Effect of electroencephalogram-guided anaesthesia administration on 1-yr mortality: follow-up of a randomised clinical trial.

Autor:	Fritz BA; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: bafritz@wustl.edu., King CR; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Mickle AM; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Wildes TS; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Budelier TP; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Oberhaus J; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Park D; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Maybrier HR; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Ben Abdallah A; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Kronzer A; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., McKinnon SL; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Torres BA; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Graetz TJ; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Emmert DA; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Palanca BJ; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Stevens TW; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., Stark SL; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA., Lenze EJ; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA., Avidan MS; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
Jazyk:	angličtina
Zdroj:	British journal of anaesthesia [Br J Anaesth] 2021 Sep; Vol. 127 (3), pp. 386-395. Date of Electronic Publication: 2021 Jul 07.
DOI:	10.1016/j.bja.2021.04.036
Abstrakt:	Background: Intraoperative EEG suppression duration has been associated with postoperative delirium and mortality. In a clinical trial testing anaesthesia titration to avoid EEG suppression, the intervention did not decrease the incidence of postoperative delirium, but was associated with reduced 30-day mortality. The present study evaluated whether the EEG-guided anaesthesia intervention was also associated with reduced 1-yr mortality. Methods: This manuscript reports 1 yr follow-up of subjects from a single-centre RCT, including a post hoc secondary outcome (1-yr mortality) in addition to pre-specified secondary outcomes. The trial included subjects aged 60 yr or older undergoing surgery with general anaesthesia between January 2015 and May 2018. Patients were randomised to receive EEG-guided anaesthesia or usual care. The previously reported primary outcome was postoperative delirium. The outcome of the current study was all-cause 1-yr mortality. Results: Of the 1232 subjects enrolled, 614 subjects were randomised to EEG-guided anaesthesia and 618 subjects to usual care. One-year mortality was 57/591 (9.6%) in the guided group and 62/601 (10.3%) in the usual-care group. No significant difference in mortality was observed (adjusted absolute risk difference, -0.7%; 99.5% confidence interval, -5.8% to 4.3%; P=0.68). Conclusions: An EEG-guided anaesthesia intervention aiming to decrease duration of EEG suppression during surgery did not significantly decrease 1-yr mortality. These findings, in the context of other studies, do not provide supportive evidence for EEG-guided anaesthesia to prevent intermediate term postoperative death. Clinical Trial Registration: NCT02241655. (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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