Anaesthetic depth and delirium after major surgery: a randomised clinical trial.

Autor:	Evered LA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Critical Care Medicine, University of Melbourne, Melbourne, VIC, Australia. Electronic address: lae4004@med.cornell.edu., Chan MTV; Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China., Han R; Department of Anesthesiology, Beijing Tiantan Hospital and Capital Medical University, Beijing, China., Chu MHM; Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China., Cheng BP; Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China., Scott DA; Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Critical Care Medicine, University of Melbourne, Melbourne, VIC, Australia., Pryor KO; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA., Sessler DI; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA., Veselis R; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Frampton C; Department of Medicine, University of Otago, Christchurch, New Zealand., Sumner M; Department of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand., Ayeni A; Department of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand., Myles PS; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, VIC, Australia., Campbell D; Department of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand; Department of Anaesthesiology, University of Auckland, Auckland, New Zealand., Leslie K; Department of Critical Care Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia., Short TG; Department of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand; Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
Jazyk:	angličtina
Zdroj:	British journal of anaesthesia [Br J Anaesth] 2021 Nov; Vol. 127 (5), pp. 704-712. Date of Electronic Publication: 2021 Aug 28.
DOI:	10.1016/j.bja.2021.07.021
Abstrakt:	Background: Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia). Methods: This multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary outcomes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression. Results: The incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38-0.88]; P=0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS ≤6 vs 20%; P<0.001). Conclusions: Among patients undergoing major surgery, targeting light anaesthesia reduced the risk of postoperative delirium and cognitive impairment at 1 yr. Clinical Trial Registration: ACTRN12612000632897. (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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