谵妄
医学
优势比
入射(几何)
麻醉
置信区间
全身麻醉
术后认知功能障碍
脑电双频指数
随机对照试验
发作性谵妄
外科
镇静
认知
内科学
精神科
物理
光学
作者
Lisbeth Evered,Matthew T. V. Chan,Ruquan Han,Mandy H.M. Chu,Benny P. Cheng,David A. Scott,Kane O. Pryor,Daniel I. Sessler,Robert A. Veselis,Christopher Frampton,Matthew Sumner,Hafis Adetokunbo Ayeni,Paul S. Myles,Douglas Campbell,Kate Leslie,Timothy G. Short
标识
DOI:10.1016/j.bja.2021.07.021
摘要
Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia).This multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary outcomes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression.The incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38-0.88]; P=0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS ≤6 vs 20%; P<0.001).Among patients undergoing major surgery, targeting light anaesthesia reduced the risk of postoperative delirium and cognitive impairment at 1 yr.ACTRN12612000632897.
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