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Perioperative, electroencephalographic characteristics of postoperative delirum in elderly

Applicant Dr. Susanne Koch
Subject Area Anaesthesiology
Human Cognitive and Systems Neuroscience
Cognitive, Systems and Behavioural Neurobiology
Term from 2018 to 2024
Project identifier Deutsche Forschungsgemeinschaft (DFG) - Project number 409495393
 
Final Report Year 2023

Final Report Abstract

Postoperative delirium (POD) is the most common neurocognitive complication after surgery, mainly seen in elderly patients during the first week after major surgeries. In the long-term, the emergence of POD is associated with an increased mortality and a persistent neurocognitive decline (NCD). The causes of POD are multifactorial and include predisposing factors as well as precipitating like excessive depth of sedation during general anesthesia and prolonged surgery procedures inducing a high inflammatory response. Intraoperative recording of an Electroencephalogram (EEG) in the forehead over the frontal cortex, one can assess on one hand the level of consciousness (awake to coma) as well as the cognitive activity. With perioperative frontal EEG recordings, we thus can investigate the level of the preoperative cognitive abilities; detect the level of the intraoperative anaesthesia-induced sedation depth. We can investigate the dynamics of EEG signatures influenced by both factors over the time of loss of consciousness during induction of anaesthesia, intraoperatively as well as during stay in the recovery room. In the ePOD study, (1) we could show that in preoperative awake situation EEG signatures differ in the high frequent oscillation range (beta and gamma) in patients, that later develop POD; (2) the dynamic of the EEG from awake to the unconscious state during anesthesia induction with propofol includes specific EEG signatures corresponding to a higher risk to develop POD. (3) We found that prolonged periods of too deep anesthesia with intraoperative burst suppression activity is related to POD, however this was not true for sevoflurane anesthesia - where this anesthetic agent seemed to be a risk factor for POD independent of duration of burst suppression activity. (4) finally, we found reduced alpha- and beta-band power in POD patients during stay in recovery room, when they present POD symptoms. All these findings may be used in future to develop an EEG-based software tool that predicts the risk of developing POD as early as at the onset of anaesthesia. Hence in future intraoperative and postoperative, the medication can be adjusted accordingly and postoperative, non-drug supportive interventions can be implemented. Finally, the early-identified patients with an increased POD risk can be monitored more closely with reliable POD screening tests in order to intervene earlier if POD emerges. All these measures can help to reduce the risk for patients and enable a therapy that is individually adapted to each patient.

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