Electroencephalograph Guidance of Anesthesia to Alleviate Geriatric Syndromes (EN

描述(申请人提供)：精神错乱是几种老年综合征之一，也是最常见的术后并发症之一，影响高达70%的60岁以上的外科患者。精神错乱是一种急性变化，表现为注意力不集中和无法进行逻辑思维，患者及其家人深感痛苦。根据我们对1000名手术患者的调查，超过30%的人担心会经历精神错乱。神志不清的患者无法有效地参与康复训练，并容易患上其他老年病综合征，如摔倒。精神错乱的发生和持续时间与更长的重症监护病房和住院时间、持续的认知恶化、再次住院和 死亡率上升。此外，精神错乱带来了巨大的社会和经济负担，每位患者每年的成本超过6万美元。尽管精神错乱对患者和社会都很重要，但还没有一种方法被证明可以预防术后精神错乱。此外，术后精神错乱经常无法识别，手术患者出院后也没有得到系统的随访。如果不诊断精神错乱或术后跟踪患者，我们在测试任何干预措施预防或治疗术后精神错乱及其后遗症的有效性方面的能力是有限的。越来越多的证据表明，全身麻醉下的脑电引导可以减少术后的妄想。具体地说，我们的团队发现，在深度麻醉下出现的脑电模式受到抑制，与术后精神错乱和死亡的增加有关。因此，脑电图仪指导的麻醉缓解老年综合征(Engages)研究将比较两种麻醉方案在减少术后精神障碍方面的有效性。一个方案将基于当前的标准麻醉实践，另一个方案将基于脑电指导。我们还期望确定麻醉方案对患者报告的与健康相关的生活质量结果的影响。在华盛顿大学，我们成功地实施了一项雄心勃勃的研究，在手术前评估诊所招募患者，并跟踪他们在手术后30天和一年的健康和幸福感。这将使我们能够评估术后精神错乱的后果，并确定麻醉管理是否会影响患者报告的结果，如与健康相关的生活质量。我们还将探讨针对神志不清患者的多组分安全干预是否能预防下游不良事件，如跌倒。这项研究-通过其结构化的麻醉方案、对精神错乱的全面评估以及跟踪患者术后健康和幸福感的能力-S准备为护理面临术后精神错乱和其他不良后果风险的老年患者做出重大贡献。

DESCRIPTION (provided by applicant): Delirium is one of several geriatric syndromes, and is among the most common postoperative complications, affecting up to 70% of surgical patients older than 60. Delirium is an acute change that manifests as inattention and inability to think logically, and is deeply distressing to patients and their families. Based on our surveys of 1,000 surgical patients, over 30% were worried about experiencing delirium. Delirious patients are unable to participate effectively in rehabilitation exercises and are susceptible to other geriatri syndromes, like falls. The occurrence and duration of delirium are associated with longer intensive care unit and hospital stay, persistent cognitive deterioration, hospital readmission and increased mortality rate. Additionally, delirium carries a huge social and economic burden, costing over $60,000 per patient per year. Despite the importance of delirium to patients and to society, no approach has been proven to prevent postoperative delirium. Furthermore postoperative delirium is frequently unrecognized, and surgical patients are not followed systematically after they are discharged from hospital. Without diagnosing delirium or following patients postoperatively, we are limited in our ability to test the effectiveness of any interventin to prevent or treat postoperative delirium and its sequelae. There is mounting evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium. Specifically, our group has found that a suppressed electroencephalogram pattern, which occurs with deep anesthesia, is associated with increased delirium and death after surgery. The Electroencephalograph Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) Study will therefore compare the effectiveness of two anesthetic protocols for reduction of postoperative delirium. One protocol will be based on current standard anesthetic practice, and the other protocol will be based on electroencephalography guidance. We also expect to determine the impact of the anesthetic protocols on patient reported outcomes of health-related quality of life. At Washington University, we have successfully implemented an ambitious study that enrolls patients at the preoperative assessment clinic, and tracks their health and wellbeing at 30 days and at 1-year postoperatively. This will enable us to assess the consequences of postoperative delirium and to determine whether anesthetic management can impact patient reported outcomes, such as health-related quality of life. We shall also explore whether a multi-component safety intervention for delirious patients prevents downstream adverse events, like falls. The ENGAGES study - through its structured anesthesia protocols, its thorough approach to delirium assessment, and its ability to track patients' health and well-being postoperatively - s poised to make a major contribution to the care of elderly patients who are at risk of postoperative delirium and other adverse outcomes.