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Bruzzone MJ, Chapin B, Walker J, Santana M, Wang Y, Amini S, Kimmet F, Perera E, Rubinos C, Arias F, Price C. Electroencephalographic Measures of Delirium in the Perioperative Setting: A Systematic Review. Anesth Analg 2025; 140:1127-1139. [PMID: 39088366 DOI: 10.1213/ane.0000000000007079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
Postoperative delirium (POD) is frequent in older adults and is associated with adverse cognitive and functional outcomes. In the last several decades, there has been an increased interest in exploring tools that easily allow the early recognition of patients at risk of developing POD. The electroencephalogram (EEG) is a widely available tool used to understand delirium pathophysiology, and its use in the perioperative setting has grown exponentially, particularly to predict and detect POD. We performed a systematic review to investigate the use of EEG in the pre-, intra-, and postoperative settings. We identified 371 studies, and 56 met the inclusion criteria. A range of techniques was used to obtain EEG data, from limited 1-4 channel setups to complex 256-channel systems. Power spectra were often measured preoperatively, yet the outcomes were inconsistent. During surgery, the emphasis was primarily on burst suppression (BS) metrics and power spectra, with a link between the frequency and timing of BS, and POD. The EEG patterns observed in POD aligned with those noted in delirium in different contexts, suggesting a reduction in EEG activity. Further research is required to investigate preoperative EEG indicators that may predict susceptibility to delirium.
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Affiliation(s)
- Maria J Bruzzone
- From the Department of Neurology, University of Florida, Gainesville, Florida
| | - Benjamin Chapin
- Department of Anesthesia, University of Florida, Gainesville, Florida
| | - Jessie Walker
- From the Department of Neurology, University of Florida, Gainesville, Florida
| | - Marcos Santana
- From the Department of Neurology, University of Florida, Gainesville, Florida
| | - Yue Wang
- From the Department of Neurology, University of Florida, Gainesville, Florida
| | - Shawna Amini
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Faith Kimmet
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Estefania Perera
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Clio Rubinos
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Catherine Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
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Dappen ER, Krause BM, Mueller RN, Banks MI, Nourski KV. Changes in cortical delta power during chronic invasive epilepsy monitoring. Epilepsia 2025. [PMID: 40286264 DOI: 10.1111/epi.18419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 03/07/2025] [Accepted: 04/03/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVE Cortical delta band (1-4 Hz) activity is considered a biomarker for states of altered consciousness, with increased delta power observed during anesthesia, sleep, coma, and delirium. The current study sought to characterize delta power following electrode implantation with respect to patient demographics and clinical characteristics as well as type and duration of surgery. METHODS Participants were 25 adult neurosurgical patients implanted with intracranial electrodes for clinical monitoring of their epilepsy. Resting state cortical activity was recorded at multiple occasions over the course of the monitoring period. The initial time point was defined as the first recording within 72 h following surgery. Analyses of cortical activity were conducted using a linear mixed effects modeling approach to account for within-participant correlations and between-participant heterogeneity. RESULTS Throughout the monitoring period, delta power decreased in frontal, occipital, parietal, and temporal regions, indicating a global phenomenon. By contrast, beta (14-30 Hz) power remained stable. Delta power was higher following surgical cases that required craniotomy compared to stereoelectroencephalography cases. Surgery duration and anesthesia emergence duration were associated with higher delta power. Recordings from depth electrodes showed higher delta power compared to subdural electrodes. No significant effects of patients' age, sex, white blood cell count, antiseizure medication, and opioid medication dosage on postoperative delta power were found. SIGNIFICANCE The results are consistent with a postoperative elevation in delta power that resolves over the course of the monitoring period and indicate an association between increased delta power and craniotomy surgery, as well as longer surgery and emergence durations. The current work provides a comprehensive analysis of surgical, clinical, and physiological factors, suggests risk factors, and lays fundamental groundwork for future studies.
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Affiliation(s)
- Emily R Dappen
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa, USA
| | - Bryan M Krause
- Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Rashmi N Mueller
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
- Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA
| | - Matthew I Banks
- Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Neuroscience, University of Wisconsin, Madison, Wisconsin, USA
| | - Kirill V Nourski
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa, USA
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Wang YP, Jiang Y, Mi L, Liu WX, Xue YX, Chen Y, Luo X, Cheng YQ, Pan J, Qu JZ, Wang DJ. Developing predictive nomogram models using quantitative electroencephalography for brain function in type a aortic dissection: a prospective observational study. Int J Surg 2025; 111:2398-2413. [PMID: 39869385 DOI: 10.1097/js9.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 11/29/2024] [Indexed: 01/28/2025]
Abstract
BACKGROUND Type A aortic dissection (TAAD) remains a significant challenge in cardiac surgery, presenting high risks of adverse outcomes such as permanent neurological dysfunction and mortality despite advances in medical technology and surgical techniques. This study investigates the use of quantitative electroencephalography (QEEG) to monitor and predict neurological outcomes during the perioperative period in TAAD patients. METHODS This prospective observational study was conducted at the hospital, involving patients undergoing TAAD surgery from February 2022 to January 2023. QEEG parameters, including the dynamic amplitude-integrated electroencephalography (aEEG) grade, which assesses changes in brain function over time, alongside aEEG and relative band power (RBP), were monitored and analyzed to assess brain function preoperatively, intraoperatively, and within 2 hours postoperatively. A predictive nomogram model was developed using these QEEG metrics along with other clinical variables to forecast neurological outcomes. RESULTS In this study, we analyzed the factors contributing to adverse outcomes (AO) and transient neurological dysfunction (TND) following TAAD surgery. For AO, multivariable analysis identified pre-mental status (odds ratio [OR] = 4.652, 95% confidence interval [CI] = 2.316-10.074, P < 0.001), cardiopulmonary bypass time (OR = 1.014, 95% CI = 1.006-1.023, P = 0.001), and dynamic aEEG grade (OR = 9.926, 95% CI = 4.493-25.268, P < 0.001) as independent risk factors. The AO model showed high discriminative ability with an area under the curve of 0.888 (95% CI = 0.818-0.960) and good calibration (Brier score = 0.0728). For TND, significant preoperative differences included dynamic aEEG grade ( P < 0.001) and Log(Post-RBP Alpha%) (6.00 vs. 4.00, P < 0.001). Multivariable analysis identified cardiopulmonary bypass time (OR = 1.014, 95% CI = 1.006-1.023, P = 0.001), Post-RBP Alpha% (OR = 0.263, 95% CI = 0.121-0.532, P < 0.001), and dynamic aEEG grade (OR = 12.444, 95% CI = 5.337-30.814, P < 0.001) as independent risk factors. The TND model had an area under the curve of 0.893 (95% CI = 0.844-0.941) and good calibration (Brier score = 0.125). These findings highlight the role of QEEG in predicting postoperative neurological dysfunction in TAAD patients. CONCLUSION Through perioperative QEEG monitoring of TAAD patients, combined with clinical indicators such as cardiopulmonary bypass time and preoperative mental status, we developed clinical predictive models for AO and TND after surgery. These models allow for early detection of postoperative brain function impairment, as assessed by QEEG parameters monitored intraoperatively and during the first 2 hours after surgery, a period chosen based on clinical definitions of delayed awakening and supported by the findings of this study. This study provides evidence supporting postoperative brain function monitoring in TAAD patients, with potential clinical implications for improved outcomes.
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Affiliation(s)
- Ya-Peng Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Yi Jiang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Lin Mi
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China
| | - Wen-Xue Liu
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China
| | - Yun-Xing Xue
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China
| | - Yang Chen
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China
| | - Xuan Luo
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China
| | - Yong-Qing Cheng
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China
| | - Jun Pan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China
| | - Jason Zhensheng Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dong-Jin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, Jiangsu, China
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, China
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Zhang G, Qi B, Li H, Zhang X, Chen J, Li H, Jing B, Huang H. A longitudinal multimodal MRI study of the visual network in postoperative delirium. Brain Imaging Behav 2024; 18:1394-1406. [PMID: 39298114 DOI: 10.1007/s11682-024-00929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 09/21/2024]
Abstract
Although structural and functional damage to the brain is considered to be an important neurobiological mechanism of postoperative delirium (POD), alterations in the visual cortical network related to this vulnerability have not yet been determined. In this study, we investigated the impact of alterations in the visual network (VN), as measured by structural and functional magnetic resonance imaging (MRI), on the development of POD. Thirty-six adult patients with frontal glioma who underwent elective craniotomy were recruited. The primary outcome was POD 1-7 days after surgery, as assessed by the Confusion Assessment Method. Cognition before surgery was measured by a battery of neuropsychological tests. Then, we evaluated preoperative and postoperative gray matter volume (GMV) and functional connectivity (FC) alterations by voxel-based morphometry and resting-state functional MRI (rs-fMRI) between the POD and non-POD groups. Multiple logistic regression models were used to investigate the associations between neuroimaging biomarkers and the occurrence of POD. Compared to those in the non-POD group, a decreased GMV in the fusiform gyrus (0.181 [0.018] vs. 0.207 [0.022], FDRp = 0.001) and decreased FC between the fusiform gyrus and VN (0.351 [0.153] vs. 0.610 [0.197], GFRp < 0.001) were observed preoperatively in the POD group, and increased FC between the fusiform gyrus and ventral attentional network (0.538 [0.180] vs. 0.452 [0.184], GFRp = < 0.001) was observed postoperatively in the POD group. According to our multiple logistic regression analysis, age (Odds ratio [OR]: 1.141 [1.015 to 1.282], P = 0.03) and preoperative fusiform-VN FC (OR 0.001 [0.001 to 0.067], P = 0.01) were significantly related to risk of POD. Our findings suggested that preoperative functional disconnectivity between fusiform and VN might be highly involved in the development of POD. These findings may allow for the discovery of additional underlying mechanisms.
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Affiliation(s)
- Guobin Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Key Laboratory of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Beier Qi
- Key Laboratory of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Haoyi Li
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Key Laboratory of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiaokang Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Key Laboratory of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jian Chen
- School of Electronic, Electrical Engineering and Physics, Fujian University of Technology, Fuzhou, 330118, Fujian, China
| | - Haiyun Li
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
| | - Bin Jing
- School of Biomedical Engineering, Beijing Key Laboratory of Fundamental Research On Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
| | - Huawei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Zhang GB, Li HY, Yu WJ, Ying YZ, Zheng D, Zhang XK, Wang YG, Shi GZ, Huang HW. Occurrence and risk factors for post-stroke delirium: A systematic review and meta-analysis. Asian J Psychiatr 2024; 99:104132. [PMID: 38981150 DOI: 10.1016/j.ajp.2024.104132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/15/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES Delirium is a significant health concern in acute stroke patients. We aim to systematically summarize existing evidence to conduct a meta-analysis to quantify the occurrence and risk factors for delirium after acute stroke. METHOD PubMed, EMBASE and MEDLINE were searched from inception to Feb. 2023 for prospective observational studies that reported the incidence or prevalence of post-stroke delirium and/or evaluated potential risk factors. The search strategy was created using controlled vocabulary terms and text words for stroke and delirium. We performed a meta-analysis of the estimates for occurrence and risk factors using random-effects models. Meta-regression and subgroup meta-analyses were conducted to explore the sources of heterogeneity. Study quality and quality of evidence were assessed using the customized Newcastle-Ottawa Scale and GRADE, respectively. RESULTS Forty-nine studies that enrolled 12383 patients were included. The pooled occurrence rate of post-stroke delirium was 24.4 % (95 %CI, 20.4 %-28.9 %, I2=96.2 %). The pooled occurrence of hyperactive, hypoactive, and mixed delirium was 8.5 %, 5.7 % and 5.0 %, respectively. Study location, delirium assessment method and stroke type independently affected the heterogeneity of the pooled estimate of delirium. Statistically significant risk factors were older age, low education level, cigarette smoking, alcohol drinking, atrial fibrillation, lower ADL level, higher pre-stroke mRS score, premorbid cognitive impairment or dementia, aphasia, total anterior circulation impairment, higher National Institute of Health Stroke Scale score and infection. CONCLUSIONS Delirium affected 1 in 4 acute stroke patients, although reported rates may depend on assessment method and stroke type. Timely prevention, recognition and intervention require prioritizing patients with dominant risk factors.
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Affiliation(s)
- Guo-Bin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Hao-Yi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Wei-Jie Yu
- Department of Neurosurgery, The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Yu-Zhe Ying
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Dao Zheng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Xiao-Kang Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Yong-Gang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Guang-Zhi Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Hua-Wei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Cavallari M, Touroutoglou A, Katsumi Y, Fong TG, Schmitt E, Travison TG, Shafi MM, Libermann TA, Marcantonio ER, Alsop DC, Jones RN, Inouye SK, Dickerson BC. Relationship between cortical brain atrophy, delirium, and long-term cognitive decline in older surgical patients. Neurobiol Aging 2024; 140:130-139. [PMID: 38788524 PMCID: PMC11983869 DOI: 10.1016/j.neurobiolaging.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
In older patients, delirium after surgery is associated with long-term cognitive decline (LTCD). The neural substrates of this association are unclear. Neurodegenerative changes associated with dementia are possible contributors. We investigated the relationship between brain atrophy rates in Alzheimer's disease (AD) and cognitive aging signature regions from magnetic resonance imaging before and one year after surgery, LTCD assessed by the general cognitive performance (GCP) score over 6 years post-operatively, and delirium in 117 elective surgery patients without dementia (mean age = 76). The annual change in cortical thickness was 0.2(1.7) % (AD-signature p = 0.09) and 0.4(1.7) % (aging-signature p = 0.01). Greater atrophy was associated with LTCD (AD-signature: beta(CI) = 0.24(0.06-0.42) points of GCP/mm of cortical thickness; p < 0.01, aging-signature: beta(CI) = 0.55(0.07-1.03); p = 0.03). Atrophy rates were not significantly different between participants with and without delirium. We found an interaction with delirium severity in the association between atrophy and LTCD (AD-signature: beta(CI) = 0.04(0.00-0.08), p = 0.04; aging-signature: beta(CI) = 0.08(0.03-0.12), p < 0.01). The rate of cortical atrophy and severity of delirium are independent, synergistic factors determining postoperative cognitive decline in the elderly.
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Affiliation(s)
- Michele Cavallari
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra Touroutoglou
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yuta Katsumi
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eva Schmitt
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Thomas G Travison
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Mouhsin M Shafi
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Towia A Libermann
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center Genomics, Proteomics, Bioinformatics and Systems Biology Center, Harvard Medical School, Boston, MA, USA
| | - Edward R Marcantonio
- Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard N Jones
- Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Sharon K Inouye
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA; Departments of Psychiatry and Human Behavior and Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Bradford C Dickerson
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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7
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Shang Z, Jiang Y, Fang P, Zhu W, Guo J, Li L, Liang Y, Zhang S, Ma S, Mei B, Fan Y, Xie Z, Shen Q, Liu X. The Association of Preoperative Diabetes With Postoperative Delirium in Older Patients Undergoing Major Orthopedic Surgery: A Prospective Matched Cohort Study. Anesth Analg 2024; 138:1031-1042. [PMID: 38335150 DOI: 10.1213/ane.0000000000006893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Postoperative delirium (POD) is a common form of postoperative brain dysfunction, especially in the elderly. However, its risk factors remain largely to be determined. This study aimed to investigate whether (1) preoperative diabetes is associated with POD after elective orthopedic surgery and (2) intraoperative frontal alpha power is a mediator of the association between preoperative diabetes and POD. METHODS This was a prospective matched cohort study of patients aged 60 years or more, with a preoperative diabetes who underwent elective orthopedic surgery. Nondiabetic patients were matched 1:1 to diabetic patients in terms of age, sex, and type of surgery. Primary outcome was occurrence of POD, assessed using the 3-minute Diagnostic Confusion Assessment Method (3D-CAM) once daily from 6 pm to 8 pm during the postoperative days 1-7 or until discharge. Secondary outcome was the severity of POD which was assessed for all participants using the short form of the CAM-Severity. Frontal electroencephalogram (EEG) was recorded starting before induction of anesthesia and lasting until discharge from the operating room. Intraoperative alpha power was calculated using multitaper spectral analyses. Mediation analysis was used to estimate the proportion of the association between preoperative diabetes and POD that could be explained by intraoperative alpha power. RESULTS A total of 138 pairs of eligible patients successfully matched 1:1. After enrollment, 6 patients in the diabetes group and 4 patients in the nondiabetes group were excluded due to unavailability of raw EEG data. The final analysis included 132 participants with preoperative diabetes and 134 participants without preoperative diabetes, with a median age of 68 years and 72.6% of patients were female. The incidence of POD was 16.7% (22/132) in patients with preoperative diabetes vs 6.0% (8/134) in patients without preoperative diabetes. Preoperative diabetes was associated with increased odds of POD after adjustment of age, sex, body mass index, education level, hypertension, arrhythmia, coronary heart disease, and history of stroke (odds ratio, 3.2; 95% confidence interval [CI], 1.4-8.0; P = .009). The intraoperative alpha power accounted for an estimated 20% (95% CI, 2.6-60%; P = .021) of the association between diabetes and POD. CONCLUSIONS This study suggests that preoperative diabetes is associated with an increased risk of POD in older patients undergoing major orthopedic surgery, and that low intraoperative alpha power partially mediates such association.
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Affiliation(s)
- Zixiang Shang
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yu Jiang
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Panpan Fang
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Wenjie Zhu
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Jiaxin Guo
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Lili Li
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yongjie Liang
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Sichen Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, P.R. China
| | - Shenglan Ma
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, P.R. China
| | - Bin Mei
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, P.R. China
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| | - Qiying Shen
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Xuesheng Liu
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
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8
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Berger M, Ryu D, Reese M, McGuigan S, Evered LA, Price CC, Scott DA, Westover MB, Eckenhoff R, Bonanni L, Sweeney A, Babiloni C. A Real-Time Neurophysiologic Stress Test for the Aging Brain: Novel Perioperative and ICU Applications of EEG in Older Surgical Patients. Neurotherapeutics 2023; 20:975-1000. [PMID: 37436580 PMCID: PMC10457272 DOI: 10.1007/s13311-023-01401-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/13/2023] Open
Abstract
As of 2022, individuals age 65 and older represent approximately 10% of the global population [1], and older adults make up more than one third of anesthesia and surgical cases in developed countries [2, 3]. With approximately > 234 million major surgical procedures performed annually worldwide [4], this suggests that > 70 million surgeries are performed on older adults across the globe each year. The most common postoperative complications seen in these older surgical patients are perioperative neurocognitive disorders including postoperative delirium, which are associated with an increased risk for mortality [5], greater economic burden [6, 7], and greater risk for developing long-term cognitive decline [8] such as Alzheimer's disease and/or related dementias (ADRD). Thus, anesthesia, surgery, and postoperative hospitalization have been viewed as a biological "stress test" for the aging brain, in which postoperative delirium indicates a failed stress test and consequent risk for later cognitive decline (see Fig. 3). Further, it has been hypothesized that interventions that prevent postoperative delirium might reduce the risk of long-term cognitive decline. Recent advances suggest that rather than waiting for the development of postoperative delirium to indicate whether a patient "passed" or "failed" this stress test, the status of the brain can be monitored in real-time via electroencephalography (EEG) in the perioperative period. Beyond the traditional intraoperative use of EEG monitoring for anesthetic titration, perioperative EEG may be a viable tool for identifying waveforms indicative of reduced brain integrity and potential risk for postoperative delirium and long-term cognitive decline. In principle, research incorporating routine perioperative EEG monitoring may provide insight into neuronal patterns of dysfunction associated with risk of postoperative delirium, long-term cognitive decline, or even specific types of aging-related neurodegenerative disease pathology. This research would accelerate our understanding of which waveforms or neuronal patterns necessitate diagnostic workup and intervention in the perioperative period, which could potentially reduce postoperative delirium and/or dementia risk. Thus, here we present recommendations for the use of perioperative EEG as a "predictor" of delirium and perioperative cognitive decline in older surgical patients.
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Affiliation(s)
- Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone Room 4315B, Box 3094, Durham, NC, 27710, USA.
- Duke Aging Center, Duke University Medical Center, Durham, NC, USA.
- Duke/UNC Alzheimer's Disease Research Center, Duke University Medical Center, Durham, NC, USA.
| | - David Ryu
- School of Medicine, Duke University, Durham, NC, USA
| | - Melody Reese
- Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone Room 4315B, Box 3094, Durham, NC, 27710, USA
- Duke Aging Center, Duke University Medical Center, Durham, NC, USA
| | - Steven McGuigan
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, Australia
| | - Lisbeth A Evered
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, Australia
- Weill Cornell Medicine, New York, NY, USA
| | - Catherine C Price
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - David A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, Australia
| | - M Brandon Westover
- Department of Neurology, Beth Israel Deaconess Hospital, Boston, MA, USA
| | - Roderic Eckenhoff
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Aoife Sweeney
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
- San Raffaele of Cassino, Cassino, FR, Italy
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9
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Lennertz RC, Sanders RD. The U-shaped curve predicting cognitive vulnerability to delirium severity. Brain 2023; 146:1743-1744. [PMID: 37019999 PMCID: PMC11004916 DOI: 10.1093/brain/awad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
This scientific commentary refers to ‘Extremes of baseline cognitive function determine the severity of delirium: a population study’ by Tsui et al. (https://doi.org/10.1093/brain/awad062).
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Affiliation(s)
- Richard C Lennertz
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Robert D Sanders
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, New South Wales, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, New South Wales, Australia
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10
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Li S, Li R, Li M, Cui Q, Zhang X, Ma T, Wang D, Zeng M, Li H, Bao Z, Peng Y, Sessler DI. Dexmedetomidine administration during brain tumour resection for prevention of postoperative delirium: a randomised trial. Br J Anaesth 2023; 130:e307-e316. [PMID: 36517290 DOI: 10.1016/j.bja.2022.10.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Delirium is common, especially after neurosurgery. Dexmedetomidine might reduce delirium by improving postoperative analgesia and sleep quality. We tested the primary hypothesis that dexmedetomidine administration during intracerebral tumour resection reduces the incidence of postoperative delirium. METHODS This randomised, double-blind, placebo-controlled trial was conducted in two tertiary-care hospitals in Beijing. We randomised 260 qualifying patients to either dexmedetomidine (n=130) or placebo (n=130). Subjects assigned to dexmedetomidine were given a loading dose of 0.6 μg kg-1 followed by continuous infusion at 0.4 μg kg-1 h-1 until dural closure; subjects in the placebo group were given comparable volumes of normal saline. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method twice daily during the initial 5 postoperative days. RESULTS The average (standard deviation) age of participating patients was 45 (12) yr, duration of surgery was 4.2 (1.5) h, and patients assigned to dexmedetomidine were given an average of 126 (45) μg of dexmedetomidine. There was less delirium during the initial 5 postoperative days in patients assigned to dexmedetomidine (22%, 28 of 130 patients) than in those given placebo (46%, 60 of 130 patients) with a risk ratio of 0.51 (95% confidence interval: 0.36-0.74, P<0.001). Postoperative pain scores with movement, and recovery and sleep quality were improved by dexmedetomidine (P<0.001). The incidence of safety outcomes was similar in each group. CONCLUSIONS Prophylactic intraoperative dexmedetomidine infusion reduced by half the incidence of delirium during the initial 5 postoperative days in patients recovering from elective brain tumour resection. CLINICAL TRIAL REGISTRATION NCT04674241.
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Affiliation(s)
- Shu Li
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Ruowen Li
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Muhan Li
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Qianyu Cui
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Xingyue Zhang
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Tingting Ma
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Dexiang Wang
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Min Zeng
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Hao Li
- Department of Anaesthesiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, PR China
| | - Zhaoshi Bao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Yuming Peng
- Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
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11
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Ahrens E, Tartler TM, Suleiman A, Wachtendorf LJ, Ma H, Chen G, Kendale SM, Kienbaum P, Subramaniam B, Wagner S, Schaefer MS. Dose-dependent relationship between intra-procedural hypoxaemia or hypocapnia and postoperative delirium in older patients. Br J Anaesth 2023; 130:e298-e306. [PMID: 36192221 DOI: 10.1016/j.bja.2022.08.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/28/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Previous studies indicated an association between impaired cerebral perfusion and post-procedural neurological disorders. We investigated whether intra-procedural hypoxaemia or hypocapnia are associated with delirium after surgery. METHODS Inpatients ≥60 yr of age undergoing anaesthesia for surgical or interventional procedures between 2009 and 2020 at an academic healthcare network in the USA (Massachusetts) were included in this hospital registry study. The primary exposure was intra-procedural hypoxaemia, defined as peripheral oxygen saturation <90% for >2 cohering min. The co-primary exposure was hypocapnia during general anaesthesia, defined as end-tidal carbon dioxide pressure ≤25 mm Hg for >5 cohering min. The primary outcome was delirium within 7 days after surgery. RESULTS Of 71 717 included patients, 1702 (2.4%) developed postoperative delirium, and hypoxaemia was detected in 2532 (3.5%). Of 42 894 patients undergoing general anaesthesia, 532 (1.2%) experienced hypocapnia. The occurrence of either hypoxaemia (adjusted odds ratio [ORadj]=1.71; 95% confidence interval [CI], 1.40-2.07; P<0.001) or hypocapnia (ORadj=1.77; 95% CI, 1.30-2.41; P<0.001) was associated with a higher risk of delirium within 7 days. Both associations were dependent on the magnitude, and increased with event duration (ORadj=1.03; 95% CI, 1.02-1.04; P<0.001 and ORadj=1.01; 95% CI, 1.00-1.01; P=0.005, for each minute increase in the longest continuous episode, respectively). There was no association between occurrence of hypercapnia and postoperative delirium (ORadj=1.24; 95% CI, 0.90-1.71; P=0.181). CONCLUSIONS Intra-procedural hypoxaemia and hypocapnia were dose-dependently associated with a higher risk of postoperative delirium. These findings support maintaining normal gas exchange to avoid postoperative neurological disorders.
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Affiliation(s)
- Elena Ahrens
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE) Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim M Tartler
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE) Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aiman Suleiman
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE) Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Luca J Wachtendorf
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE) Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Haobo Ma
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Guanqing Chen
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE) Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samir M Kendale
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Kienbaum
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Balachundhar Subramaniam
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Sadhguru Center for a Conscious Planet, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Soeren Wagner
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany; Department of Anesthesiology, Katharinenhospital Klinikum Stuttgart, Stuttgart, Germany
| | - Maximilian S Schaefer
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE) Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.
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12
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Guay CS, Kafashan M, Huels ER, Jiang Y, Beyoglu B, Spencer JW, Geczi K, Apakama G, Ju YES, Wildes TS, Avidan MS, Palanca BJA. Postoperative Delirium Severity and Recovery Correlate With Electroencephalogram Spectral Features. Anesth Analg 2023; 136:140-151. [PMID: 36130079 PMCID: PMC9653519 DOI: 10.1213/ane.0000000000006075] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Delirium is an acute syndrome characterized by inattention, disorganized thinking, and an altered level of consciousness. A reliable biomarker for tracking delirium does not exist, but oscillations in the electroencephalogram (EEG) could address this need. We evaluated whether the frequencies of EEG oscillations are associated with delirium onset, severity, and recovery in the postoperative period. METHODS Twenty-six adults enrolled in the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES; ClinicalTrials.gov NCT02241655) study underwent major surgery requiring general anesthesia, and provided longitudinal postoperative EEG recordings for this prespecified substudy. The presence and severity of delirium were evaluated with the confusion assessment method (CAM) or the CAM-intensive care unit. EEG data obtained during awake eyes-open and eyes-closed states yielded relative power in the delta (1-4 Hz), theta (4-8 Hz), and alpha (8-13 Hz) bands. Discriminability for delirium presence was evaluated with c-statistics. To account for correlation among repeated measures within patients, mixed-effects models were generated to assess relationships between: (1) delirium severity and EEG relative power (ordinal), and (2) EEG relative power and time (linear). Slopes of ordinal and linear mixed-effects models are reported as the change in delirium severity score/change in EEG relative power, and the change in EEG relative power/time (days), respectively. Bonferroni correction was applied to confidence intervals (CIs) to account for multiple comparisons. RESULTS Occipital alpha relative power during eyes-closed states offered moderate discriminability (c-statistic, 0.75; 98% CI, 0.58-0.87), varying inversely with delirium severity (slope, -0.67; 98% CI, -1.36 to -0.01; P = .01) and with severity of inattention (slope, -1.44; 98% CI, -2.30 to -0.58; P = .002). Occipital theta relative power during eyes-open states correlated directly with severity of delirium (slope, 1.28; 98% CI, 0.12-2.44; P = .007), inattention (slope, 2.00; 98% CI, 0.48-3.54; P = .01), and disorganized thinking (slope, 3.15; 98% CI, 0.66-5.65; P = .01). Corresponding frontal EEG measures recapitulated these relationships to varying degrees. Severity of altered level of consciousness correlated with frontal theta relative power during eyes-open states (slope, 11.52; 98% CI, 6.33-16.71; P < .001). Frontal theta relative power during eyes-open states correlated inversely with time (slope, -0.05; 98% CI, -0.12 to -0.04; P = .002). CONCLUSIONS Presence, severity, and core features of postoperative delirium covary with spectral features of the EEG. The cost and accessibility of EEG facilitate the translation of these findings to future mechanistic and interventional trials.
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Affiliation(s)
- Christian S Guay
- From the Department of Anesthesiology
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - MohammadMehdi Kafashan
- From the Department of Anesthesiology
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Emma R Huels
- Neuroscience Graduate Program
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | - Bora Beyoglu
- Baylor Scott and White Research Institute, Plano, Texas
| | | | - Kristin Geczi
- From the Department of Anesthesiology
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Yo-El S Ju
- From the Department of Anesthesiology
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Neurology
- Hope Center for Neurological Disorders
| | | | - Michael S Avidan
- From the Department of Anesthesiology
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Psychiatry
| | - Ben Julian A Palanca
- Department of Psychiatry
- Division of Biology and Biomedical Sciences
- Department of Biomedical Engineering; Washington University School of Medicine in St Louis, St Louis, Missouri
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13
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Tanabe S, Parker M, Lennertz R, Pearce RA, Banks MI, Sanders RD. Reduced Electroencephalogram Complexity in Postoperative Delirium. J Gerontol A Biol Sci Med Sci 2022; 77:502-506. [PMID: 34958346 PMCID: PMC8893195 DOI: 10.1093/gerona/glab352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Indexed: 09/12/2023] Open
Abstract
Delirium is associated with electroencephalogram (EEG) slowing and impairments in connectivity. We hypothesized that delirium would be accompanied by a reduction in the available cortical information (ie, there is less information processing occurring), as measured by a surrogate, Lempil-Ziv Complexity (LZC), a measure of time-domain complexity. Two ongoing perioperative cohort studies (NCT03124303, NCT02926417) contributed EEG data from 91 patients before and after surgery; 89 participants were used in the analyses. After cleaning and filtering (0.1-50Hz), the perioperative change in LZC and LZC normalized (LZCn) to a phase-shuffled distribution were calculated. The primary outcome was the correlation of within-patient paired changes in delirium severity (Delirium Rating Scale-98 [DRS]) and LZC. Scalp-wide threshold-free cluster enhancement was employed for multiple comparison correction. LZC negatively correlated with DRS in a scalp-wide manner (peak channel r2 = .199, p < .001). This whole brain effect remained for LZCn, though the correlations were weaker (peak channel r2 = .076, p = .010). Delirium diagnosis was similarly associated with decreases in LZC (peak channel p < .001). For LZCn, the topological significance was constrained to the midline posterior regions (peak channel p = .006). We found a negative correlation of LZC in the posterior and temporal regions with monocyte chemoattractant protein-1 (peak channel r2 = .264, p < .001, n = 47) but not for LZCn. Complexity of the EEG signal fades proportionately to delirium severity implying reduced cortical information. Peripheral inflammation, as assessed by monocyte chemoattractant protein-1, does not entirely account for this effect, suggesting that additional pathogenic mechanisms are involved.
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Affiliation(s)
- Sean Tanabe
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maggie Parker
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Richard Lennertz
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Matthew I Banks
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Sydney, Australia
- Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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14
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Chung CKE, Poon CCM, Irwin MG. Peri‐operative neurological monitoring with electroencephalography and cerebral oximetry: a narrative review. Anaesthesia 2022; 77 Suppl 1:113-122. [DOI: 10.1111/anae.15616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022]
Affiliation(s)
- C. K. E. Chung
- Department of Anaesthesiology Queen Mary Hospital Hong Kong China
| | - C. C. M. Poon
- Department of Anaesthesiology Queen Mary Hospital Hong Kong Special Administrative Region China
| | - M. G. Irwin
- Department of Anaesthesiology University of Hong Kong Hong Kong Special Administrative Region China
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15
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Kunkel D, Parker M, Casey C, Krause B, Pearce RA, Lennertz R, Sanders RD. Impact of postoperative delirium on days alive and at home after surgery: a prospective cohort study. Br J Anaesth 2021; 127:e205-e207. [PMID: 34598782 DOI: 10.1016/j.bja.2021.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- David Kunkel
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Margaret Parker
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Cameron Casey
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Bryan Krause
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Richard Lennertz
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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