Koch Susanne, Spies Claudia
Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Curr Opin Anaesthesiol. 2019 Feb;32(1):101-107. doi: 10.1097/ACO.0000000000000677.
To summarize recent recommendations on intraoperative electroencephalogram (EEG) neuromonitoring in the elderly aimed at the prevention of postoperative delirium and long-term neurocognitive decline. We discuss recent perioperative EEG investigations relating to aging and cognitive dysfunction, and their implications on intraoperative EEG neuromonitoring in elderly patients.
The incidence of postoperative delirium in elderly can be reduced by monitoring depth of anesthesia, using an index number (0-100) derived from processed frontal EEG readings. The recently published European Society of Anaesthesiology guideline on postoperative delirium in elderly now recommends guiding general anesthesia with such indices (Level A). However, intraoperative EEG signatures are heavily influenced by age, cognitive function, and choice of anesthetic agents. Detailed spectral EEG analysis and research on EEG-based functional connectivity provide new insights into the pathophysiology of neuronal excitability, which is seen in elderly patients with postoperative delirium.
Anesthesiologists should become acquainted with intraoperative EEG signatures and their relation to age, anesthetic agents, and the risk of postoperative cognitive complications. A working knowledge would allow an optimized and individualized provision of general anesthesia for the elderly.
总结近期关于老年人术中脑电图（EEG）神经监测的建议，旨在预防术后谵妄和长期神经认知功能下降。我们讨论了近期与衰老和认知功能障碍相关的围手术期脑电图研究，以及它们对老年患者术中脑电图神经监测的影响。
通过监测麻醉深度，使用从处理后的额叶脑电图读数得出的指数（0 - 100），可以降低老年人术后谵妄的发生率。最近发表的欧洲麻醉学会关于老年人术后谵妄的指南现在建议使用此类指数指导全身麻醉（A级）。然而，术中脑电图特征受年龄、认知功能和麻醉药物选择的影响很大。详细的脑电图频谱分析和基于脑电图的功能连接研究为术后谵妄老年患者中所见的神经元兴奋性病理生理学提供了新的见解。
麻醉医生应熟悉术中脑电图特征及其与年龄、麻醉药物和术后认知并发症风险的关系。具备实用知识将有助于为老年人优化并个性化地提供全身麻醉。
