Targeted Interventions to Increase Blood Pressure and Decrease Anaesthetic Concentrations Reduce Intraoperative Burst Suppression: A Randomised, Interventional Clinical Trial.

Autor:	Georgii MT; Department of Anaesthesia and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Kreuzer M; Department of Anaesthesia and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Fleischmann A; Department of Anaesthesia and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Schuessler J; Department of Anaesthesia and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Schneider G; Department of Anaesthesia and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Pilge S; Department of Anaesthesia and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in systems neuroscience [Front Syst Neurosci] 2022 Mar 04; Vol. 16, pp. 786816. Date of Electronic Publication: 2022 Mar 04 (Print Publication: 2022).
DOI:	10.3389/fnsys.2022.786816
Abstrakt:	Background: 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. Objectives: We aimed to demonstrate that targeted anaesthetic interventions-treating intraoperative hypotension and/or reducing the anaesthetic concentration-reduce BSupp. Methods: 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). Results: 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. Conclusion: 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. Clinical Trial Registration: NCT03775356 [ClinicalTrials.gov], DRKS00015839 [German Clinical Trials Register (Deutsches Register klinischer Studien, DRKS)]. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Georgii, Kreuzer, Fleischmann, Schuessler, Schneider and Pilge.)
Databáze:	MEDLINE
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