TOPLINE:
In the ENGAGES-Canada trial, patients who received electroencephalography (EEG)-guided anesthesia or usual care during cardiac surgery experienced similar rates of postoperative delirium.
METHODOLOGY:
ENGAGES-Canada was a randomized clinical trial involving 1140 patients aged 60 years or older undergoing cardiac surgery at four Canadian hospitals.Participants were randomly assigned to receive either EEG-guided anesthesia or usual care —on the basis of levels of expired anesthetic gasses and hemodynamics — with the primary outcome being the incidence of delirium during postoperative days 1-5.
TAKEAWAY:
EEG-guided anesthesia did not significantly reduce the incidence of postoperative delirium compared with usual care, with roughly 18% of patients in either group experiencing the condition.The study suggested that minimizing the time spent in EEG suppression and reducing the administration of volatile anesthetics may not influence delirium outcomes in older adults after cardiac surgery.
IN PRACTICE:
The new finding “highlights a key question about postoperative delirium of relevance to patients undergoing both cardiac and noncardiac surgical procedures,” Miles Berger, MD, PhD, of Duke University, in Durham, North Carolina, and Mark D. Neuman, MD, MSc, of the University of Pennsylvania, in Philadelphia, wrote in an editorial accompanying the journal article. “Why, at a given anesthetic dose, do certain patients demonstrate EEG suppression while others do not? And why do patients who are more sensitive to developing EEG suppression in response to anesthetics more often develop postoperative delirium? Answering these questions could help to identify individuals at greatest postoperative delirium risk and target these patients for delirium prevention interventions.”
SOURCE:
The study was led by Alain Deschamps, MD, PhD, of the Montreal Heart Institute, Montreal, Quebec, Canada, and was published online on June 10, 2024, in JAMA.
LIMITATIONS:
Despite a significant reduction in EEG suppression time, a greater reduction might be required to affect the incidence of postoperative delirium, according to the authors. The 17.5% decrease in the administration of volatile anesthetic agents in the patients who received EEG-guided care may have been insufficient to prevent delirium.
DISCLOSURES:
Neuman reported receiving grants from the PCORI and the Donaghue Foundation outside the submitted work. Berger reported receiving grants from the National Institute on Aging/National Institutes of Health during the study and nonfinancial support from Massimo for a research study outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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