Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

• Type of Material: Article
• Authors: S. Hesse, Emory University; M. Kreuzer, Emory University; D. Hight, University of Auckland; A. Gaskell, University of Auckland; P. Devari, Emory University; D. Singh, Emory University; N. B. Taylor, Emory University; Matthew Whalin, Emory University; Simon Lee, Emory University; JW Sleigh, University of Auckland; Paul Garcia, Emory University
• Language: English
• Date: 2019-05-01
• Publisher: Elsevier Science Ltd.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.bja.2018.09.016
• Title of Journal or Parent Work: British Journal of Anaesthesia
• Volume: 122
• Issue: 5
• Start Page: 622
• End Page: 634
• Grant/Funding Information: Career Development Award #BX00167 from the US Department of Veteran Affairs, Biomedical Laboratory Research and Development Service, and the James S. McDonnell Foundation (Grant number 220023046) to P.S.G; National Institutes of Health (T32 grant 5T32NS007480-15) to Emory University for Translational Research in Neurology and a Burroughs Wellcome Fund Collaborative Research Travel Grant (1015183) to S.H
• Keywords: Sleep spindles; Anesthesiology; Propofol; Inadequate emergence; neurocognitive disorders; general anaesthesia; Dynamics; Life Sciences & Biomedicine; intraoperative monitoring; EEG; Confusion assessment method; General anesthesia; Slow wave activity; Surgery; Science & Technology; complications; delirium; recovery room; postoperative outcome; Risk-factors
• Research Categories: Engineering, Biomedical; Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery

Abstract

Background: Postoperative delirium is associated with an increased risk of morbidity and mortality, especially in the elderly. Delirium in the postanaesthesia care unit (PACU) could predict adverse clinical outcomes. Methods: We investigated a potential link between intraoperative EEG patterns and PACU delirium as well as an association of PACU delirium with perioperative outcomes, readmission and length of hospital stay. The risk factors for PACU delirium were also explored. Data were collected from 626 patients receiving general anaesthesia for procedures that would not interfere with frontal EEG recording. Results: Of the 626 subjects enrolled, 125 tested positive for PACU delirium. Whilst age, renal failure, and pre-existing neurological disease were associated with PACU delirium in the univariable analysis, the multivariable analysis revealed the importance of information derived from the EEG, anaesthetic technique, anaesthesia duration, and history of stroke or neurodegenerative disease. The occurrence of EEG burst suppression during maintenance [odds ratio (OR)=1.86 (1.13–3.05)] and the type of EEG emergence trajectory may be predictive of PACU delirium. Specifically, EEG emergence trajectories lacking significant spindle power were strongly associated with PACU delirium, especially in cases that involved ketamine or nitrous oxide [OR=6.51 (3.00–14.12)]. Additionally, subjects with PACU delirium were at an increased risk for readmission [OR=2.17 (1.13–4.17)] and twice as likely to stay >6 days in the hospital. Conclusions: Specific EEG patterns were associated with PACU delirium. These findings provide valuable information regarding how the brain reacts to surgery and anaesthesia that may lead to strategies to predict PACU delirium and identify key areas of investigation for its prevention.