Electroencephalogram Dynamics during General Anesthesia Predict the Later Incidence and Duration of Burst-suppression During Cardiopulmonary Bypass

Publication date: Available online 16 November 2018

Source: Clinical Neurophysiology

Author(s): George S. Plummer, Reine Ibala, Eunice Hahm, Jingzhi An, Jacob Gitlin, Hao Deng, Kenneth T Shelton, Ken Solt, Jason Z. Qu, Oluwaseun Akeju

Abstract

Objective

Electroencephalogram burst-suppression during general anesthesia is associated with post-operative delirium (POD). Whether burst-suppression causes POD or merely reflects susceptibility to POD is unclear. We hypothesized decreased intraoperative alpha (8-12 Hz) and beta (13-33 Hz) power prior to the occurrence of burst-suppression in susceptible patients.

Methods

We analyzed intraoperative electroencephalogram data of cardiac surgical patients undergoing cardiopulmonary bypass (CPB). We detected the incidence and duration of CPB burst-suppression with an automated burst-suppression detection algorithm. We analyzed EEG data with multi-taper spectral estimation methods. We assessed associations between patient characteristics and burst-suppression using Binomial and Zero-inflated Poisson Regression Models.

Results

We found significantly decreased alpha and beta power (7.8-22.95 Hz) in the CPB burst-suppression cohort. The odds ratio for the association between point estimates for alpha and beta power (7.8-22.95 Hz) and the incidence of burst-suppression was 0.88 (95% CI: 0.79 to 0.98). The incidence rate ratio for the association between point estimates for power between the alpha and beta range and the duration of burst-suppression was 0.89 (95% CI: 0.84 to 0.93).

Conclusion

Decreased intra-operative power within the alpha and beta range was associated with susceptibility to burst-suppression during CPB.

Significance

This dynamic may be used to develop principled neurophysiological-based approaches to aid the preemptive identification and targeted care of POD vulnerable patients.

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