Journal
BRITISH JOURNAL OF ANAESTHESIA
Volume 127, Issue 5, Pages 704-712Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.bja.2021.07.021
Keywords
anaesthesia; bispectral index; cognitive dysfunction; delirium; electroencephalography; postoperative delirium
Categories
Funding
- Health Research Council of New Zealand
- National Health and Medical Research Council, Australia
- Research Grant Council of Hong Kong
- National Institute for Health and Research, UK
- Health and Medical Research Fund [13140851]
- Food and Health Bureau, Hong Kong Special Administrative Region, China
- National Institutes of Health, USA
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The study found that targeting light anesthesia in patients undergoing major surgery reduced the risk of postoperative delirium and cognitive impairment at 1 year compared to targeting deep anesthesia.
Background: Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia). Methods: This multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary outcomes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression. Results: The incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38-0.88]; P=0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS <= 6 vs 20%; P<0.001). Conclusions: Among patients undergoing major surgery, targeting light anaesthesia reduced the risk of postoperative delirium and cognitive impairment at 1 yr.
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