老年人心脏手术麻醉诱发的脑电图振荡和围手术期结局

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-07 DOI:10.1016/j.jclinane.2025.111770

Isaac G. Freedman , Gonzalo Boncompte , Jason Z. Qu , Zain Q. Khawaja , Isabella Turco , Ariel Mueller , Kwame Wiredu , Tina B. McKay , M. Brandon Westover , Juan C. Pedemonte , Oluwaseun Akeju

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引用次数: 0

摘要

背景：全身麻醉期间的脑电图振荡可能作为认知和身体健康的功能而改变。本研究旨在探讨60岁以上心脏手术患者麻醉诱发振荡与术后预后之间的关系。方法：这是一项预先指定的二级数据分析，来自右美托咪定诱导睡眠的重症监护病房功能障碍最小化（MINDDS）研究。参与者在家中接受选择性心脏手术和体外循环。主要预后指标为术后神志不清评定法获得的谵妄。次要结局为非居家出院和30天再入院。兴趣暴露是在异氟烷-全身麻醉维持阶段测量的α功率。收集混淆的认知和身体健康变量。结果在MINDDS研究的394名参与者中，302人有可分析的脑电图。术后谵妄发生率为11.1%。α功率每增加1分贝，术后谵妄的发生率降低14% (OR 0.86, 95% CI: 0.78 ~ 0.95；p = 0.004)。这一发现在校正分析中不显著(ORadj 0.92, 95% CI: 0.81 ~ 1.03；p = 0.154)。非家庭出院设置结果与α功率无关。α功率每增加1分贝，30天再入院的几率降低20% (ORadj 0.80, 95% CI: 0.71 ~ 0.91；P & lt;0.001)。在探索性和敏感性分析中发现是保守的。结论在本研究中，麻醉引起的振荡与术后预后相关；然而，在考虑术前认知和身体健康后，这些与谵妄或出院处置没有独立的关联。然而，这些振荡与30天的再入院密切相关，这可能有助于麻醉师识别高危患者，提供手术室以外的好处。临床试验注册：注册号：NCT02856594

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Anesthesia-induced electroencephalogram oscillations and perioperative outcomes in older adults undergoing cardiac surgery

Background

Electroencephalogram oscillations during general anesthesia may change as a function of cognitive and physical health. This study aimed to characterize associations between anesthesia-induced oscillations and postoperative outcomes in cardiac surgery patients over 60 years.

Methods

This was a prespecified secondary data analysis from the Minimizing Intensive Care Unit Dysfunction with Dexmedetomidine-induced Sleep (MINDDS) study. Participants were admitted from home for elective cardiac surgery with cardiopulmonary bypass. The primary outcome was postoperative delirium obtained using the Confusion Assessment Method. Secondary outcomes were non-home discharge and 30-day readmission. The exposure of interest was alpha power measured during the maintenance phase of isoflurane-general anesthesia. Confounding cognitive and physical health variables were collected.

Results

Of 394 participants in the MINDDS study, 302 had analyzable electroencephalograms. The incidence of postoperative delirium was 11.1 %. Odds of postoperative delirium decreased by 14 % for every decibel increase in alpha power (OR 0.86, 95 % CI: 0.78 to 0.95; P = 0.004). This finding was not significant in adjusted analysis (OR_adj 0.92, 95 % CI: 0.81 to 1.03; P = 0.154). Non-home discharge setting findings were not associated with alpha power. The odds of 30-day readmission decreased by 20 % for every decibel increase in alpha power (OR_adj 0.80, 95 % CI: 0.71 to 0.91; P < 0.001). Findings were conserved in exploratory and sensitivity analyses.

Conclusions

In this study anesthesia-induced oscillations were associated with postoperative outcomes; however, these were not independently associated with delirium or discharge disposition after considering preoperative cognitive and physical health. These oscillations were robustly associated with 30-day readmission however, which may help anesthesiologists identify high-risk patients, offering benefits beyond the operating room.

Clinical trial registration: Registration Number: NCT02856594

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.