Effects Of Visual Analysis Electroencephalography-guided Anesthetic Administration On Postoperative Delirium In Patients Undergoing Heart Valve Replacement Surgery

Background and Aims Postoperative delirium(POD)is a common complication in patients undergoing heart valve replacement under cardiopulmonary bypass,and it is often associated with prolonged hospital stay and ICU stay,increased postoperative morbidity and mortality,seriously affecting the prognosis of patients.Electroencephalogram(EEG)monitoring,as a common method to reflect the depth of sedation during perioperative period,has received more and more attention in preventing the occurrence of POD.Bispectral index(BIS)is the most widely used EEG technology recently.Many studies have confirmed that BIS-guided sedation can reduce the incidence of POD after non-cardiac surgery.However,the shortcomings of CPB and hypothermia on the accuracy of BIS values and the hysteresis reflected by BIS itself make the application of BIS in cardiac surgery questionable.In recent years,anesthesia scholars have begun to use raw electroencephalographic analysis techniques to guide the depth management of anesthesia.Emerging studies have shown that visual analysis of electroencephalogram monitoring technology could be used to guide the depth management of sedation in non-cardiac surgery,and it is helpful to accurately assess the burst suppression ratio during surgery,however,the effectiveness and feasibility of the visual analysis of electroencephalogram monitoring technology in cardiac surgery is remain unclear.This study intends to explore whether visual analysis of electroencephalography to guide the depth of sedation can reduce the incidence of PODin patients undergoing heart valve replacement surgery,so that provide a reference for clinical monitoring of the depth of anesthesia in cardiac surgery with CPB.Methods Eighty eight patients who undergoing elective cardiac valve replacement surgery under cardiopulmonary bypass were enrolled.The patients were divided into 2groups by random number table(n = 44): The infusion rate of propofol was adjusted to maintain the corresponding anesthesia depth with C or D stage in group A and 40 ? BIS value ? 60 in group B respectively.Patient's characteristics,duration of surgery,duration of anesthesia,duration of aortic cross clamping,duration of cardiopulmonary bypass,intraoperative propofol use,dosage of vasoactive drugs,blood gas analysis results of the patients were recorded during the surgery.The main endpoint was the incidence of postoperative delirium.The secondary endpoints including intraoperative awareness,extubation time,length of ICU stay,length of hospital stay were recorded after the surgery.Results A total of 88 patients were selected,after excluding non-conforming cases,a total of 80 patients were included for data analysis.There was no significant difference between the two groups of patient's characteristics,intraoperative anesthesia and surgery-related data,dosage of vasoactive drugs,blood gas analysis results,length of postoperative ICU and extubation time(P >0.05).The incidence of delirium was lower in group A(23%)than group B(45%),and the length of hospital stay was shorter in group A(13.2±3.4)than group B(13.5±5.9)(P <0.05).Conclusion Compared with BIS monitoring,visual analysis electroencephalography-guided anesthetic administration may help to reduce the incidence of postoperative delirium in patients undergoing heart valve replacement under cardiopulmonary bypass.