Charles H Brown1, Charles Edwards2, Charles Lin3, Emily Ledford Jones1, Lisa R Yanek4, Melody Esmaili3, Yara Gorashi5, Richard Skelton6, Daniel Kaganov7, Ryan Curto8, Noah L Lessing8, Stephanie Cha1, Elizabeth Colantuoni9, Karin Neufeld10, Frederick Sieber1, Clayton L Dean2, Charles W Hogue11. 1. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Maryland Spine Center at Mercy, Baltimore, Maryland. 3. Mercy Anesthesiology Associates, Baltimore, Maryland. 4. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Tufts University School of Medicine, Boston, Massachusetts. 6. University of Miami Miller School of Medicine, Miami, Florida. 7. Wake Forest School of Medicine, Winston Salem, North Carolina. 8. University of Maryland School of Medicine, Baltimore, Maryland. 9. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 10. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. 11. the Department of Anesthesiology, Northwestern Feinberg School of Medicine, Chicago, Illinois.
Abstract
BACKGROUND: Reducing depth of anesthesia and anesthetic exposure may help prevent delirium, but trials have been conflicting. Most studies were conducted under general anesthesia or in cognitively impaired patients. It is unclear whether reducing depth of anesthesia beyond levels consistent with general anesthesia reduces delirium in cognitively intact patients. The authors' objective was to determine whether a bundled approach to reduce anesthetic agent exposure as determined by Bispectral Index (BIS) values (spinal anesthesia with targeted sedation based on BIS values) compared with general anesthesia (masked BIS) reduces delirium. METHODS: Important eligibility criteria for this parallel-arm randomized trial were patients 65 yr or greater undergoing lumbar spine fusion. The intervention group received spinal anesthesia with targeted sedation to BIS greater than 60 to 70. The control group received general anesthesia (masked BIS). The primary outcome was delirium using the Confusion Assessment Method daily through postoperative day 3, with blinded assessment. RESULTS: The median age of 217 patients in the analysis was 72 (interquartile range, 69 to 77). The median BIS value in the spinal anesthesia with targeted sedation based on BIS values group was 62 (interquartile range, 53 to 70) and in the general anesthesia with masked BIS values group was 45 (interquartile range, 41 to 50; P < 0.001). Incident delirium was not different in the spinal anesthesia with targeted sedation based on BIS values group (25.2% [28 of 111] vs. the general anesthesia with masked BIS values group (18.9% [20 of 106]; P = 0.259; relative risk, 1.22 [95% CI, 0.85 to 1.76]). In prespecified subgroup analyses, the effect of anesthetic strategy differed according to the Mini-Mental State Examination, but not the Charlson Comorbidity Index or age. Two strokes occurred among patients receiving spinal anesthesia and one death among patients receiving general anesthesia. CONCLUSIONS: Spinal anesthesia with targeted sedation based on BIS values compared with general anesthesia with masked BIS values did not reduce delirium after lumbar fusion.
BACKGROUND: Reducing depth of anesthesia and anesthetic exposure may help prevent delirium, but trials have been conflicting. Most studies were conducted under general anesthesia or in cognitively impaired patients. It is unclear whether reducing depth of anesthesia beyond levels consistent with general anesthesia reduces delirium in cognitively intact patients. The authors' objective was to determine whether a bundled approach to reduce anesthetic agent exposure as determined by Bispectral Index (BIS) values (spinal anesthesia with targeted sedation based on BIS values) compared with general anesthesia (masked BIS) reduces delirium. METHODS: Important eligibility criteria for this parallel-arm randomized trial were patients 65 yr or greater undergoing lumbar spine fusion. The intervention group received spinal anesthesia with targeted sedation to BIS greater than 60 to 70. The control group received general anesthesia (masked BIS). The primary outcome was delirium using the Confusion Assessment Method daily through postoperative day 3, with blinded assessment. RESULTS: The median age of 217 patients in the analysis was 72 (interquartile range, 69 to 77). The median BIS value in the spinal anesthesia with targeted sedation based on BIS values group was 62 (interquartile range, 53 to 70) and in the general anesthesia with masked BIS values group was 45 (interquartile range, 41 to 50; P < 0.001). Incident delirium was not different in the spinal anesthesia with targeted sedation based on BIS values group (25.2% [28 of 111] vs. the general anesthesia with masked BIS values group (18.9% [20 of 106]; P = 0.259; relative risk, 1.22 [95% CI, 0.85 to 1.76]). In prespecified subgroup analyses, the effect of anesthetic strategy differed according to the Mini-Mental State Examination, but not the Charlson Comorbidity Index or age. Two strokes occurred among patients receiving spinal anesthesia and one death among patients receiving general anesthesia. CONCLUSIONS: Spinal anesthesia with targeted sedation based on BIS values compared with general anesthesia with masked BIS values did not reduce delirium after lumbar fusion.
Authors: Sharon K Inouye; Edward R Marcantonio; Cyrus M Kosar; Douglas Tommet; Eva M Schmitt; Thomas G Travison; Jane S Saczynski; Long H Ngo; David C Alsop; Richard N Jones Journal: Alzheimers Dement Date: 2016-04-18 Impact factor: 21.566
Authors: Charles H Brown; Julia Probert; Ryan Healy; Michelle Parish; Yohei Nomura; Atsushi Yamaguchi; Jing Tian; Kenton Zehr; Kaushik Mandal; Vidyulata Kamath; Karin J Neufeld; Charles W Hogue Journal: Anesthesiology Date: 2018-09 Impact factor: 7.892
Authors: Frederick E Sieber; Khwaji J Zakriya; Allan Gottschalk; Mary-Rita Blute; Hochang B Lee; Paul B Rosenberg; Simon C Mears Journal: Mayo Clin Proc Date: 2010-01 Impact factor: 7.616
Authors: Charles H Brown; Emily L Jones; Charles Lin; Melody Esmaili; Yara Gorashi; Richard A Skelton; Daniel Kaganov; Elizabeth A Colantuoni; Lisa R Yanek; Karin J Neufeld; Vidyulata Kamath; Frederick E Sieber; Clayton L Dean; Charles C Edwards; Charles W Hogue Journal: BMC Anesthesiol Date: 2019-10-27 Impact factor: 2.217