Abstract
Background: Although cognitive decline (CD) is associated with increased post-operative morbidity and mortality, routinely screening patients remains difficult. The main objective of this prospective study is to use the EEG response to a Propofol-based general anesthesia (GA) to reveal CD.Methods: 42 patients with collected EEG and Propofol target concentration infusion (TCI) during GA had a preoperative cognitive assessment using MoCA. We evaluated the performance of three variables to detect CD (MoCA < 25 points): age, Propofol requirement to induce unconsciousness (TCI at SEF95: 8–13 Hz) and the frontal alpha band power (AP at SEF95: 8–13 Hz).Results: The 17 patients (40%) with CD were significantly older (p < 0.001), had lower TCI (p < 0.001), and AP (p < 0.001). We found using logistic models that TCI and AP were the best set of variables associated with CD (AUC: 0.89) and performed better than age (p < 0.05). Propofol TCI had a greater impact on CD probability compared to AP, although both were complementary in detecting CD.Conclusion: TCI and AP contribute additively to reveal patient with preoperative cognitive decline. Further research on post-operative cognitive trajectory are necessary to confirm the interest of intra operative variables in addition or as a substitute to cognitive evaluation.
Highlights
Cognitive Decline (CD) is characterized by an impairment or a gradual weakening in cognitive functions such as memory, language, or judgment
The objective of this present study is to evaluate the relationship between intraoperative EEG, especially the alpha band power, effective Propofol dosage and the pre-operative cognitive decline (CD) evaluated using the Montreal Cognitive Assessment (MoCA)
Between November 2018 and May 2019, a total of 56 patients were selected to evaluate the relationship between the peroperative alpha-band, sedation levels during a Propofol based general anesthesia and a pre-operative MoCA psychometric testing
Summary
Cognitive Decline (CD) is characterized by an impairment or a gradual weakening in cognitive functions such as memory, language, or judgment Besides being common among elderly people, it is associated with an increased risk to develop postoperative neurocognitive disorders (Greene et al, 2009; Lee et al, 2011; Silbert et al, 2015). The increase in surgical procedures among the elderly, as a results of ageing population, has recently motivated the medical community to administer rapid neurocognitive tests prior to surgical intervention (Berger et al, 2018). Such assessments are time-consuming and come with several pitfalls related to test administration. The main objective of this prospective study is to use the EEG response to a Propofol-based general anesthesia (GA) to reveal CD
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