Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: a prospective, observational study

Authors: Martin Soehle, Alexander Dittmann, Richard K Ellerkmann, Georg Baumgarten, Christian Putensen, Ulf Guenther

Published in: BMC Anesthesiology | Issue 1/2015

Login to get access

Abstract

Background

Postoperative delirium (POD) occurs frequently after cardiac surgery and is associated with increased morbidity and mortality. We analysed whether perioperative bilateral BIS monitoring may detect abnormalities before the onset of POD in cardiac surgery patients.

Methods

In a prospective observational study, 81 patients undergoing cardiac surgery were included. Bilateral Bispectral Index (BIS)-monitoring was applied during the pre-, intra- and postoperative period, and BIS, EEG Asymmetry (ASYM), and Burst Suppression Ratio (BSR) were recorded. POD was diagnosed according to the Confusion Assessment Method for the Intensive Care Unit, and patients were divided into a delirium and non-delirium group.

Results

POD was detected in 26 patients (32%). A trend towards a lower ASYM was observed in the delirium group as compared to the non-delirium group on the preoperative day (ASYM = 48.2 ± 3.6% versus 50.0 ± 4.7%, mean ± sd, p = 0.087) as well as before induction of anaesthesia, with oral midazolam anxiolysis (median ASYM = 49.5%, IQR [47.4;51.5] versus 50.6%, IQR [49.1;54.2], p = 0.081). Delirious patients remained significantly (p = 0.018) longer in a burst suppression state intraoperatively (107 minutes, IQR [47;170] versus 44 minutes, IQR [11;120]) than non-delirious patients. Receiver operating analysis revealed burst suppression duration (area under the curve = 0.73, p = 0.001) and BSR (AUC = 0.68, p = 0.009) as predictors of POD.

Conclusions

Intraoperative assessment of BSR may identify patients at risk of POD and should be investigated in further studies. So far it remains unknown whether there is a causal relationship or rather an association between intraoperative burst suppression and the development of POD.

Trial registration

clinicaltrials.gov NCT01048775
Literature
1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders - DSM-IV-TR. 4th ed. Washington DC: American Psychiatric Association; 2000.
2.
Guenther U, Theuerkauf N, Frommann I, Brimmers K, Malik R, Stori S, et al. Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study. Ann Surg. 2013;257(6):1160–7.CrossRefPubMed
3.
Mu DL, Wang DX, Li LH, Shan GJ, Li J, Yu QJ, et al. High serum cortisol level is associated with increased risk of delirium after coronary artery bypass graft surgery: a prospective cohort study. Crit Care. 2010;14(6):R238.CrossRefPubMedPubMedCentral
4.
van der Mast RC, van den Broek WW, Fekkes D, Pepplinkhuizen L, Habbema JD. Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res. 1999;46(5):479–83.CrossRefPubMed
5.
Whitlock EL, Torres BA, Lin N, Helsten DL, Nadelson MR, Mashour GA, et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg. 2014;118(4):809–17.CrossRefPubMedPubMedCentral
6.
Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell Jr FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753–62.CrossRefPubMed
7.
Guenther U, Radtke FM. Delirium in the postanaesthesia period. Curr Opin Anaesthesiol. 2011;24(6):670–5.CrossRefPubMed
8.
9.
Plaschke K, Hill H, Engelhardt R, Thomas C, von Haken R, Scholz M, et al. EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit. Anaesthesia. 2007;62(12):1217–23.CrossRefPubMed
10.
Thomas C, Hestermann U, Kopitz J, Plaschke K, Oster P, Driessen M, et al. Serum anticholinergic activity and cerebral cholinergic dysfunction: an EEG study in frail elderly with and without delirium. BMC Neurosci. 2008;9:86.CrossRefPubMedPubMedCentral
11.
Reischies FM, Neuhaus AH, Hansen ML, Mientus S, Mulert C, Gallinat J. Electrophysiological and neuropsychological analysis of a delirious state: the role of the anterior cingulate gyrus. Psychiatry Res. 2005;138(2):171–81.CrossRefPubMed
12.
Soehle M, Ellerkmann RK, Grube M, Kuech M, Wirz S, Hoeft A, et al. Comparison between bispectral index and patient state index as measures of the electroencephalographic effects of sevoflurane. Anesthesiology. 2008;109(5):799–805.CrossRefPubMed
13.
Soehle M, Kuech M, Grube M, Wirz S, Kreuer S, Hoeft A, et al. Patient state index vs bispectral index as measures of the electroencephalographic effects of propofol. Br J Anaesth. 2010;105(2):172–8.CrossRefPubMed
14.
Gottesman RF, Grega MA, Bailey MM, Pham LD, Zeger SL, Baumgartner WA, et al. Delirium after coronary artery bypass graft surgery and late mortality. Ann Neurol. 2010;67(3):338–44.PubMedPubMedCentral
15.
Watson PL, Shintani AK, Tyson R, Pandharipande PP, Pun BT, Ely EW. Presence of electroencephalogram burst suppression in sedated, critically ill patients is associated with increased mortality. Crit Care Med. 2008;36(12):3171–7.CrossRefPubMedPubMedCentral
16.
Kelley SD. Monitoring consciousness using the Bispectral Index during anesthesia. 2nd ed. Boulder, CO: Covidien; 2010.
17.
Aspect Medical Systems: BIS VISTA Monitoring System - Bilateral Monitoring Addendum. Newton, MA 2010.
18.
Aspect Medical Systems: BIS VISTA Monitoring System - Operating Manual. Newton, MA 2008.
19.
Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology. 1998;89(4):980–1002.CrossRefPubMed
20.
Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703–10.CrossRefPubMed
21.
Guenther U, Popp J, Koecher L, Muders T, Wrigge H, Ely EW, et al. Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients. J Crit Care. 2010;25(1):144–51.CrossRefPubMed
22.
Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–44.CrossRefPubMed
23.
Pandharipande P, Cotton BA, Shintani A, Thompson J, Costabile S, Truman Pun B, et al. Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med. 2007;33(10):1726–31.CrossRefPubMed
24.
Galasko D, Bennett D, Sano M, Ernesto C, Thomas R, Grundman M, et al. An inventory to assess activities of daily living for clinical trials in Alzheimer's disease. The Alzheimer's Disease Cooperative Study. Alzheimer Dis Assoc Disord. 1997;11 Suppl 2:S33–39.CrossRefPubMed
25.
Pascual-Marqui RD, Michel CM, Lehmann D. Low resolution electromagnetic tomography: a new method for localizing electrical activity in the brain. Int J Psychophysiol. 1994;18(1):49–65.CrossRefPubMed
26.
Bruhn J, Bouillon TW, Shafer SL. Bispectral index (BIS) and burst suppression: revealing a part of the BIS algorithm. J Clin Monit Comput. 2000;16(8):593–6.CrossRefPubMed
27.
Hartikainen KM, Rorarius M, Perakyla JJ, Laippala PJ, Jantti V. Cortical reactivity during isoflurane burst-suppression anesthesia. Anesth Analg. 1995;81(6):1223–8.PubMed
28.
Yoshitani K, Kawaguchi M, Takahashi M, Kitaguchi K, Furuya H. Plasma propofol concentration and EEG burst suppression ratio during normothermic cardiopulmonary bypass. Br J Anaesth. 2003;90(2):122–6.CrossRefPubMed
29.
Kertai MD, Pal N, Palanca BJ, Lin N, Searleman SA, Zhang L, et al. Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the B-Unaware Trial. Anesthesiology. 2010;112(5):1116–27.CrossRefPubMed
30.
Leslie K, Myles PS, Forbes A, Chan MT. The effect of bispectral index monitoring on long-term survival in the B-aware trial. Anesth Analg. 2010;110(3):816–22.CrossRefPubMed
31.
Lindholm ML, Traff S, Granath F, Greenwald SD, Ekbom A, Lennmarken C, et al. Mortality within 2 years after surgery in relation to low intraoperative bispectral index values and preexisting malignant disease. Anesth Analg. 2009;108(2):508–12.CrossRefPubMed
32.
Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100(1):4–10.CrossRefPubMed
33.
Kelley SD. Monitoring level of consciousness during anesthesia and sedation. A clinician’s guide to the Bispectral Index. Newton: Aspect Medical Systems, Inc.; 2003.
34.
Radtke FM, Franck M, Lendner J, Kruger S, Wernecke KD, Spies CD. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013;110 Suppl 1:i98–105.CrossRefPubMed
35.
Besch G, Liu N, Samain E, Pericard C, Boichut N, Mercier M, et al. Occurrence of and risk factors for electroencephalogram burst suppression during propofol-remifentanil anaesthesia. Br J Anaesth. 2011;107(5):749–56.CrossRefPubMed
36.
37.
Koster S, Hensens AG, van der Palen J. The long-term cognitive and functional outcomes of postoperative delirium after cardiac surgery. Ann Thorac Surg. 2009;87(5):1469–74.CrossRefPubMed
38.
Loponen P, Luther M, Wistbacka JO, Nissinen J, Sintonen H, Huhtala H, et al. Postoperative delirium and health related quality of life after coronary artery bypass grafting. Scand Cardiovasc J. 2008;42(5):337–44.CrossRefPubMed
Metadata
Title
Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: a prospective, observational study
Authors
Martin Soehle
Alexander Dittmann
Richard K Ellerkmann
Georg Baumgarten
Christian Putensen
Ulf Guenther
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-015-0051-7

Other articles of this Issue 1/2015

BMC Anesthesiology 1/2015 Go to the issue

Review

Obesity: physiologic changes and implications for preoperative management

Research article

Epinephrine reversed high-concentration bupivacaine- induced inhibition of calcium channels and transient outward potassium current channels, but not on sodium channel in ventricular myocytes of rats

Research article

Optimal pain management for radical prostatectomy surgery: what is the evidence?

Research article

Meta-analysis of the cardioprotective effect of sevoflurane versus propofol during cardiac surgery

Research article

Safety and efficacy of combined epidural/general anesthesia during major abdominal surgery in patients with increased intracranial pressure: a cohort study

Research article

Preoperative and postoperative analgesic techniques in the treatment of patients undergoing transabdominal hysterectomy: a preliminary randomized trial