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Cooter Wright M, Bunning T, Eleswarpu SS, et al. A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study. Anesth Analg. 2022;134(1):149-158doi: 10.1213/ANE.0000000000005660.
Cooter Wright, M., Bunning, T., Eleswarpu, S. S., Heflin, M. T., McDonald, S. R., Lagoo-Deenadalayan, S., Whitson, H. E., Martinez-Camblor, P., Deiner, S. G., & Berger, M. (2022). A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study. Anesthesia and analgesia, 134(1), 149-158. https://doi.org/10.1213/ANE.0000000000005660
Cooter Wright, Mary, et al. "A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study." Anesthesia and analgesia vol. 134,1 (2022): 149-158. doi: https://doi.org/10.1213/ANE.0000000000005660
Cooter Wright M, Bunning T, Eleswarpu SS, Heflin MT, McDonald SR, Lagoo-Deenadalayan S, Whitson HE, Martinez-Camblor P, Deiner SG, Berger M. A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study. Anesth Analg. 2022 Jan 01;134(1):149-158. doi: 10.1213/ANE.0000000000005660. PMID: 34252066; PMCID: PMC8678136.
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Anesth Analg. 2022 Jan 01;134(1):149-158. doi: 10.1213/ANE.0000000000005660.

A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study.

Anesthesia and analgesia

Mary Cooter Wright, Thomas Bunning, Sarada S Eleswarpu, Mitchell T Heflin, Shelley R McDonald, Sandhya Lagoo-Deenadalayan, Heather E Whitson, Pablo Martinez-Camblor, Stacie G Deiner, Miles Berger

Affiliations

  1. From the Anesthesiology Department.
  2. Geriatrics Division, Department of Medicine.
  3. Department of Surgery.
  4. Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.
  5. Geisel School of Medicine, Dartmouth College, New Hanover, New Hampshire.
  6. Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
  7. Center for Cognitive Neuroscience, Duke University, Durham, North Carolina.

PMID: 34252066 PMCID: PMC8678136 DOI: 10.1213/ANE.0000000000005660

Abstract

BACKGROUND: Some older adults show exaggerated responses to drugs that act on the brain. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG-based measure of the brain's resistance to volatile anesthetics and hypothesized that low scores on it would be associated with postoperative delirium risk.

METHODS: We defined the Duke Anesthesia Resistance Scale (DARS) as the average bispectral index (BIS) divided by the quantity (2.5 minus the average age-adjusted end-tidal minimum alveolar concentration [aaMAC] inhaled anesthetic fraction). The relationship between DARS and postoperative delirium was analyzed in 139 older surgical patients (age ≥65) from Duke University Medical Center (n = 69) and Mt Sinai Medical Center (n = 70). Delirium was assessed by geriatrician interview at Duke, and by research staff utilizing the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument at Mt Sinai. We examined the relationship between DARS and delirium and used the Youden index to identify an optimal low DARS threshold (for delirium risk), and its associated 95% bootstrap confidence bounds. We used multivariable logistic regression to examine the relationship between low DARS and delirium risk.

RESULTS: The relationship between DARS and delirium risk was nonlinear, with higher delirium risk at low DARS scores. A DARS threshold of 28.755 maximized the Youden index for the association between low DARS and delirium, with bootstrap 95% confidence bounds of 26.18 and 29.80. A low DARS (<28.755) was associated with increased delirium risk in multivariable models adjusting for site (odds ratio [OR] [95% confidence interval {CI}] = 4.30 [1.89-10.01]; P = .001), or site-plus-patient risk factors (OR [95% CI] = 3.79 [1.63-9.10]; P = .003). These associations with postoperative delirium risk remained significant when using the 95% bootstrap confidence bounds for the low DARS threshold (P < .05 for all). Further, a low DARS (<28.755) was associated with delirium risk after accounting for opioid, midazolam, propofol, phenylephrine, and ketamine dosage as well as site (OR [95% CI] = 4.21 [1.80-10.16]; P = .002). This association between low DARS and postoperative delirium risk after controlling for these other medications remained significant (P < .05) when using either the lower or the upper 95% bootstrap confidence bounds for the low DARS threshold.

CONCLUSIONS: These results demonstrate that an intraoperative processed EEG-based measure of lower brain anesthetic resistance (ie, low DARS) is independently associated with increased postoperative delirium risk in older surgical patients.

Copyright © 2021 International Anesthesia Research Society.

Conflict of interest statement

Conflicts of Interest: See Disclosures at the end of the article.

References

  1. Cancer. 1950 Jan;3(1):32-5 - PubMed
  2. Anesthesiology. 2016 Feb;124(2):417-27 - PubMed
  3. Br J Anaesth. 2019 Sep;123(3):288-297 - PubMed
  4. Anesth Analg. 2020 May;130(5):1274-1277 - PubMed
  5. J Neuroinflammation. 2016 Aug 30;13(1):211 - PubMed
  6. J Am Geriatr Soc. 2015 Jan;63(1):142-50 - PubMed
  7. Front Syst Neurosci. 2017 May 08;11:24 - PubMed
  8. Br J Anaesth. 2015 Jul;115 Suppl 1:i95-i103 - PubMed
  9. Br J Anaesth. 2020 Jan;124(1):e4-e7 - PubMed
  10. Ann Intern Med. 1990 Dec 15;113(12):941-8 - PubMed
  11. Mol Psychiatry. 2019 Feb;24(2):266-281 - PubMed
  12. Br J Anaesth. 2018 Jul;121(1):241-248 - PubMed
  13. Mech Ageing Dev. 2015 Nov;151:2-12 - PubMed
  14. Clin Neurophysiol. 2016 Jun;127(6):2414-22 - PubMed
  15. BMC Geriatr. 2015 Mar 25;15:31 - PubMed
  16. Eur J Anaesthesiol. 2017 Apr;34(4):192-214 - PubMed
  17. Cell. 2013 Jun 6;153(6):1194-217 - PubMed
  18. Anesthesiology. 2012 Oct;117(4):717-25 - PubMed
  19. Br J Anaesth. 2015 Jul;115 Suppl 1:i46-i57 - PubMed
  20. Anesthesiology. 2020 Aug;133(2):280-292 - PubMed
  21. JAMA. 2001 Dec 5;286(21):2703-10 - PubMed
  22. Anesth Analg. 2018 Dec;127(6):1406-1413 - PubMed
  23. J Vis Exp. 2019 Nov 13;(153): - PubMed
  24. Front Aging Neurosci. 2020 Jan 10;11:371 - PubMed
  25. Br J Anaesth. 2018 Nov;121(5):1005-1012 - PubMed
  26. Crit Rev Neurobiol. 2000;14(1):69-89 - PubMed
  27. N Engl J Med. 2011 Aug 18;365(7):591-600 - PubMed
  28. Clin Neurophysiol. 2016 Jan;127(1):556-564 - PubMed
  29. Br J Anaesth. 2019 May;122(5):622-634 - PubMed
  30. Anesth Analg. 2020 May;130(5):1278-1291 - PubMed
  31. Clin Interv Aging. 2009;4:225-33 - PubMed
  32. Am J Respir Crit Care Med. 2011 Aug 1;184(3):340-4 - PubMed
  33. JAMA Surg. 2018 May 1;153(5):454-462 - PubMed
  34. Front Immunol. 2017 Nov 13;8:1528 - PubMed
  35. Anesth Analg. 2016 Jan;122(1):234-42 - PubMed
  36. Acta Anaesthesiol Scand. 2004 Jan;48(1):27-34 - PubMed
  37. BMC Anesthesiol. 2015 Apr 28;15:61 - PubMed
  38. Br J Pharmacol. 1998 Aug;124(7):1534-40 - PubMed
  39. Dement Geriatr Cogn Disord. 2019;48(1-2):83-92 - PubMed
  40. Nat Rev Endocrinol. 2018 Oct;14(10):576-590 - PubMed
  41. Anesth Analg. 2015 Sep;121(3):645-651 - PubMed
  42. J Clin Monit Comput. 2000;16(8):593-6 - PubMed
  43. Anesth Analg. 2004 May;98(5):1336-40, table of contents - PubMed
  44. Anesthesiology. 2011 Dec;115(6):1209-18 - PubMed

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