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Impact of Processed Electroencephalography in Cardiac Surgery: A Retrospective Analysis

Published:March 30, 2022DOI:https://doi.org/10.1053/j.jvca.2022.03.030

      Objective

      The use of brain function monitoring with processed electroencephalography (pEEG) during cardiac surgery is gaining interest for the optimization of hypnotic agent delivery during the maintenance of anesthesia. The authors sought to determine whether the routine use of pEEG-guided anesthesia is associated with a reduction of hemodynamic instability during cardiopulmonary bypass (CPB) separation and subsequently reduces vasoactive and inotropic requirements in the intensive care unit.

      Design

      This is a retrospective cohort study based on an existing database.

      Setting

      A single cardiac surgical center.

      Participants

      Three hundred patients undergoing cardiac surgery, under CPB, between December 2013 and March 2020.

      Interventions

      None.

      Measurements and Main Results

      One hundred and fifty patients had pEEG-guided anesthesia, and 150 patients did not have a pEEG-guided anesthesia. Multiple logistic regression demonstrated that pEEG-guided anesthesia was not associated with a successful CPB separation (p = 0.12). However, the use of pEEG-guided anesthesia reduced by 57% the odds of being in a higher category for vasoactive inotropic score compared to patients without pEEG (odds ratio = 0.43; 95% confidence interval: 0.26-0.73; p = 0.002). Duration of mechanical ventilation, fluid balance, and blood losses were also reduced in the pEEG anesthesia-guided group (p < 0.003), but there were no differences in organ dysfunction duration and mortality.

      Conclusion

      During cardiac surgery, pEEG-guided anesthesia allowed a reduction in the use of inotropic or vasoactive agents at arrival in the intensive care unit. However, it did not facilitate weaning from CPB compared to a group where pEEG was unavailable. A pEEG-guided anesthetic management could promote early vasopressor weaning after cardiac surgery.

      Key Words

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      Linked Article

      • Predicting Outcomes in Cardiac Surgery Using Processed Electroencephalography
        Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 9
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          We read with interest a recent paper looking at the use of processed electroencephalography (pEEG) and outcomes in patients undergoing cardiac surgery.1 We note not only that this was a retrospective single-center study, but also the data included were based on the practice of only 1 anesthesiologist. Thus, the outcomes potentially could have been heavily influenced by bias. We should, therefore, be cautious in extrapolating the findings to wider clinical practice. We question the association between the use of pEEG and the primary outcome.
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          Various strategies for intraoperative cerebral monitoring have been evaluated over the decades, with electroencephalography (EEG) monitoring as one of the oldest. There are reports in the literature from as early as 1937 comparing EEG (referred to as electroencephalogram) to an electrocardiogram, with the evaluation of this technique for the detection of changes in brain activity with drug administration.1 Subsequently, numerous investigative studies have led to recognizing alterations in brain activity patterns in a dose-response manner to anesthetic agents.
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