2024年6月10日，《美国医学会杂志》在线发表了加拿大蒙特利尔大学Alain Deschamps等研究人员的最新成果。该研究完成脑电图引导下的麻醉与心脏手术后老年人的谵妄：ENGAGES-加拿大随机临床试验。

研究人员表示，术中脑电图（EEG）波形抑制表明全身麻醉过度，与术后谵妄有关。

为了评估EEG引导麻醉是否会降低心脏手术后谵妄的发生率。研究人员在加拿大4家医院对1140名60岁或以上接受心脏手术的成人进行随机平行分组临床试验。招募时间为2016年12月至2022年2月，随访至2023年2月。

在1140名随机患者（中位数[IQR]年龄为70 [65-75]岁；282 [24.7%]为女性）中，有1131人（99.2%）接受了主要结果评估。在术后第1到5天，EEG引导组的562位患者中有102位（18.15%）出现谵妄，常规护理组的569位患者中有103位（18.10%）出现谵妄（差异为0.05% [95%CI，-4.57%到4.67%]）。与常规护理组相比，EEG引导组的挥发性麻醉剂最低肺泡浓度中位数降低了0.14（95%CI，0.15至0.13）（0.66vs0.80），脑电图抑制总时间中位数减少了7.7分钟（95%CI，10.6至4.7）（4.0vs11.7分钟）。

两组患者在重症监护室的中位住院时间（差异为0天 [95%CI, -0.31到0.31]）或住院时间（差异为0天 [95%CI, -0.94到0.94]）没有明显差异。没有患者报告术中出现意识障碍。EEG引导组567名患者中有64名（11.3%）出现医疗并发症，常规护理组573名患者中有73名（12.7%）出现医疗并发症。EEG引导组567例患者中有8例（1.4%）出现30天死亡，常规护理组573例患者中有13例（2.3%）出现30天死亡。

该研究表明，在接受心脏手术的老年人中，与常规护理相比，在EEG指导下进行麻醉以尽量减少EEG抑制并不能降低术后谵妄的发生率。这一结果并不支持将EEG引导麻醉用于这一适应症。

附：英文原文

Title: Electroencephalography-Guided Anesthesia and Delirium in Older Adults After Cardiac Surgery: The ENGAGES-Canada Randomized Clinical Trial

Author: Alain Deschamps, Arbi Ben Abdallah, Eric Jacobsohn, Tarit Saha, George Djaiani, Renée El-Gabalawy, Charles Overbeek, Jennifer Palermo, Athanase Courbe, Isabelle Cloutier, Rob Tanzola, Alex Kronzer, Bradley A. Fritz, Eva M. Schmitt, Sharon K. Inouye, Michael S. Avidan, Canadian Perioperative Anesthesia Clinical Trials Group, André Denault, David Mazer, Alexis Turgeon, Franois Martin Carrier, Deschamps Alain, Scott Beattie, Hilary Grocott, Richard Hall, Gregory Hare, Manoj Lalu, Philip Jones, Greg Bryson, Jessica Spence, Summer Syed, Diem Tran, Renée El-Gabalawy, Tarit Saha, Eric Jacobsohn, George Djaiani, Yoan Lamarche

Issue&Volume: 2024-06-10

Abstract: Importance  Intraoperative electroencephalogram (EEG) waveform suppression, suggesting excessive general anesthesia, has been associated with postoperative delirium.

Objective  To assess whether EEG-guided anesthesia decreases the incidence of delirium after cardiac surgery.

Design, Setting, and Participants  Randomized, parallel-group clinical trial of 1140 adults 60 years or older undergoing cardiac surgery at 4 Canadian hospitals. Recruitment was from December 2016 to February 2022, with follow-up until February 2023.

Interventions  Patients were randomized in a 1:1 ratio (stratified by hospital) to receive EEG-guided anesthesia (n=567) or usual care (n=573). Patients and those assessing outcomes were blinded to group assignment.

Main Outcomes and Measures  The primary outcome was delirium during postoperative days 1 through 5. Intraoperative measures included anesthetic concentration and EEG suppression time. Secondary outcomes included intensive care and hospital length of stay. Serious adverse events included intraoperative awareness, medical complications, and 30-day mortality.

Results  Of 1140 randomized patients (median [IQR] age, 70 [65-75] years; 282 [24.7%] women), 1131 (99.2%) were assessed for the primary outcome. Delirium during postoperative days 1 to 5 occurred in 102 of 562 patients (18.15%) in the EEG-guided group and 103 of 569 patients (18.10%) in the usual care group (difference, 0.05% [95% CI, 4.57% to 4.67%]). In the EEG-guided group compared with the usual care group, the median volatile anesthetic minimum alveolar concentration was 0.14 (95% CI, 0.15 to 0.13) lower (0.66 vs 0.80) and there was a 7.7-minute (95% CI, 10.6 to 4.7) decrease in the median total time spent with EEG suppression (4.0 vs 11.7 min). There were no significant differences between groups in median length of intensive care unit (difference, 0 days [95% CI, 0.31 to 0.31]) or hospital stay (difference, 0 days [95% CI, 0.94 to 0.94]). No patients reported intraoperative awareness. Medical complications occurred in 64 of 567 patients (11.3%) in the EEG-guided group and 73 of 573 (12.7%) in the usual care group. Thirty-day mortality occurred in 8 of 567 patients (1.4%) in the EEG-guided group and 13 of 573 (2.3%) in the usual care group.

Conclusions and Relevance  Among older adults undergoing cardiac surgery, EEG-guided anesthetic administration to minimize EEG suppression, compared with usual care, did not decrease the incidence of postoperative delirium. This finding does not support EEG-guided anesthesia for this indication.

DOI: 10.1001/jama.2024.8144

Source: https://jamanetwork.com/journals/jama/fullarticle/2819715