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Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction: a randomised controlled trial
Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Department of Anaesthesiology, Linköping University, Linköping, Sweden.ORCID iD: 0000-0001-6128-7752
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2011 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 3, p. 213-219Article in journal (Refereed) Published
Abstract [en]

Background: Post-operative cognitive dysfunction (POCD) after non-cardiac surgery is a well known problem in some categories of patients. This study aims to evaluate the influence of auditory evoked potential (AEP)-guided anaesthesia on the requirement for anaesthetic drugs and their influence on POCD.

Methods: Four hundred and fifty patients aged between 18 and 92 years scheduled for ophthalmic surgery under general anaesthesia were assigned randomly to one of two groups. In group A (AEP group), the depth of anaesthesia (DoA) was aimed at an AEP index (AAI) between 15 and 25. In group C (control group), DoA was guided by clinical signs. Hypotension was treated with fluids and vasopressors using a standardised algorithm. A mini-mental test and the Cognitive Failure Questionnaire were used to evaluate cognitive function.

Results: Anaesthetic drug requirements were significantly lower in group A than in group C: propofol 92.526.5 vs. 103.839.5mg (P¼<0.001) and desflurane end-tidal concentration 2.50.58 vs. 3.30.79% (P<0.001). In group A, 36 patients (16%) received additional fluids and vasopressors compared to 65 patients (29%) in group C (P<0.01). AAI values differed significantly between the groups: 18 (11–21) in group A vs. 12 (10–19) in group C (P<0.001). The number of patients with POCD was 16 in group C compared to two in group A (P<0.001) at day 1 post-operation.

Conclusion: AEP monitoring allows dose reduction of anaesthetic agents, leading to better cardiovascular stability and decreased requirements for intra-operative fluids and vasopressors. Cognitive decline seen following minor ophthalmic surgery, even when anaesthesia is assessed clinically, is short-lived with no long-term sequelae.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2011. Vol. 28, no 3, p. 213-219
Keywords [en]
Auditory evoked potential monitoring, cognitive decline, general anaesthesia, minor surgery
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-34015DOI: 10.1097/EJA.0b013e328340dbb9ISI: 000287439400014PubMedID: 21088592Scopus ID: 2-s2.0-79953879703OAI: oai:DiVA.org:oru-34015DiVA, id: diva2:699963
Available from: 2014-03-03 Created: 2014-03-03 Last updated: 2018-05-05Bibliographically approved
In thesis
1. Influence of depth of anesthesia on postoperative cognitive dysfunction (POCD) and inflammatory markers
Open this publication in new window or tab >>Influence of depth of anesthesia on postoperative cognitive dysfunction (POCD) and inflammatory markers
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients may suffer from various forms of postoperative cognitive dysfunction (POCD). In most cases, the impact on cognitive function is relatively transient but POCD can sometimes be long-lasting (> 1 year). Studies showing that up to one in four patients with known risk factors are affected by some form of cognitive loss. The cause of cognitive impairment after surgery and anaesthesia is still unclear. One hypothesis is that anaesthetic drugs may have an impact on the inflammatory process which occurs in conjunction to the tissue trauma caused by surgery. Titrating anaesthetic administration by the use of a depth of anaesthesia (DOA) monitors (AEP or BIS), usually reduce anaesthetic consumption and facilitate early recovery. In the initial two studies, the EEG-based DOA monitoring (AEP) was compared with a control group with standard monitoring for administration of anaesthesia. The AEP group required less anaesthetics and opioids and had faster early recovery but was also associated with a lower number of patients with < 25 MMSE score at 24-hours. We found in study III a relationship between the DOA and postoperative inflammatory response (IL-6). Patients with < 25 MMSE score had higher postoperative 24 hrs IL-6 levels. In the final study, we investigated the attitudes and knowledge among Swedish anaesthesiologists and nurse anaesthetists including the use of DOA, and to what extent written procedures regarding the pre-and postoperative cognitivedysfunction were used.

In conclusion, our studies show, the EEG-based guided DOA monitoring reduces consumption of anaesthetics and opioids during surgery, allows a faster postoperative recovery, and reduces the occurrence of cognitive impairment the first day after surgery and decrease inflammatory response after eye surgery. We found also an association between perioperative DOA, cognitive impairment and an increased inflammatory response after surgery. The interest and knowledge about assessment and management of neurocognitive side-effects before and after anaesthesia was found to be low among anaesthesiologists and nurse anaesthetists. They were critical about the benefits of the DOA monitoring. Swedish anaesthesiologists and nurse anaesthetists need to improve their knowledge of assessment and management of cognitive dysfunction.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2014. p. 94
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 101
Keywords
Postoperative cognitive dysfunction, minor and major surgery, anaesthesia, depth of anaesthesia monitoring, auditory evoked potential, AAI, inflammatory marker
National Category
Medical and Health Sciences Surgery
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32842 (URN)978-91-7668-987-5 (ISBN)
Public defence
2014-02-07, Hörsal C2, Campus USÖ, Universitetssjukhuset, S Grev Rosengatan, 701 85 Örebro, 08:45 (Swedish)
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Available from: 2014-01-23 Created: 2013-12-19 Last updated: 2017-10-17Bibliographically approved

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Jildenstål,, Pether K.Rawal, NarinderGupta, AnilBerggren, Lars

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