ADAPT-2: A Randomized Clinical Trial to Reduce Intraoperative EEG Suppression in Older Surgical Patients Undergoing Major Noncardiac Surgery.
ADAPT-2: A Randomized Clinical Trial to Reduce Intraoperative EEG Suppression in Older Surgical Patients Undergoing Major Noncardiac Surgery.
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DOI：
10.1213/ane.0000000000004713
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发表时间：
2020-10
影响因子：
5.7
通讯作者：
Leung JM
中科院分区：
文献类型：
--
作者：
Tang CJ;Jin Z;Sands LP;Pleasants D;Tabatabai S;Hong Y;Leung JM
最近有限的证据表明，使用脑电监护仪来指导麻醉管理可能会影响术后的认知结果，然而，其机制尚不清楚。这项探索性的单中心随机临床试验纳入了接受择期非心脏手术的65岁≥患者。这项研究的目的是确定使用经过处理的脑电监测器监测大脑是否减少了脑电抑制和随后的术后精神错乱。干预组接受脑电引导的麻醉处理，使患者状态指数(PSI)保持在SEDLine脑功能监测仪计算的35以上，而标准护理组也接受监测，但脑电数据对临床医生保密。主要结果是术中脑电抑制。次要结果是术后前三天内发生的术后精神错乱。所有结果均采用意向治疗范式进行分析。204例患者平均年龄(72±5)岁。根据手术时间调整的脑电抑制分钟数，干预组少于标准护理组(中位数，四分位数范围分别为1.4%(5.0%)和2.5%(10.4%)；Hodges-Lehmann估计的中位数差值(95%CI)为−0.8%(−2.1%，−0.000009%)。术前有认知功能障碍组和无认知功能障碍组干预对脑电的抑制作用不同(交互作用P=0.01)，术前有认知功能障碍组和无认知功能障碍组的发病率比和95%CI分别为0.39(0.33，0.44)和0.48(0.44，0.51)。干预组(17%)和标准护理组(20%)的精神障碍发生率差异无统计学意义，风险比=0.85，95%可信区间(CI)=(0.47，1.5)。使用经过处理的脑电来维持PSI和GT；35与术中脑电抑制所花费的时间较少相关。术前认知障碍与手术时间花在脑电抑制上的百分比较大有关。有必要进行一项更大规模的前瞻性队列研究，以显示减少脑电抑制的干预措施在减少术后精神障碍方面是否有效。
Recent limited evidence suggests that the use of processed electroencephalographic (EEG) monitor to guide anesthetic management may influence postoperative cognitive outcomes, however, the mechanism is unclear. This exploratory single center, randomized clinical trial included patients who were ≥ 65 years of age undergoing elective non-cardiac surgery. The study aimed to determine whether monitoring the brain using a processed EEG monitor reduced EEG suppression and subsequent postoperative delirium. The interventional group received processed EEG-guided anesthetic management to keep the Patient State Index (PSI) above 35 computed by the SEDline Brain Function Monitor while the standard care group was also monitored but the EEG data were blinded from the clinicians. The primary outcome was intraoperative EEG suppression. A secondary outcome was incident postoperative delirium during the first three days after surgery. All outcomes were analyzed using the intention-to-treat paradigm. 204 patients with a mean age of 72 ± 5 years were studied. Minutes of EEG suppression adjusted by the length of surgery was found to be less for the interventional group than the standard care group (median, interquartile range 1.4% (5.0%) and 2.5% (10.4%); Hodges-Lehmann estimated median difference (95% CI) of −0.8% (−2.1%, −0.000009%). The effect of the intervention on EEG suppression differed for those with and without preoperative cognitive impairment (interaction P=0.01), with the estimated incidence rate ratio and 95% CI of 0.39 (0.33, 0.44) for those with preoperative cognitive impairment and 0.48 (0.44, 0.51) for those without preoperative cognitive impairment. The incidence of delirium was not found to be different between the interventional (17%) and the standard care groups (20%), risk ratio = 0.85, 95% confidence interval (CI) = (0.47, 1.5). The use of processed EEG to maintain the PSI >35 was associated with less time spent in intraoperative EEG suppression. Preoperative cognitive impairment was associated with greater percent of surgical time spent in EEG suppression. A larger prospective cohort study to include more cognitively vulnerable patients is necessary to show whether an intervention to reduce EEG suppression is efficacious in reducing postoperative delirium.