AUTHOR=Xu Na , Li Li-Xia , Wang Tian-Long , Jiao Li-Qun , Hua Yang , Yao Dong-Xu , Wu Jie , Ma Yan-Hui , Tian Tian , Sun Xue-Li 

TITLE=Processed Multiparameter Electroencephalogram-Guided General Anesthesia Management Can Reduce Postoperative Delirium Following Carotid Endarterectomy: A Randomized Clinical Trial

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.666814

DOI=10.3389/fneur.2021.666814

ISSN=1664-2295

ABSTRACT=Background: Patients undergoing carotid endarterectomy (CEA) for severe carotid stenosis are vulnerable to postoperative delirium(POD), a complication frequently associated with poor outcome. This study investigated the impact of processed electroencephalogram (EEG)-guided anesthesia management on the incidence of postoperative delirium in patients undergoing CEA.
Methods: This single-center, prospective, randomized clinical trial compared outcomes among 255 patients receiving CEA under general anesthesia with routine monitoring (standard group, n = 128) or processed EEG-guided monitoring [SEDLine Brain Function Monitor (Masimo, Inc, Irvine, CA)] to reduce the risk of intraoperative EEG burst suppression (intervention group, n = 127). All patients were monitored by continuous transcranial Doppler ultrasound (TCD) and near-infrared spectroscopy (NIRS) to avoid perioperative cerebral hypoperfusion or hyperperfusion. According to the surgical process, EEG suppression time was calculated separately for three stages: S1 (from anesthesia induction to carotid artery clamping), S2 (from clamping to declamping), and S3 (from declamping to the end of surgery). The primary outcome was incidence of postoperative delirium according to the Confusion Assessment Method algorithm during the first 3 days post-surgery, and secondary outcomes were other neurologic complications and length of hospital stay.
Results:No episodes of cerebral hypoperfusion or hyperperfusion according to TCD and NIRS monitoring in either group during surgery.  The incidence of POD within 3 days post-surgery was significantly lower in the interventional group than the standard group (7.87% vs. 28.91%, P < 0.01). In the intervention group, the total EEG suppression time and the EEG suppression time during S2 and S3 were shorter [Total, 0.63(3.70)	vs. 2.63(6.60) min, P =	0.043; S2, 0(0) vs. 0.72(1.66) min, P ＜ 0.001; S3, 0(0.35) vs. 0.40(1.43) min, P = 0.031]. Logistic analysis indicated that the reduction in postoperative delirium was strongly associated with processed EEG-guided anesthesia management [odds ratio 0.267 (99.5% Confidence Interval 0.112–0.638)]. There were no group differences in incidence of neurologic complications and length of postoperative hospital stay.
Conclusion: Processed electroencephalogram-guide general anesthesia management can significantly reduce the risk of postoperative delirium in patients undergoing CEA. Patients may benefit from EEG monitoring during surgery, especially those exhibiting hemodynamic fluctuations or receiving surgical procedures that disrupt brain perfusion.