Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass

• Published in: Clinical neurophysiology Vol. 130; no. 1; pp. 55 - 60
• Main Authors: Plummer, George S., Ibala, Reine, Hahm, Eunice, An, Jingzhi, Gitlin, Jacob, Deng, Hao, Shelton, Kenneth T., Solt, Ken, Qu, Jason Z., Akeju, Oluwaseun
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2019
• Subjects: Aged; Anesthesia, General - adverse effects; Anesthesia, General - trends; Brain Waves - physiology; Burst-suppression; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - trends; EEG oscillations, alpha and beta oscillations; Electroencephalography - adverse effects; Electroencephalography - trends; Female; General anesthesia; Humans; Incidence; Intraoperative Complications - diagnosis; Intraoperative Complications - physiopathology; Male; Middle Aged; Monitoring, Intraoperative - methods; Monitoring, Intraoperative - trends; Post-operative delirium; Predictive Value of Tests; General anesthesia; Post-operative delirium; EEG oscillations, alpha and beta oscillations; Burst-suppression
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2018.11.003

•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. 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. 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. 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). Decreased intra-operative power within the alpha and beta range was associated with susceptibility to burst-suppression during CPB. This dynamic may be used to develop principled neurophysiological-based approaches to aid the preemptive identification and targeted care of POD vulnerable patients.