Newly Published
Perioperative Medicine  |   June 2018
Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis
Author Notes
  • From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California (K.K.M., J.M.L.); Department of Kinesiology, University of Indianapolis, Indianapolis, Indiana (A.M.B.-S.); and Virginia Polytechnic Institute and State University, Center for Gerontology, Blacksburg, Virginia (L.P.S.).
  • Submitted for publication May 17, 2017. Accepted for publication May 22, 2018.
    Submitted for publication May 17, 2017. Accepted for publication May 22, 2018.×
  • Research Support: Supported in part by National Institute on Aging of the National Institutes of Health (Bethesda, Maryland) grant Nos. R21AG04845602 and R21AG05371501A1.
    Research Support: Supported in part by National Institute on Aging of the National Institutes of Health (Bethesda, Maryland) grant Nos. R21AG04845602 and R21AG05371501A1.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Leung: 500 Parnassus Avenue, Room MUE-415, University of California, San Francisco, California 94143-0648. Jacqueline.Leung@ucsf.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems
Perioperative Medicine   |   June 2018
Processed Electroencephalogram Monitoring and Postoperative Delirium: A Systematic Review and Meta-analysis
Anesthesiology Newly Published on June 14, 2018. doi:10.1097/ALN.0000000000002323
Anesthesiology Newly Published on June 14, 2018. doi:10.1097/ALN.0000000000002323
Abstract

Background: Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction.

Methods: A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs.

Results: Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76).

Conclusions: Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.