Anaesthetic depth and delirium after major surgery: a randomised clinical trial
Lisbeth A Evered, Matthew T V Chan, Ruquan Han, Mandy H M Chu, Benny P Cheng, David A Scott, Kane O Pryor, Daniel I Sessler, Robert Veselis, Christopher Frampton, Matthew Sumner, Ade Ayeni, Paul S Myles, Douglas Campbell, Kate Leslie, Timothy G Short, Lisbeth A Evered, Matthew T V Chan, Ruquan Han, Mandy H M Chu, Benny P Cheng, David A Scott, Kane O Pryor, Daniel I Sessler, Robert Veselis, Christopher Frampton, Matthew Sumner, Ade Ayeni, Paul S Myles, Douglas Campbell, Kate Leslie, Timothy G Short
Abstract
Background: Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia).
Methods: This multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary outcomes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression.
Results: The incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38-0.88]; P=0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS ≤6 vs 20%; P<0.001).
Conclusions: Among patients undergoing major surgery, targeting light anaesthesia reduced the risk of postoperative delirium and cognitive impairment at 1 yr.
Clinical trial registration: ACTRN12612000632897.
Keywords: anaesthesia; bispectral index; cognitive dysfunction; delirium; electroencephalography; postoperative delirium.
Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
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Source: PubMed