International Journal of General Medicine (Jan 2021)
Reducing Perioperative Neurocognitive Disorders (PND) Through Depth of Anesthesia Monitoring: A Critical Review
Abstract
Lisbeth A Evered,1– 4 Peter A Goldstein1,4,5 1Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; 2Department of Anaesthesia and Acute Pain Medicine, St. Vincent’s Hospital, Melbourne, VIC, Australia; 3Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; 4Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA; 5Department of Medicine, Weill Cornell Medicine, New York, NY, USACorrespondence: Peter A GoldsteinDepartment of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USATel +1-212-746-5325Email [email protected]: General anesthesia has been administered for over 150 years, and in that time, has become progressively safer. Improvements in outcomes have been driven by multiple advances, including the use of non-invasive monitors to assess cardiovascular and respiratory status. More recent advances have included the development and use of monitors to measure neurologic status by means of “processed” electroencephalography (pEEG), wherein the frontal EEG signal is analyzed by proprietary algorithms to produce a dimensionless number (scaled from 0 to 100), wherein low values are associated with deepening levels of sedation that progresses to loss of consciousness. Such monitors have been shown to enable anesthetic titration so as to expedite emergence and early recovery, and their use is advocated for the prevention of intraoperative awareness in the setting of administration of total intravenous anesthesia and neuromuscular blockade. Whether their use can minimize, or prevent, longer term adverse events is a matter of debate. In this narrative review of the most recent literature, we provide an assessment on the use of pEEG monitors in the prevention of a notable, and important, postoperative adverse outcome – delirium – in elderly patients. As we will discuss, the existing data do not support its routine use for the prevention of postoperative delirium in this, or any other, patient population.Keywords: delirium, outcome, postoperative, EEG, electroencephalography
