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EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults
The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) – electroencephalography (EEG) with repeated periods of suppression (very low-voltage brai...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10499509/ https://www.ncbi.nlm.nih.gov/pubmed/37711992 http://dx.doi.org/10.3389/fnagi.2023.1229081 |
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author | Reese, Melody Christensen, Soren Anolick, Harel Roberts, Kenneth C. Wong, Megan K. Wright, Mary Cooter Acker, Leah Browndyke, Jeffrey N. Woldorff, Marty G. Berger, Miles |
author_facet | Reese, Melody Christensen, Soren Anolick, Harel Roberts, Kenneth C. Wong, Megan K. Wright, Mary Cooter Acker, Leah Browndyke, Jeffrey N. Woldorff, Marty G. Berger, Miles |
author_sort | Reese, Melody |
collection | PubMed |
description | The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) – electroencephalography (EEG) with repeated periods of suppression (very low-voltage brain activity). However, BSup has modest sensitivity for predicting POD. We hypothesized that a brain state of lowered EEG power immediately precedes BSup, which we have termed “pre-burst suppression” (preBSup). Further, we hypothesized that even patients without BSup experience these preBSup transient reductions in EEG power, and that preBSup (like BSup) would be associated with preoperative cognitive function and delirium risk. Data included 83 32-channel intraoperative EEG recordings of the first hour of surgery from 2 prospective cohort studies of patients ≥age 60 scheduled for ≥2-h non-cardiac, non-neurologic surgery under general anesthesia (maintained with a potent inhaled anesthetic or a propofol infusion). Among patients with BSup, we defined preBSup as the difference in 3–35 Hz power (dB) during the 1-s preceding BSup relative to the average 3–35 Hz power of their intraoperative EEG recording. We then recorded the percentage of time that each patient spent in preBSup, including those without BSup. Next, we characterized the association between percentage of time in preBSup and (1) percentage of time in BSup, (2) preoperative cognitive function, and (3) POD incidence. The percentage of time in preBSup and BSup were correlated (Spearman’s ρ [95% CI]: 0.52 [0.34, 0.66], p < 0.001). The percentage of time in BSup, preBSup, or their combination were each inversely associated with preoperative cognitive function (β [95% CI]: −0.10 [−0.19, −0.01], p = 0.024; −0.04 [−0.06, −0.01], p = 0.009; −0.04 [−0.06, −0.01], p = 0.003, respectively). Consistent with prior literature, BSup was significantly associated with POD (odds ratio [95% CI]: 1.34 [1.01, 1.78], p = 0.043), though this association did not hold for preBSup (odds ratio [95% CI]: 1.04 [0.95, 1.14], p = 0.421). While all patients had ≥1 preBSup instance, only 20.5% of patients had ≥1 BSup instance. These exploratory findings suggest that future studies are warranted to further study the extent to which preBSup, even in the absence of BSup, can identify patients with impaired preoperative cognition and/or POD risk. |
format | Online Article Text |
id | pubmed-10499509 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-104995092023-09-14 EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults Reese, Melody Christensen, Soren Anolick, Harel Roberts, Kenneth C. Wong, Megan K. Wright, Mary Cooter Acker, Leah Browndyke, Jeffrey N. Woldorff, Marty G. Berger, Miles Front Aging Neurosci Neuroscience The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) – electroencephalography (EEG) with repeated periods of suppression (very low-voltage brain activity). However, BSup has modest sensitivity for predicting POD. We hypothesized that a brain state of lowered EEG power immediately precedes BSup, which we have termed “pre-burst suppression” (preBSup). Further, we hypothesized that even patients without BSup experience these preBSup transient reductions in EEG power, and that preBSup (like BSup) would be associated with preoperative cognitive function and delirium risk. Data included 83 32-channel intraoperative EEG recordings of the first hour of surgery from 2 prospective cohort studies of patients ≥age 60 scheduled for ≥2-h non-cardiac, non-neurologic surgery under general anesthesia (maintained with a potent inhaled anesthetic or a propofol infusion). Among patients with BSup, we defined preBSup as the difference in 3–35 Hz power (dB) during the 1-s preceding BSup relative to the average 3–35 Hz power of their intraoperative EEG recording. We then recorded the percentage of time that each patient spent in preBSup, including those without BSup. Next, we characterized the association between percentage of time in preBSup and (1) percentage of time in BSup, (2) preoperative cognitive function, and (3) POD incidence. The percentage of time in preBSup and BSup were correlated (Spearman’s ρ [95% CI]: 0.52 [0.34, 0.66], p < 0.001). The percentage of time in BSup, preBSup, or their combination were each inversely associated with preoperative cognitive function (β [95% CI]: −0.10 [−0.19, −0.01], p = 0.024; −0.04 [−0.06, −0.01], p = 0.009; −0.04 [−0.06, −0.01], p = 0.003, respectively). Consistent with prior literature, BSup was significantly associated with POD (odds ratio [95% CI]: 1.34 [1.01, 1.78], p = 0.043), though this association did not hold for preBSup (odds ratio [95% CI]: 1.04 [0.95, 1.14], p = 0.421). While all patients had ≥1 preBSup instance, only 20.5% of patients had ≥1 BSup instance. These exploratory findings suggest that future studies are warranted to further study the extent to which preBSup, even in the absence of BSup, can identify patients with impaired preoperative cognition and/or POD risk. Frontiers Media S.A. 2023-08-30 /pmc/articles/PMC10499509/ /pubmed/37711992 http://dx.doi.org/10.3389/fnagi.2023.1229081 Text en Copyright © 2023 Reese, Christensen, Anolick, Roberts, Wong, Wright, Acker, Browndyke, Woldorff, Berger and the MADCO-PC and INTUIT Investigators. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neuroscience Reese, Melody Christensen, Soren Anolick, Harel Roberts, Kenneth C. Wong, Megan K. Wright, Mary Cooter Acker, Leah Browndyke, Jeffrey N. Woldorff, Marty G. Berger, Miles EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults |
title | EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults |
title_full | EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults |
title_fullStr | EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults |
title_full_unstemmed | EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults |
title_short | EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults |
title_sort | eeg pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults |
topic | Neuroscience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10499509/ https://www.ncbi.nlm.nih.gov/pubmed/37711992 http://dx.doi.org/10.3389/fnagi.2023.1229081 |
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