Anaesthetic depth and delirium: a challenging balancing act.
Anaesthetic depth and delirium: a challenging balancing act.
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DOI：
10.1016/j.bja.2021.08.003
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发表时间：
2021-09
影响因子：
9.8
通讯作者：
E. Whitlock;E. Gross;C. King;M. Avidan
中科院分区：
文献类型：
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作者：
E. Whitlock;E. Gross;C. King;M. Avidan
这篇社论强调了Delirium平衡麻醉研究的结果，该研究是6644名患者平衡麻醉试验的515名患者的子研究，该研究发现，在接受重大非心脏手术的患者中进行靶向深度麻醉与术后死亡率或主要发病率的显著增加无关。这项子研究发现，使用脑电双频指数(BIS)指导，意图故意实现基于深度挥发性药物的麻醉(目标BIS读数为35vs50)显著增加妄想症的发生率(28%vs19%)，但不会增加亚综合征妄想症的发生率(45%vs49%)。我们讨论了这些发现对麻醉实践的影响，并讨论了是否应该使用BIS作为指导，为预防精神错乱提供精确的麻醉。我们假设，这项多中心亚研究中基于亚群的差异可能影响了精神错乱的发生，因为研究结果似乎依赖于东亚患者的结果。我们的结论是，深度麻醉是否以及对谁来说是致幻性的问题仍然没有答案。
This editorial highlights the findings of the Balanced Anaesthesia Delirium study, a 515-patient substudy of the 6644 patient Balanced Anaesthesia trial, which found that targeting deep anaesthesia in patients undergoing major noncardiac surgery was not associated with significantly increased postoperative death or major morbidity. The substudy found that using bispectral index (BIS) guidance with the intention of deliberately achieving deep volatile agent-based anaesthesia (target BIS reading 35vs50) significantly increased delirium incidence (28%vs19%), although not subsyndromal delirium incidence (45%vs49%). We discuss the implications of these findings for anaesthetic practice, and address whether the BIS should be used as a guide to deliver precision anaesthesia for delirium prevention. We posit that subpopulation-based differences within this multicentre substudy could have affected delirium occurrence, since the findings appeared to rest on outcomes in patients from East Asia. We conclude that questions of whether and for whom deep anaesthesia is deliriogenic remain unanswered.