We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial.
- Authors
Wildes, Troy S.; Mickle, Angela M.; Ben Abdallah, Arbi; Maybrier, Hannah R.; Oberhaus, Jordan; Budelier, Thaddeus P.; Kronzer, Alex; McKinnon, Sherry L.; Park, Daniel; Torres, Brian A.; Graetz, Thomas J.; Emmert, Daniel A.; Palanca, Ben J.; Goswami, Shreya; Jordan, Katherine; Lin, Nan; Fritz, Bradley A.; Stevens, Tracey W.; Jacobsohn, Eric; Schmitt, Eva M.
- Abstract
<bold>Importance: </bold>Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.<bold>Objective: </bold>To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.<bold>Design, Setting, and Participants: </bold>Randomized clinical trial of 1232 adults aged 60 years and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.<bold>Interventions: </bold>Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n = 614) or usual anesthetic care (n = 618).<bold>Main Outcomes and Measures: </bold>The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures included anesthetic concentration, EEG suppression, and hypotension. Adverse events included undesirable intraoperative movement, intraoperative awareness with recall, postoperative nausea and vomiting, medical complications, and death.<bold>Results: </bold>Of the 1232 randomized patients (median age, 69 years [range, 60 to 95]; 563 women [45.7%]), 1213 (98.5%) were assessed for the primary outcome. Delirium during postoperative days 1 to 5 occurred in 157 of 604 patients (26.0%) in the guided group and 140 of 609 patients (23.0%) in the usual care group (difference, 3.0% [95% CI, -2.0% to 8.0%]; P = .22). Median end-tidal volatile anesthetic concentration was significantly lower in the guided group than the usual care group (0.69 vs 0.80 minimum alveolar concentration; difference, -0.11 [95% CI, -0.13 to -0.10), and median cumulative time with EEG suppression was significantly less (7 vs 13 minutes; difference, -6.0 [95% CI, -9.9 to -2.1]). There was no significant difference between groups in the median cumulative time with mean arterial pressure below 60 mm Hg (7 vs 7 minutes; difference, 0.0 [95% CI, -1.7 to 1.7]). Undesirable movement occurred in 137 patients (22.3%) in the guided and 95 (15.4%) in the usual care group. No patients reported intraoperative awareness. Postoperative nausea and vomiting was reported in 48 patients (7.8%) in the guided and 55 patients (8.9%) in the usual care group. Serious adverse events were reported in 124 patients (20.2%) in the guided and 130 (21.0%) in the usual care group. Within 30 days of surgery, 4 patients (0.65%) in the guided group and 19 (3.07%) in the usual care group died.<bold>Conclusions and Relevance: </bold>Among older adults undergoing major surgery, EEG-guided anesthetic administration, compared with usual care, did not decrease the incidence of postoperative delirium. This finding does not support the use of EEG-guided anesthetic administration for this indication.<bold>Trial Registration: </bold>ClinicalTrials.gov Identifier: NCT02241655.
- Subjects
CARDIOTONIC agents; PHENYLEPHRINE; ALGORITHMS; ANESTHETICS; COMPARATIVE studies; ELECTROENCEPHALOGRAPHY; HYPOTENSION; INTRAOPERATIVE monitoring; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH funding; SURGICAL complications; OPERATIVE surgery; EVALUATION research; RANDOMIZED controlled trials; DISEASE incidence; GENERAL anesthesia; THERAPEUTICS
- Publication
JAMA: Journal of the American Medical Association, 2019, Vol 321, Issue 5, p473
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2018.22005