Relação do índice bispetral e da taxa de supressão do traçado do eletroencefalograma com disfunção cognitiva pós-operatória em cirurgia de revascularização do miocárdio

• Main Author: Lineburger, Eric Benedet [UNESP]
• Publication Date: 2014
• Format: Master thesis
• Language: por
• Source: Repositório Institucional da UNESP
• Download full: http://hdl.handle.net/11449/113900
• topic: Cérebro; Pneumopatias obstrutivas; Miocardio - Cirurgia; Eletrodos; Anestesicos; Índice bispectral; Lungs Diseases, Obstructive

Background: It is still controversial whether bispectral index (BIS) and burst suppression ratio (BSR) values are related to postoperative cognitive dysfunction (POCD). OBJECTIVE: To evaluate BIS and BSR values and their relation to POCD after coronary artery bypass grafting (CABG) surgery in patients undergoing BIS-guided sevoflurane (SEVO) anaesthesia. DESIGN: Prospective, observational study. SETTING: Teaching hospital. PATIENTS: Ninety adult patients scheduled for on- or off-pump CABG surgery. INTERVENTIONS: Anaesthesia was induced with propofol, remifentanil and atracurium and maintained with end-tidal SEVO (ETSEVO) at age-adapted minimum alveolar concentration (MACSEVO) targeting BIS values of 40-60. Mini-Mental State Examination (MMSE) for cognitive assessment of the patients was applied on hospital admission and at 3 months after surgery. MAIN OUTCOME MEASUREMENTS: BIS, BSR, ETSEVO and MACSEVO values were recorded every 5 minutes during the procedure. A decrease of 1 standard deviation or more from the basal MMSE was defined as POCD. RESULTS: The POCD proportion was 40%. The patients were allocated into two groups: with POCD (n=36) or no POCD (n=54). There was no difference of POCD incidence between patients who were submitted to on- versus off-pump CABG (P=1.0). With regard to the patient’s characteristics, only body mass index (BMI) was higher in the no-POCD group (P=0.009). Mean BSR, ETSEVO and MACSEVO values were higher in the no-POCD group (P<0.05). In a multivariable analysis, lower values of BSR (odds ratio-OR 0.008; 95%CI [0.001-0.53]; P=0.02), MACSEVO (OR 0.001; 95%CI [0.001-0.08]; P=0.008), ETSEVO (OR 0.03; 95%CI [0.002-0.66]; P=0.02) and BMI (OR 0.82; 95%CI [0.70-0.96]; P=0.01) were independent predictors of risk for POCD incidence. BIS values did not influence POCD incidence (OR 1.0; 95%CI [0.95-1.11]; P=0.40). CONCLUSION: BIS-guided SEVO anaesthesia titrated to a range between 40 and 60 is not a predictive factor ...