Effect of sedation management based on visual analysis of electroencephalography on postoperative delirium in patients undergoing cardiac valve replacement with cardiopulmonary bypass / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the effect of sedation management based on visual analysis of electroencephalography (EEG) on postoperative delirium in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods:Eighty patients, aged ≥ 18 yr, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ, with New York Heart Association Ⅱ-Ⅳ, scheduled for elective cardiac valve replacement with CPB, were randomly divided into visual analysis of EEG-guided sedation management group (group A, n=40) and BIS-guided sedation management group (group B, n=40). The target plasma concentration of propofol was adjusted to maintain the depth of anaesthesia at grade C or grade D in group A and BIS value at 40-60 in group B. Propofol consumption during CPB and total consumption of propofol during surgery, requirement for vasoactive agents during surgery, and parameters of intraoperative arterial blood gas analysis were recorded.Postoperative delirium was evaluated using Confusion Assessment Method for the Intensive Care Unit (ICU) at 1-7 days after surgery.Extubation time, length of ICU stay, length of postoperative hospital stay and intraoperative awareness were also recorded. Results:Compared with group B, the length of postoperative hospital stay was significantly shortened, the incidence of postoperative delirium was decreased, and no significant change was found in the parameters of arterial blood gas analysis, propofol consumption, requirement for vasoactive agents, extubation time, or length of postoperative ICU stay in group A ( P<0.05). No intraoperative awareness occurred in both groups. Conclusion:Sedation management based on visual analysis of EEG is helpful in decreasing the development of postoperative delirium in the patients undergoing cardiac valve replacement with CPB.