Preoperative characterization of baseline EEG recordings for risk stratification of post-anesthesia care unit delirium
Institution:
1. Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Inova Fairfax Hospital/Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, VA 22042, USA;2. Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, 1364 Clifton Rd. Suite C220, Atlanta, GA 30322, USA;1. Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, United States of America;2. Department of Anesthesiology, Center for Blood Conservation, Duke University Medical Center, Durham, NC, United States of America;3. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America;4. Department of Medicine (Hematology), Oncology, and Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, United States of America;2. Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain;3. Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States;4. Department Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States;1. Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States of America;2. Department of Orthopaedics, New Jersey Medical School, Newark, NJ, United States of America;3. American Preventive Screening & Education Association (APSEA), Stratford, NJ, United States of America
Abstract:
Study objectiveDelirium in the post-anesthesia care unit (PACU-D) presents a serious condition with a high medical and socioeconomic impact. In particular, PACU-D is among common postoperative complications of elderly patients. As PACU-D may be associated with postoperative delirium, early detection of at-risk patients and strategies to prevent PACU-D are important. We characterized EEG baseline signatures of patients who developed PACU-D following surgery and general anesthesia and patients who did not.Design and settingWe conducted a post-hoc analysis of preoperative EEG recordings between patients with and without PACU-D, as indicated by positive bCAM scores post general anesthesia and surgery.Patients and measurementsPreoperative baseline EEG recordings from 89 patients were recorded at controlled eyes-open (focused wakefulness) and eyes-closed (relaxed wakefulness) conditions. We computed power spectral densities, permutation entropy, spectral entropy and spectral edge frequency to see if these parameters can reflect potential baseline EEG differences between PACU-D (31.5%) and noPACU-D (68.5%) patients. Wilcoxon's Rank Sum Test as well as AUC values were used to determine statistical significance.Main resultsBaseline EEG recordings showed significant differences between PACU-D and noPACU-D patients preoperatively. Compared to the noPACU-D group, PACU-D patients presented with lower power in higher frequencies during relaxed and focused wakefulness alike. These differences in power led to AUC values of 0.73 0.59;0.85] (permutation entropy) and 0.72 0.61;0.83] (spectral edge frequency) indicative of a “fair” performance to separate patients with and without PACU-D.ConclusionsThe baseline EEG of relaxed wakefulness as well as focused wakefulness may be used to assess the risk of developing PACU-D following surgery under general anesthesia. Moreover, routinely used monitoring parameters capture these differences as well, potentially allowing an easy transfer to clinical settings.Clinical trial number: NCT03775356
