Ramachandran Rushil Vladimir, Behera Alkananda, Hussain Zaid, Peck Jordan, Ananthakrishanan Ajay, Mathur Priyam, Banner-Goodspeed Valerie, Muehlschlegel J Danny, Pittet Jean-Francois, Bardia Amit, Schonberger Robert, Marcantonio Edward R, Kveraga Kestutis, Subramaniam Balachundhar
From the Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Anesth Analg. 2025 May 1;140(5):1086-1092. doi: 10.1213/ANE.0000000000007209.
Increased intraoperative electroencephalographic (EEG) burst suppression is associated with postoperative delirium. Cerebral desaturation is considered as one of the factors associated with burst suppression. Our study investigates the association between cerebral desaturation and burst suppression by analyzing their concurrence. Additionally, we aim to examine their association with cardiac surgical phases to identify potential for targeted interventions.
We retrospectively analyzed intraoperative 1-minute interval observations in 51 patients undergoing cardiac surgery. Processed EEG and cerebral oximetry were collected, with the anesthesiologists blinded to the information. The associations between cerebral desaturation (defined as a 10% decrease from baseline) and burst suppression, as well as with phase of cardiac surgery, were analyzed using the Generalized Logistic Mixed Effect Model. The results were presented as odds ratio and 95% confidence intervals (CIs). A value of P < .05 was considered statistically significant.
The odds of burst suppression increased 1.5 times with cerebral desaturation (odds ratio [OR], 1.52, 95% CI, 1.11-2.07; P = .009). Compared to precardiopulmonary bypass (pre-CPB), the odds of cerebral desaturation were notably higher during CPB (OR, 22.1, 95% CI, 12.4-39.2; P < .001) and post-CPB (OR, 18.2, 95% CI, 12.2-27.3; P < .001). However, the odds of burst suppression were lower during post-CPB (OR, 0.69, 95% CI, 0.59-0.81; P < .001) compared to pre-CPB. Compared to pre-CPB, the odds of concurrent cerebral desaturation and burst suppression were notably higher during CPB (OR, 52.3, 95% CI, 19.5-140; P < .001) and post-CPB (OR, 12.7, 95% CI, 6.39-25.2; P < .001). During CPB, the odds of cerebral desaturation (OR, 6.59, 95% CI, 3.62-12; P < .001) and concurrent cerebral desaturation and burst suppression (OR, 10, 95% CI, 4.01-25.1; P < .001) were higher in the period between removal of aortic cross-clamp and end of CPB. During the entire surgery, the odds of burst suppression increased 8 times with higher inhalational anesthesia concentration (OR, 7.81, 95% CI, 6.26-9.74; P < .001 per 0.1% increase).
Cerebral desaturation is associated with intraoperative burst suppression during cardiac surgery, most significantly during CPB, especially during the period between the removal of the aortic cross-clamp and end of CPB. Further exploration with simultaneous cerebral oximetry and EEG monitoring is required to determine the causes of burst suppression. Targeted interventions to address cerebral desaturation may assist in mitigating burst suppression and consequently enhance postoperative cognitive function.
术中脑电图（EEG）爆发抑制增加与术后谵妄相关。脑氧饱和度降低被认为是与爆发抑制相关的因素之一。我们的研究通过分析脑氧饱和度降低与爆发抑制的同时出现情况，来探究它们之间的关联。此外，我们旨在研究它们与心脏手术阶段的关联，以确定有针对性干预的可能性。
我们回顾性分析了51例接受心脏手术患者术中每分钟的观察数据。收集了处理后的脑电图和脑氧饱和度数据，麻醉医生对这些信息不知情。使用广义逻辑混合效应模型分析脑氧饱和度降低（定义为较基线下降10%）与爆发抑制之间的关联，以及与心脏手术阶段的关联。结果以比值比和95%置信区间（CI）表示。P <.05被认为具有统计学意义。
脑氧饱和度降低时爆发抑制的几率增加1.5倍（比值比[OR]，1.52，95% CI，1.11 - 2.07；P =.009）。与体外循环前（CPB前）相比，CPB期间脑氧饱和度降低的几率显著更高（OR，22.1，95% CI，12.4 - 39.2；P <.001）以及CPB后（OR，18.2，95% CI，12.2 - 27.3；P <.001）。然而，与CPB前相比，CPB后爆发抑制的几率较低（OR，0.69，95% CI，0.59 - 0.81；P <.001）。与CPB前相比，CPB期间和CPB后同时出现脑氧饱和度降低和爆发抑制的几率显著更高（CPB期间：OR，52.3，95% CI，19.5 - 140；P <.001；CPB后：OR，12.7，95% CI，6.39 - 25.2；P <.001）。在CPB期间，在主动脉阻断钳移除至CPB结束期间，脑氧饱和度降低（OR，6.59，95% CI，3.62 - 12；P <.001）以及同时出现脑氧饱和度降低和爆发抑制（OR，10，95% CI，4.01 - 25.1；P <.001）的几率更高。在整个手术过程中，吸入麻醉浓度每增加0.1%，爆发抑制的几率增加8倍（OR，7.81，95% CI，6.26 - 9.74；P <.001）。
脑氧饱和度降低与心脏手术期间术中爆发抑制相关，在CPB期间最为显著，尤其是在主动脉阻断钳移除至CPB结束期间。需要同时进行脑氧饱和度和脑电图监测的进一步探索，以确定爆发抑制的原因。针对脑氧饱和度降低的有针对性干预可能有助于减轻爆发抑制，从而改善术后认知功能。
