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BIS index monitoring and perioperative neurocognitive disorders in older adults: a systematic review and meta-analysis

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Abstract

Background and aims

Perioperative neurocognitive disorders (PND) are common in elderly patients after surgery. It has been reported that BIS-guided anesthesia potentially influenced the occurrence of PND. Therefore, we conducted this systematic review and meta-analysis to explore the associations between bispectral index (BIS) monitoring and PND.

Methods

Two researchers independently searched for relevant randomized controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Library (CENTRAL) using keywords related to the BIS and PND from inception to April 22, 2019. Odds ratios (OR) with 95% CI were calculated using a random effects model.

Results

Nine RCTs involving 4023 participants aged 60 years or older were included into this meta-analysis. BIS-guided anesthesia was not associated with lower incidence of POD (random effects; OR: 0.69; 95% CI 0.48, 1.01), delayed neurocognitive recovery (DNR) at 1 day, 7 days (random effects; OR: 0.14; 95% CI 0.02, 1.23; random effects; OR: 0.97; 95% CI 0.57, 1.63), and postoperative neurocognitive disorder (NCD) at 90 days and 1 year after surgery in older adults (random effects; OR:0.72; 95% CI 0.52, 1.00; random effects; OR: 0.26; 95% CI 0.03, 2.47).

Conclusions

No definite evidence demonstrated that BIS-guided anesthesia decreased the incidence of POD, DNR and postoperative NCD in older patients. More homogeneous RCTs assessing the efficacy of BIS monitoring on reducing the occurrence of these perioperative cognitive disorders are needed.

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References

  1. Inouye SK (2006) Delirium in older persons. New England J Med 354:1157–1165. https://doi.org/10.1056/NEJMra052321

    Article  CAS  Google Scholar 

  2. Marcantonio ER (2011) In the clinic Delirium. Ann Intern Med 154:ITC6-1–ITC6-15. https://doi.org/10.7326/0003-4819-154-11-201106070-01006

    Article  Google Scholar 

  3. Zhu C, Wang B, Yin J et al (2019) Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01319-y

    Article  PubMed  PubMed Central  Google Scholar 

  4. Johnson T, Monk T, Rasmussen LS et al (2002) Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology 96:1351–1357. https://doi.org/10.1097/00000542-200206000-00014

    Article  PubMed  Google Scholar 

  5. Marcantonio ER (2012) Postoperative delirium: a 76-year-old woman with delirium following surgery. JAMA 308:73–81. https://doi.org/10.1001/jama.2012.6857

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Inouye SK, Charpentier PA (1996) Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 275:852–857

    Article  CAS  Google Scholar 

  7. Lynch EP, Lazor MA, Gellis JE et al (1998) The impact of postoperative pain on the development of postoperative delirium. Anesth Analg 86:781–785

    Article  CAS  Google Scholar 

  8. Radtke FM, Franck M, Lendner J et al (2013) Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. British J Anaesth 110:i98–i105. https://doi.org/10.1093/bja/aet055

    Article  CAS  Google Scholar 

  9. Gan J, Tu Q, Miao S et al (2019) Effects of oxycodone applied for patient-controlled analgesia on postoperative cognitive function in elderly patients undergoing total hip arthroplasty: a randomized controlled clinical trial. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01202-w

    Article  PubMed  Google Scholar 

  10. Zhou Y, Li Y, Wang K (2018) Bispectral index monitoring during anesthesia promotes early postoperative recovery of cognitive function and reduces acute delirium in elderly patients with colon carcinoma: a prospective controlled study using the attention network test. Med Sci Monit 24:7785–7793. https://doi.org/10.12659/MSM.910124

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Punjasawadwong Y, Pipanmekaporn T, Wongpakaran N (2016) Optimized anesthesia to reduce incidence of postoperative delirium in elderly undergoing elective, non-cardiac surgery: a randomized controlled trial. Anesth Analg 123:211. https://doi.org/10.1213/01.ane.0000492565.93046.fc

    Article  Google Scholar 

  12. Chan MTV, Cheng BCP, Lee TMC et al (2013) BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol 25:33–42. https://doi.org/10.1097/ANA.0b013e3182712fba

    Article  PubMed  Google Scholar 

  13. Bruhn J, Bouillon TW, Shafer SL (2000) Bispectral index (BIS) and burst suppression: revealing a part of the BIS algorithm. J Clin Monit Comput 16:593–596

    Article  CAS  Google Scholar 

  14. Turkmen A, Altan A, Turgut N et al (2006) The correlation between the Richmond agitation-sedation scale and bispectral index during dexmedetomidine sedation. Eur J Anaesthesiol 23:300–304. https://doi.org/10.1017/s0265021506000081

    Article  CAS  PubMed  Google Scholar 

  15. Galante D, Fortarezza D, Caggiano M et al (2015) Correlation of bispectral index (BIS) monitoring and end-tidal sevoflurane concentration in a patient with lobar holoprosencephaly. Brazilian J Anesthesiol (Elsevier) 65:379–383. https://doi.org/10.1016/j.bjane.2014.07.003

    Article  Google Scholar 

  16. Wildes TS, Mickle AM, Abdallah AB et al (2019) Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery the engages randomized clinical trial. JAMA 321:473–483. https://doi.org/10.1001/jama.2018.22005

    Article  PubMed  PubMed Central  Google Scholar 

  17. MacKenzie KK, Britt-Spells AM, Sands LP et al (2018) Processed Electroencephalogram Monitoring and Postoperative Delirium: a Systematic Review and Meta-analysis. Anesthesiology 129:417–427. https://doi.org/10.1097/ALN.0000000000002323

    Article  PubMed  PubMed Central  Google Scholar 

  18. Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://handbook.cochrane.org

  19. Zhao JG, Zeng XT, Wang J et al (2017) Association between calcium or vitamin d supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis. JAMA 318:2466–2482. https://doi.org/10.1001/jama.2017.19344

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sieber FE, Zakriya KJ, Gottschalk A et al (2010) Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc 85:18–26. https://doi.org/10.4065/mcp.2009.0469

    Article  PubMed  PubMed Central  Google Scholar 

  21. Quan C, Chen J, Luo Y et al (2019)  BIS-guided deep anesthesia decreases short-term postoperative cognitive dysfunction and peripheral inflammation in elderly patients undergoing abdominal surgery. Brain Behav:e01238. https://doi.org/10.1002/brb3.1238

  22. Hou R, Wang H, Chen L et al (2018) POCD in patients receiving total knee replacement under deep vs light anesthesia: a randomized controlled trial. Brain Behav 8:e00910

    Article  Google Scholar 

  23. Ballard C, Jones E, Gauge N et al (2012) Optimised anaesthesia to reduce post operative cognitive decline (POCD) in older patients undergoing elective surgery, a randomised controlled trial. PLoS One 7:e37410. https://doi.org/10.1371/journal.pone.0037410

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Short TG, Leslie K, Chan MTV et al (2015) Rationale and design of the balanced anesthesia study: a prospective randomized clinical trial of two levels of anesthetic depth on patient outcome after major surgery. Anesth Analg 121:357–365. https://doi.org/10.1213/ANE.0000000000000797

    Article  PubMed  Google Scholar 

  25. Whitlock EL, Torres BA, Lin N et al (2014) Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg 118:809–817. https://doi.org/10.1213/ANE.0000000000000028

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Shu AH, Wang Q, Chen XB (2015) Effect of different depths of anesthesia on postoperative cognitive function in laparoscopic patients: a randomized clinical trial. Curr Med Res Opin 31:1883–1887. https://doi.org/10.1185/03007995.2015.1075968

    Article  CAS  PubMed  Google Scholar 

  27. An J, Fang Q, Huang C et al (2011) Deeper total intravenous anesthesia reduced the incidence of early postoperative cognitive dysfunction after microvascular decompression for facial spasm. J Neurosurg Anesthesiol 23:12–17. https://doi.org/10.1097/ANA.0b013e3181f59db4

    Article  PubMed  Google Scholar 

  28. Farag E, Chelune GJ, Schubert A et al (2006) Is depth of anesthesia, as assessed by the Bispectral Index, related to postoperative cognitive dysfunction and recovery? Anesth Analg 103:633–640. https://doi.org/10.1213/01.ane.0000228870.48028.b5

    Article  PubMed  Google Scholar 

  29. Chan MT, Gin T (2014) Delirium and cognitive decline after surgery: a randomised controlled trial of anaesthetic management to improve postoperative mental health outcome. Hong Kong Med J 7:28–29

    Google Scholar 

  30. Brown CH, Azman AS, Gottschalk A et al (2014) Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair. Anesth Analg 118:977–980. https://doi.org/10.1213/ane.0000000000000157

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Brown C, Gottschalk A, Sieber F (2013) Survival following a randomized trial of light vs deep sedation in patients undergoing surgical repair of a hip fracture under spinal anesthesia. Clin Transl Sci 6:130. https://doi.org/10.1111/cts.12047

    Article  Google Scholar 

  32. Banerjee A, McGrane S, Pandharipande P (2010) Minimizing perioperative sedation to reduce delirium. Future Neurology 5:357–361. https://doi.org/10.2217/fnl.10.20

    Article  Google Scholar 

  33. Gauge N, Salaunkey K, Zhu J et al (2014) Optimization of intra-operative depth of anaesthesia and cerebral oxygenation significantly reduces postoperative delirium after coronary artery bypass graft surgery. Appl Cardiopulm Pathophysiol 18:68

    Google Scholar 

  34. Abbott J, Henderson K, Szypula K (2014) An audit of adherence to NICE guidance recommending the use of depth of anaesthesia monitoring in elderly patients undergoing general anaesthesia in a district general hospital. Anaesthesia 69:60. https://doi.org/10.1111/anae.12765

    Article  Google Scholar 

  35. Wong J, Song D, Blanshard H et al (2002) Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries. Can J Anaesth 49:13–18. https://doi.org/10.1007/BF03020413

    Article  PubMed  Google Scholar 

  36. Punjasawadwong Y, Chau-In W, Laopaiboon M et al (2018) Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Cochrane Database Syst Rev 5:Cd011283. https://doi.org/10.1002/14651858.cd011283.pub2

    Article  PubMed  Google Scholar 

  37. Smith D, Andrzejowski J, Smith A (2013) Certainty and uncertainty: NICE guidance on ‘depth of anaesthesia’ monitoring. Anaesthesia 68:1000–1005. https://doi.org/10.1111/anae.12385

    Article  CAS  PubMed  Google Scholar 

  38. Aldecoa C, Bettelli G, Bilotta F et al (2017) European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 34:192–214. https://doi.org/10.1097/eja.0000000000000594

    Article  PubMed  Google Scholar 

  39. Fritz BA, Kalarickal PL, Maybrier HR et al (2016) Intraoperative Electroencephalogram Suppression Predicts Postoperative Delirium. Anesth Analg 122:234–242. https://doi.org/10.1213/ane.0000000000000989

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We gratefully acknowledge Professor Daqing Ma (Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK) for his critically revising during manuscript preparation.

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Authors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, China

    Mengrong Miao, Yuehua Xu, Mingyang Sun, Enqiang Chang, Xuhui Cong & Jiaqiang Zhang

  2. Department of Surgery, First Hospital of Henan Provincial People’s Hospital, Zhengzhou, Henan, China

    Yuehua Xu

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Contributions

Study concept and design: MM and JZ. Acquisition of data: MM and YX. Analysis and interpretation of data: MS, MM, EC, and XC. Preparation of manuscript: MM, YX, EC, XC, and JZ. Revision of manuscript: MM, MS, and JZ.

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Correspondence to Jiaqiang Zhang.

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Miao, M., Xu, Y., Sun, M. et al. BIS index monitoring and perioperative neurocognitive disorders in older adults: a systematic review and meta-analysis. Aging Clin Exp Res 32, 2449–2458 (2020). https://doi.org/10.1007/s40520-019-01433-x

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