M Willingham1, A Ben Abdallah1, S Gradwohl1, D Helsten1, N Lin2, A Villafranca3, E Jacobsohn3, M Avidan1, H Kaiser4. 1. Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA. 2. Department of Mathematics, Washington University in St Louis, Campus Box 1146, One Brookings Drive, St Louis, MO 63130, USA. 3. Department of Anesthesia and Perioperative Medicine, University of Manitoba, 2nd Floor, Harry Medovy House, 671 William Ave., Winnipeg, Canada MB R3E 0Z2. 4. Department of Anesthesiology, Washington University in St Louis School of Medicine, Campus Box 8054, 660 S. Euclid Ave., St Louis, MO 63110, USA heikokaiser@me.com.
Abstract
BACKGROUND: Low bispectral index values frequently reflect EEG suppression and have been associated with postoperative mortality. This study investigated whether intraoperative EEG suppression was an independent predictor of 90 day postoperative mortality and explored risk factors for EEG suppression. METHODS: This observational study included 2662 adults enrolled in the B-Unaware or BAG-RECALL trials. A cohort was defined with >5 cumulative minutes of EEG suppression, and 1:2 propensity-matched to a non-suppressed cohort (≤5 min suppression). We evaluated the association between EEG suppression and mortality using multivariable logistic regression, and examined risk factors for EEG suppression using zero-inflated mixed effects analysis. RESULTS:Ninety day postoperative mortality was 3.9% overall, 6.3% in the suppressed cohort, and 3.0% in the non-suppressed cohort {odds ratio (OR) [95% confidence interval (CI)]=2.19 (1.48-3.26)}. After matching and multivariable adjustment, EEG suppression was not associated with mortality [OR (95% CI)=0.83 (0.55-1.25)]; however, the interaction between EEG suppression and mean arterial pressure (MAP) <55 mm Hg was [OR (95% CI)=2.96 (1.34-6.52)]. Risk factors for EEG suppression were older age, number of comorbidities, chronic obstructive pulmonary disease, and higher intraoperative doses of benzodiazepines, opioids, or volatile anaesthetics. EEG suppression was less likely in patients with cancer, preoperative alcohol, opioid or benzodiazepine consumption, and intraoperative nitrous oxide exposure. CONCLUSIONS: Although EEG suppression was associated with increasing anaesthetic administration and comorbidities, the hypothesis that intraoperative EEG suppression is a predictor of postoperative mortality was only supported if it was coincident with low MAP. CLINICAL TRIAL REGISTRATION: NCT00281489 and NCT00682825.
RCT Entities:
BACKGROUND: Low bispectral index values frequently reflect EEG suppression and have been associated with postoperative mortality. This study investigated whether intraoperative EEG suppression was an independent predictor of 90 day postoperative mortality and explored risk factors for EEG suppression. METHODS: This observational study included 2662 adults enrolled in the B-Unaware or BAG-RECALL trials. A cohort was defined with >5 cumulative minutes of EEG suppression, and 1:2 propensity-matched to a non-suppressed cohort (≤5 min suppression). We evaluated the association between EEG suppression and mortality using multivariable logistic regression, and examined risk factors for EEG suppression using zero-inflated mixed effects analysis. RESULTS: Ninety day postoperative mortality was 3.9% overall, 6.3% in the suppressed cohort, and 3.0% in the non-suppressed cohort {odds ratio (OR) [95% confidence interval (CI)]=2.19 (1.48-3.26)}. After matching and multivariable adjustment, EEG suppression was not associated with mortality [OR (95% CI)=0.83 (0.55-1.25)]; however, the interaction between EEG suppression and mean arterial pressure (MAP) <55 mm Hg was [OR (95% CI)=2.96 (1.34-6.52)]. Risk factors for EEG suppression were older age, number of comorbidities, chronic obstructive pulmonary disease, and higher intraoperative doses of benzodiazepines, opioids, or volatile anaesthetics. EEG suppression was less likely in patients with cancer, preoperative alcohol, opioid or benzodiazepine consumption, and intraoperative nitrous oxide exposure. CONCLUSIONS: Although EEG suppression was associated with increasing anaesthetic administration and comorbidities, the hypothesis that intraoperative EEG suppression is a predictor of postoperative mortality was only supported if it was coincident with low MAP. CLINICAL TRIAL REGISTRATION: NCT00281489 and NCT00682825.
Authors: Daniel I Sessler; Jeffrey C Sigl; Scott D Kelley; Nassib G Chamoun; Paul J Manberg; Leif Saager; Andrea Kurz; Scott Greenwald Journal: Anesthesiology Date: 2012-06 Impact factor: 7.892
Authors: Shinung Ching; Patrick L Purdon; Sujith Vijayan; Nancy J Kopell; Emery N Brown Journal: Proc Natl Acad Sci U S A Date: 2012-02-07 Impact factor: 11.205
Authors: R A M Damhuis; B P L Wijnhoven; P W Plaisier; W J Kirkels; R Kranse; J J van Lanschot Journal: Br J Surg Date: 2012-06-20 Impact factor: 6.939
Authors: Miklos D Kertai; Ben J A Palanca; Nirvik Pal; Beth A Burnside; Lini Zhang; Furqaan Sadiq; Kevin J Finkel; Michael S Avidan Journal: Anesthesiology Date: 2011-03 Impact factor: 7.892
Authors: Michael S Avidan; Lini Zhang; Beth A Burnside; Kevin J Finkel; Adam C Searleman; Jacqueline A Selvidge; Leif Saager; Michelle S Turner; Srikar Rao; Michael Bottros; Charles Hantler; Eric Jacobsohn; Alex S Evers Journal: N Engl J Med Date: 2008-03-13 Impact factor: 91.245
Authors: Maj-Lis Lindholm; Stefan Träff; Fredrik Granath; Scott D Greenwald; Anders Ekbom; Claes Lennmarken; Rolf H Sandin Journal: Anesth Analg Date: 2009-02 Impact factor: 5.108
Authors: Sean Coeckelenbergh; Philippe Richebé; Dan Longrois; Alexandre Joosten; Stefan De Hert Journal: J Clin Monit Comput Date: 2021-11-26 Impact factor: 1.977
Authors: Bradley A Fritz; Philip L Kalarickal; Hannah R Maybrier; Maxwell R Muench; Doug Dearth; Yulong Chen; Krisztina E Escallier; Arbi Ben Abdallah; Nan Lin; Michael S Avidan Journal: Anesth Analg Date: 2016-01 Impact factor: 5.108
Authors: Mark D Willingham; Elliott Karren; Amy M Shanks; Michael F O'Connor; Eric Jacobsohn; Sachin Kheterpal; Michael S Avidan Journal: Anesthesiology Date: 2015-10 Impact factor: 7.892
Authors: Francisco Almeida Lobo; Susana Vacas; Andrea O Rossetti; Chiara Robba; Fabio Silvio Taccone Journal: Best Pract Res Clin Anaesthesiol Date: 2020-10-31
Authors: Bradley A Fritz; Christopher R King; Angela M Mickle; Troy S Wildes; Thaddeus P Budelier; Jordan Oberhaus; Daniel Park; Hannah R Maybrier; Arbi Ben Abdallah; Alex Kronzer; Sherry L McKinnon; Brian A Torres; Thomas J Graetz; Daniel A Emmert; Ben J Palanca; Tracey W Stevens; Susan L Stark; Eric J Lenze; Michael S Avidan Journal: Br J Anaesth Date: 2021-07-07 Impact factor: 11.719