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Association between intraoperative electroencephalographic suppression and postoperative mortality.

Abstract：

BACKGROUND:Low bispectral index values frequently reflect EEG suppression and have been associated with postoperative mortality. This study investigated whether intraoperative EEG suppression was an independent predictor of 90 day postoperative mortality and explored risk factors for EEG suppression. METHODS:This observational study included 2662 adults enrolled in the B-Unaware or BAG-RECALL trials. A cohort was defined with >5 cumulative minutes of EEG suppression, and 1:2 propensity-matched to a non-suppressed cohort (≤5 min suppression). We evaluated the association between EEG suppression and mortality using multivariable logistic regression, and examined risk factors for EEG suppression using zero-inflated mixed effects analysis. RESULTS:Ninety day postoperative mortality was 3.9% overall, 6.3% in the suppressed cohort, and 3.0% in the non-suppressed cohort {odds ratio (OR) [95% confidence interval (CI)]=2.19 (1.48-3.26)}. After matching and multivariable adjustment, EEG suppression was not associated with mortality [OR (95% CI)=0.83 (0.55-1.25)]; however, the interaction between EEG suppression and mean arterial pressure (MAP) <55 mm Hg was [OR (95% CI)=2.96 (1.34-6.52)]. Risk factors for EEG suppression were older age, number of comorbidities, chronic obstructive pulmonary disease, and higher intraoperative doses of benzodiazepines, opioids, or volatile anaesthetics. EEG suppression was less likely in patients with cancer, preoperative alcohol, opioid or benzodiazepine consumption, and intraoperative nitrous oxide exposure. CONCLUSIONS:Although EEG suppression was associated with increasing anaesthetic administration and comorbidities, the hypothesis that intraoperative EEG suppression is a predictor of postoperative mortality was only supported if it was coincident with low MAP. CLINICAL TRIAL REGISTRATION:NCT00281489 and NCT00682825.

journal_name

Br J Anaesth

journal_title

British journal of anaesthesia

authors

Willingham M,Ben Abdallah A,Gradwohl S,Helsten D,Lin N,Villafranca A,Jacobsohn E,Avidan M,Kaiser H

doi

10.1093/bja/aeu105

subject

Has Abstract

pub_date

2014-12-01 00:00:00

pages

1001-8

issue

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(17)30657-8

journal_volume

113

pub_type

杂志文章,多中心研究,随机对照试验

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Association between intraoperative electroencephalographic suppression and postoperative mortality.