Key result
Auditory evoked potential-guided anesthesia reduces early postoperative cognitive dysfunction ~86% versus clinical signs monitoring.
Why the study?
The role of depth of anesthesia on postoperative cognitive dysfunction and postoperative inflammatory response after major ENT surgery was unclear.
Does AEP-guided depth of anesthesia reduce postoperative cognitive dysfunction and inflammatory response in patients undergoing major ENT surgery?
RCT (n=32)
Does AEP-guided depth of anesthesia reduce postoperative cognitive dysfunction and inflammatory response in patients undergoing major ENT surgery?
Absolute Event Rate: 6.25% vs 43.75%
p-value: p=<0.03
AEP-guided anesthesia allows for dose reduction of anesthetics and reduces early postoperative cognitive dysfunction following major ENT surgery, though it does not alter the inflammatory response.
AEP-guided anesthesia reduces early POCD after major ENT surgery; extends RCT evidence for depth monitoring on cognitive outcomes.
The aim of this study was to evaluate the role of depth of anesthesia on POCD after major ENT surgery and to assess changes in postoperative inflammatory markers in patients undergoing major ENT surgery. Thirty two patients aged 40 to 94 yrs, scheduled for surgery under general anesthesia were randomly assigned to one of two groups. In group A (AEP group) depth of anesthesia (DOA) was measured with auditory evoked potential (AEP). In the control group (group C) DOA was monitored according to clinical signs. Cognitive function was evaluated using Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM) and Cognitive Failure Questionnaire (CFQ). Inflammatory markers were measured before and after anesthesia. Perioperative requirements for desflurane and fentanyl were significantly lower in group A. On the first postoperative day MMSE changes indicating POCD were noted in 1 patient in group A and 7 patients in group C (P<0.03). One month follow up did not show any difference between the groups regarding POCD. Our study indicates that AEP-guided anesthesia allows dose reduction of anesthetic agents including opioids leading to better cardiovascular stability and less early POCD. Anesthesia depth did not influence the inflammatory response to surgery.
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Pether Jildenstål (2012) conducted an RCT in Major ENT surgery (n=32). Auditory evoked potential (AEP)-guided depth of anesthesia monitoring vs. Depth of anesthesia monitored according to clinical signs was evaluated on Postoperative cognitive dysfunction (POCD) on the first postoperative day (p=<0.03). Auditory evoked potential-guided anesthesia monitoring reduced early postoperative cognitive dysfunction compared to clinical signs monitoring (6.25% vs 43.75%; P<0.03).
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