• Gudrun Kunst, Nathan Gauge, Kiran Salaunkey, Martina Spazzapan, Derek Amoako, Nicola Ferreira, David W Green, and Clive Ballard.
• Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, Faculty of Life Sciences and Medicine, London, United Kingdom. Electronic address: gudrun.kunst@kcl.ac.uk.
• J. Cardiothorac. Vasc. Anesth. 2020 May 1; 34 (5): 1172-1181.

ObjectivesDoes intraoperative optimization of both depth of anesthesia and regional cerebral tissue oxygenation (rScO2) in elderly patients reduce postoperative cognitive decline (primary outcome) or delirium (secondary outcome)?DesignProspective randomized controlled single blind trial.SettingA single major urban teaching and university hospital and tertiary referral center.ParticipantsPatients, 65 years of age and older, undergoing elective coronary artery bypass graft surgery on cardiopulmonary bypass.InterventionsIntraoperative depth of anesthesia bispectral index (BIS) values were targeted at 50 ± 10. Regional cerebral tissue desaturations of more than 15% of the pre-induction value, or below 50%, were avoided.Measurements And Main ResultsEighty-two patients were included, and mean depth of anesthesia values using BIS were significantly higher during surgery in the intervention group with 40.6 (7.3) versus 35.4 (6.7) in the control group, mean (standard deviation), p = 0.004. The cognitive function was similar between the treatment and control groups at 6 weeks postoperatively with a Mini Mental State Examination (MMSE) of 27 (26,29) in the intervention group and an MMSE of 29 (27,29) in the control group, median (interquartile range), with p = 0.12. The authors observed a reduction in the incidence of delirium, occurring in 2.4% (n = 1) of patients in the intervention group and in 20% (n = 8) in the control group (p = 0.01).ConclusionsThis pilot trial demonstrates that noninvasive target-controlled depth of anesthesia monitoring is feasible. Cognitive function at 6 weeks showed no difference between the treatment and control groups; however, postoperative delirium was reduced in the intervention group.Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

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