• Jule Schüßler, Julian Ostertag, Marie-Therese Georgii, Antonia Fleischmann, Gerhard Schneider, Stefanie Pilge, and Matthias Kreuzer.
• Technical University of Munich - School of Medicine, Department of Anesthesiology & Intensive Care, Munich, Germany.
• J Clin Anesth. 2023 Jun 1; 86: 111058111058.

Study ObjectiveDelirium in the post-anesthesia care unit (PACU-D) presents a serious condition with a high medical and socioeconomic impact. In particular, PACU-D is among common postoperative complications of elderly patients. As PACU-D may be associated with postoperative delirium, early detection of at-risk patients and strategies to prevent PACU-D are important. We characterized EEG baseline signatures of patients who developed PACU-D following surgery and general anesthesia and patients who did not.Design And SettingWe conducted a post-hoc analysis of preoperative EEG recordings between patients with and without PACU-D, as indicated by positive bCAM scores post general anesthesia and surgery.Patients And MeasurementsPreoperative baseline EEG recordings from 89 patients were recorded at controlled eyes-open (focused wakefulness) and eyes-closed (relaxed wakefulness) conditions. We computed power spectral densities, permutation entropy, spectral entropy and spectral edge frequency to see if these parameters can reflect potential baseline EEG differences between PACU-D (31.5%) and noPACU-D (68.5%) patients. Wilcoxon's Rank Sum Test as well as AUC values were used to determine statistical significance.Main ResultsBaseline EEG recordings showed significant differences between PACU-D and noPACU-D patients preoperatively. Compared to the noPACU-D group, PACU-D patients presented with lower power in higher frequencies during relaxed and focused wakefulness alike. These differences in power led to AUC values of 0.73 [0.59;0.85] (permutation entropy) and 0.72 [0.61;0.83] (spectral edge frequency) indicative of a "fair" performance to separate patients with and without PACU-D.ConclusionsThe baseline EEG of relaxed wakefulness as well as focused wakefulness may be used to assess the risk of developing PACU-D following surgery under general anesthesia. Moreover, routinely used monitoring parameters capture these differences as well, potentially allowing an easy transfer to clinical settings.Clinical Trial NumberNCT03775356.Copyright © 2023 Elsevier Inc. All rights reserved.

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