险比:0.90;95%置信区间:0.69-1.17;P = 0.41)。每组均有3例患者报告术中意识。结论:与常规护理相比，SedLine谱边缘频率引导和患者状态指数引导的异丙酚-瑞芬太尼麻醉护理既没有改变麻醉输送，也没有降低相对年轻的中国腹腔镜手术患者意外的低发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurosurgical anesthesiology 医学-临床神经学

CiteScore

6.20

自引率

10.80%

发文量

119

审稿时长

>12 weeks

期刊介绍： The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.