S Hesse1, M Kreuzer2, D Hight3, A Gaskell3, P Devari1, D Singh1, N B Taylor1, M K Whalin4, S Lee5, J W Sleigh3, P S García6. 1. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA; Research Division, Atlanta VA Medical Center, Atlanta, GA, USA. 2. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA; Research Division, Atlanta VA Medical Center, Atlanta, GA, USA; Department of Anaesthesiology and Intensive Care, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 3. Department of Anaesthesiology, Waikato Clinical School, University of Auckland, Hamilton, New Zealand. 4. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA; Department of Anesthesiology, Grady Memorial Hospital, Atlanta, GA, USA. 5. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA; Department of Anesthesiology, Emory University Hospital Midtown, Atlanta, GA, USA. 6. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA; Research Division, Atlanta VA Medical Center, Atlanta, GA, USA; Department of Anesthesiology, Columbia University Medical Center, NewYork-Presbyterian Hospital - Irving, New York, NY, USA. Electronic address: pg2618@cumc.columbia.edu.
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. Published by Elsevier Ltd.
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 PACUdelirium as well as an association of PACUdelirium with perioperative outcomes, readmission and length of hospital stay. The risk factors for PACUdelirium 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 PACUdelirium. Whilst age, renal failure, and pre-existing neurological disease were associated with PACUdelirium 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 PACUdelirium. Specifically, EEG emergence trajectories lacking significant spindle power were strongly associated with PACUdelirium, especially in cases that involved ketamine or nitrous oxide [OR=6.51 (3.00-14.12)]. Additionally, subjects with PACUdelirium 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 PACUdelirium. These findings provide valuable information regarding how the brain reacts to surgery and anaesthesia that may lead to strategies to predict PACUdelirium and identify key areas of investigation for its prevention. Published by Elsevier Ltd.
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