Georgii Marie-Therese, Kreuzer Matthias, Fleischmann Antonia, Schuessler Jule, Schneider Gerhard, Pilge Stefanie
Department of Anaesthesia and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Front Syst Neurosci. 2022 Mar 4;16:786816. doi: 10.3389/fnsys.2022.786816. eCollection 2022.
It has been suggested that intraoperative electroencephalographic (EEG) burst suppression (BSupp) may be associated with post-operative neurocognitive disorders in the elderly, and EEG-guided anaesthesia may help to reduce BSupp. Despite of this suggestion, a standard treatment does not exist, as we have yet to fully understand the phenomenon and its underlying pathomechanism. This study was designed to address two underlying phenomena-cerebral hypoperfusion and individual anaesthetic overdose.
We aimed to demonstrate that targeted anaesthetic interventions-treating intraoperative hypotension and/or reducing the anaesthetic concentration-reduce BSupp.
We randomly assigned patients to receive EEG-based interventions during anaesthesia or EEG-blinded standard anaesthesia. If BSupp was detected, defined as burst suppression ratio (BSR) > 0, the primary intervention aimed to adjust the mean arterial blood pressure to patient baseline (MAP intervention) followed by reduction of anaesthetic concentration (MAC intervention).
EEG-based intervention significantly reduced total cumulative BSR, BSR duration, and maximum BSR. MAP intervention caused a significant MAP increase at the end of a BSR > 0 episode compared to the control group. Coincidentally, the maximum BSR decreased significantly; in 55% of all MAP interventions, the BSR decreased to 0% without any further action. In the remaining events, additional MAC intervention was required.
Our results show that targeted interventions (MAC/MAP) reduce total cumulative amount, duration, and maximum BSR > 0 in the elderly undergoing general anaesthesia. Haemodynamic intervention already interrupted or reduced BSupp, strengthening the current reflections that hypotension-induced cerebral hypoperfusion may be seen as potential pathomechanism of intraoperative BSupp.
NCT03775356 [ClinicalTrials.gov], DRKS00015839 [German Clinical Trials Register (Deutsches Register klinischer Studien, DRKS)].
有研究表明，术中脑电图（EEG）爆发抑制（BSupp）可能与老年人术后神经认知障碍有关，而EEG引导下的麻醉可能有助于减少BSupp。尽管有此建议，但目前尚无标准治疗方法，因为我们尚未完全了解这一现象及其潜在的病理机制。本研究旨在探讨两个潜在现象——脑灌注不足和个体麻醉过量。
我们旨在证明针对性的麻醉干预——治疗术中低血压和/或降低麻醉浓度——可减少BSupp。
我们将患者随机分配，使其在麻醉期间接受基于EEG的干预或EEG盲法标准麻醉。如果检测到BSupp，定义为爆发抑制率（BSR）>0，则主要干预措施旨在将平均动脉血压调整至患者基线水平（MAP干预），随后降低麻醉浓度（MAC干预）。
基于EEG的干预显著降低了总累积BSR、BSR持续时间和最大BSR。与对照组相比，MAP干预在BSR>0发作结束时导致MAP显著升高。巧合的是，最大BSR显著下降；在所有MAP干预中，55%的BSR降至0%，无需采取任何进一步措施。在其余情况下，则需要额外的MAC干预。
我们的结果表明，针对性干预（MAC/MAP）可减少接受全身麻醉的老年人的总累积量、持续时间和最大BSR>0。血流动力学干预已经中断或减少了BSupp，强化了目前的观点，即低血压引起的脑灌注不足可能被视为术中BSupp的潜在病理机制。
NCT03775356 [ClinicalTrials.gov]，DRKS00015839 [德国临床试验注册中心（Deutsches Register klinischer Studien，DRKS）]
