Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Plummer, George S.; Ibala, Reine; Hahm, Eunice; An, Jingzhi; Gitlin, Jacob; Deng, Hao; Shelton, Kenneth T.; Solt, Ken; Qu, Jason Z.; Akeju, Oluwaseun
• Is Part Of: Clinical neurophysiology. Volume 130:Issue 1(2019:Jan.)
• Page Start: 55
• Page End: 60
• Publication Date: 2019-01
• Subjects: General anesthesia -- EEG oscillations, alpha and beta oscillations -- Burst-suppression -- Post-operative delirium; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2018.11.003
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Intraoperative electroencephalogram burst-suppression is associated with post-operative delirium. Decreased alpha and beta power was evident in the EEG prior to the occurrence of burst-suppression. Decreased EEG alpha and beta power predicted the later incidence and duration of burst-suppression. Abstract: Objective: Electroencephalogram burst-suppression during general anesthesia is associated with post-operative delirium (POD). Whether burst-suppression causes POD or merely reflects susceptibility to POD is unclear. We hypothesized decreased intraoperative alpha (8–12 Hz) and beta (13–33 Hz) power prior to the occurrence of burst-suppression in susceptible patients. Methods: We analyzed intraoperative electroencephalogram data of cardiac surgical patients undergoing cardiopulmonary bypass (CPB). We detected the incidence and duration of CPB burst-suppression with an automated burst-suppression detection algorithm. We analyzed EEG data with multitaper spectral estimation methods. We assessed associations between patient characteristics and burst-suppression using Binomial and Zero-inflated Poisson Regression Models. Results: We found significantly decreased alpha and beta power (7.8–22.95 Hz) in the CPB burst-suppression cohort. The odds ratio for the association between point estimates for alpha and beta power (7.8–22.95 Hz) and the incidence of burst-suppression was 0.88 (95% CI: 0.79–0.98). The incidence rate ratio for the association between point estimates for power between the alpha and beta range and the duration of burst-suppression was 0.89 (95% CI: 0.84–0.93). Conclusion: Decreased intra-operative power within the alpha and beta range was associated with susceptibility to burst-suppression during CPB. Significance: This dynamic may be used to develop principled neurophysiological-based approaches to aid the preemptive identification and targeted care of POD vulnerable patients.