Details

Autor(en) / Beteiligte

• Evered, Lisbeth A.
• Chan, Matthew T.V.
• Han, Ruquan
• Chu, Mandy H.M.
• Cheng, Benny P.
• Scott, David A.
• Pryor, Kane O.
• Sessler, Daniel I.
• Veselis, Robert
• Frampton, Christopher
• Sumner, Matthew
• Ayeni, Ade
• Myles, Paul S.
• Campbell, Douglas
• Leslie, Kate
• Short, Timothy G.

Titel

Anaesthetic depth and delirium after major surgery: a randomised clinical trial

Ist Teil von

• British journal of anaesthesia : BJA, 2021-11, Vol.127 (5), p.704-712

Ort / Verlag

England: Elsevier Ltd

Erscheinungsjahr

2021

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• 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). 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. 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). Among patients undergoing major surgery, targeting light anaesthesia reduced the risk of postoperative delirium and cognitive impairment at 1 yr. ACTRN12612000632897.