Meta-analysis pooled data continues to suggest that processed-EEG guided general anaesthesia is associated with a slightly lower incidence of postoperative delirium compared to usual care or deeper-guided GA.

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• Matthew Sumner, Carolyn Deng, Lis Evered, Chris Frampton, Kate Leslie, Timothy Short, and Doug Campbell.
• Auckland City Hospital, Auckland, New Zealand.
• Br J Anaesth. 2023 Feb 1; 130 (2): e243e253e243-e253.

BackgroundPostoperative delirium (POD) is the most common serious postoperative complication in older adults. It has uncertain aetiology, limited preventative strategies, and poor long-term outcomes. This updated systematic review and meta-analysis aimed to estimate the effect of processed electroencephalography (pEEG)-guided general anaesthesia during surgery on POD incidence.MethodsWe performed a systematic review and meta-analysis by searching OVID MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases. Studies of adult patients having general anaesthesia for any surgery where pEEG was used and POD was an outcome measure were included. Full-text reports of RCTs published from database inception until August 28, 2021, were included. Trials were excluded if sedation rather than general anaesthesia was administered, or the setting was intensive care. The primary outcome was POD assessed by validated tools. The study was prospectively registered with PROSPERO.ResultsNine studies, which included 4648 eligible subjects, were identified. The incidence of POD in the pEEG-guided general anaesthesia or lighter pEEG target group was 19.0% (440/2310) compared with 23.3% (545/2338) in the usual care or deeper pEEG target group (pooled odds ratio=0.78; 95% confidence interval, 0.60-1.00; P=0.054). Significant heterogeneity was detected (I2=53%).ConclusionsOur primary analysis demonstrated a highly sensitive result with a pooled analysis of trials in which the intervention group adhered to manufacturer's recommended guidelines, showing reduced incidence of POD with pEEG guidance. High clinical heterogeneity limits inferences from this and any future meta-analyses.Clinical Trial RegistrationCRD42020199404 (PROSPERO).Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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