Key result
Monitoring depth of anesthesia and nociception using Entropy and SPI during emergency surgery resulted in fewer POCD episodes compared to control, though not statistically significant (p<0.08).
Why the study?
Trauma patients have often been excluded from studies evaluating modifiable factors for postoperative cognitive disturbance, despite their high risk of developing postoperative delirium and cognitive dysfunction during emergency surgery.
Does monitoring depth of anesthesia and nociception using Entropy and SPI reduce postoperative cognitive dysfunction in adult multiple trauma patients undergoing emergency surgery?
RCT (n=95)
Does monitoring depth of anesthesia and nociception using Entropy and SPI reduce postoperative cognitive dysfunction in adult multiple trauma patients undergoing emergency surgery?
Monitoring depth of anesthesia using Entropy and SPI showed a non-significant trend towards reducing postoperative cognitive dysfunction in trauma patients undergoing emergency surgery.
Answers are grounded in this paper and cite their sources.
Non-significant trend toward fewer POCD with Entropy/SPI monitoring; does not support adoption and leaves open efficacy in larger trauma trials.
Background and Objectives: Patients with traumatic injuries have often been excluded from studies that have attempted to pinpoint modifiable factors to predict the transient disturbance of the cognitive function in the postoperative settings. Anesthetists must be aware of the high risk of developing postoperative delirium and cognitive dysfunction (POCD) in patients undergoing emergency surgery. Monitoring the depth of anesthesia in order to tailor anesthetic delivery may reduce this risk. The primary aim of this study was to improve the prevention strategies for the immediate POCD by assessing anesthetic depth and nociception during emergency surgery. Material and Methods: Of 107 trauma ASA physical status II–IV patients aged over 18 years undergoing emergency noncardiac surgery, 95 patients were included in a prospective randomized study. Exclusion criteria were neurotrauma, chronic use of psychoactive substances or alcohol, impaired preoperative cognitive function, pre-existing psychopathological symptoms, or expected surgery time less than 2 h. Entropy and Surgical Pleth Index (SPI) values were constantly recorded for one group during anesthesia. POCD was assessed 24 h, 48 h, and 72 h after surgery using the Neelon and Champagne (NEECHAM) Confusion Scale. Results: Although in the intervention group, fewer patients experienced POCD episodes in comparison to the control group, the results were not statistically significant (p < 0.08). The study showed a statistically significant inverse correlation between fentanyl and the NEECHAM Confusion Scale at 24 h (r = −0.32, p = 0.0005) and 48 h (r = −0.46, p = 0.0002), sevoflurane and the NEECHAM Confusion Scale at 24 h (r = −0.38, p = 0.0014) and 48 h (r = −0.52, p = 0.0002), and noradrenaline and POCD events in the first 48 h (r = −0.46, p = 0.0013 for the first 24 h, respectively, and r = −0.46, p = 0.0002 for the next 24 h). Conclusions: Entropy and SPI monitoring during anesthesia may play an important role in diminishing the risk of developing immediate POCD after emergency surgery.
No takes yet. Share an insight, caveat, or question.
Cotae et al. (2021) conducted an RCT in Adult multiple trauma patients undergoing emergency noncardiac surgery (n=95). Monitoring depth of anesthesia and nociception (Entropy and Surgical Pleth Index) vs. Control group was evaluated on Postoperative cognitive dysfunction (POCD) assessed 24 h, 48 h, and 72 h after surgery using the NEECHAM Confusion Scale (p=<0.08). Monitoring depth of anesthesia and nociception using Entropy and SPI during emergency surgery resulted in fewer POCD episodes compared to control, though not statistically significant (p<0.08).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: