MedicalResearch.com Interview with:
Michael Avidan, MBBCh, FCA SA
Dr. Seymour and Rose T. Brown Professor of Anesthesiology
Chief of the Division of Clinical and Translational Research
Director of the Infrastructure of Quality Improvement, Research and Informatics
Washington University School of Medicine
St Louis, MO
MedicalResearch.com: What is the background for this study?
Response: Postoperative delirium, a temporary state of confusion and inattention, is common in older adults after major surgery. Delirium can be distressing to patients, family members and clinicians. It is associated with longer hospital stays, other medical complications, cognitive decline, and death.
Some previous studies have found that using electroencephalography (EEG) monitoring of the brain during general anesthesia decreases the occurrence of delirium following surgery.
Therefore we conducted a rigorous study to determine whether using information from the EEG to guide the safe reduction of inhaled anesthetic drugs would prevent postoperative delirium and improve other outcomes in older adults following major surgery.
MedicalResearch.com: What are the main findings?
Response: A total of 1232 patients were randomized either to EEG monitoring during surgery or to current standard anesthetic care. As intended, the group that had EEG monitoring had less exposure to anesthetic drugs, but contrary to our expectations, this group did not have a lower occurrence of delirium (26%) than the group that received standard care (23%). However, when we looked at our results after the study was complete, we discovered something surprising. In the group that had EEG monitoring, there were only four deaths (0.7%) by thirty days after surgery, whereas, in the other group, there were nineteen deaths (3.1%).
MedicalResearch.com: What should readers take away from your report?
Response: Delirium continues to be a common complication for older adults after surgery. It is important to educate patients, clinicians and family members about this problem.
Our study shows that it will not be easy to find a simple solution to this distressing complication. Although EEG brain monitoring did not improve postoperative delirium, it might be helpful for preventing other complications. Further research is needed to clarify the benefits of EEG brain monitoring during general anesthesia.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: A single study is not sufficient to provide definitive evidence. Additional multi-center trials are currently ongoing to determine whether EEG guidance of anesthesia can prevent postoperative delirium. One of these is the ENGAGES Canada trial, which is being conducted at four Canadian hospitals.
MedicalResearch.com: Is there anything else you would like to add?
Response: We have no conflicts of interest to disclose. We would like to thank the clinicians and numerous ENGAGES team members for help and support in conducting the study.
Wildes TS, Mickle AM, Ben Abdallah A, et al. Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. JAMA. 2019;321(5):473–483. doi:10.1001/jama.2018.22005
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