Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).

<h4>Introduction</h4>The number of elderly patients undergoing major surgery is rapidly increasing. They are particularly at risk of developing postoperative neurocognitive disorders (NCD). Earlier studies suggested that processed electroencephalographic (EEG) monitors may reduce the inc...

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Autores principales:	Louis Morisson, Pascal Laferrière-Langlois, François Martin Carrier, Gabrielle Pagé, Cédric Godbout, Louis-Philippe Fortier, David Ogez, Geneviève Létourneau, Stéphanie Jarry, André Denault, Annik Fortier, Marie-Claude Guertin, Olivier Verdonck, Philippe Richebé
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/491260d8b0b4422b983dcc56ea664d21
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spelling	oai:doaj.org-article:491260d8b0b4422b983dcc56ea664d212021-12-02T20:18:26ZEffect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).1932-620310.1371/journal.pone.0255852https://doaj.org/article/491260d8b0b4422b983dcc56ea664d212021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255852https://doaj.org/toc/1932-6203<h4>Introduction</h4>The number of elderly patients undergoing major surgery is rapidly increasing. They are particularly at risk of developing postoperative neurocognitive disorders (NCD). Earlier studies suggested that processed electroencephalographic (EEG) monitors may reduce the incidence of postoperative NCD. However, none of these studies controlled for intraoperative nociception levels or personalized blood pressure targets. Their results remain unclear if the reduction in the incidence of postoperative NCD relates to avoidance of any electroencephalographic pattern suggesting excessive anesthesia depth.<h4>Objective</h4>The objective of this trial is to investigate-in patients ≥ 70 years old undergoing major non-cardiac surgery-the effect of EEG-guided anesthesia on postoperative NCD while controlling for intraoperative nociception, personalized blood pressure targets, and using detailed information provided by the EEG monitor (including burst suppression ratio, density spectral array, and raw EEG waveform).<h4>Material and methods</h4>This prospective, randomized, controlled trial will be conducted in a single Canadian university hospital. Patients ≥ 70 years old undergoing elective major non-cardiac surgery will be included in the trial. The administration of sevoflurane will be adjusted to maintain a BIS index value between 40 and 60, to keep a Suppression Ratio (SR) at 0%, to keep a direct EEG display without any suppression time and a spectrogram with most of the EEG wave frequency within the alpha, theta, and delta frequencies in the EEG-guided group. In the control group, sevoflurane will be administered to achieve an age-adjusted minimum alveolar concentration of [0.8-1.2]. In both groups, a nociception monitor will guide intraoperative opioid administration, individual blood pressure targets will be used, and cerebral oximetry used to tailor intraoperative hemodynamic management. The primary endpoint will be the incidence of NCD at postoperative day 1, as evaluated by the Montreal Cognitive Assessment (MoCA). Secondary endpoints will include the incidence of postoperative NCD at different time points and the evaluation of cognitive trajectories up to 90 days after surgery among EEG-guided and control groups.<h4>Study registration</h4>NCT04825847 on ClinicalTrials.gov.Louis MorissonPascal Laferrière-LangloisFrançois Martin CarrierGabrielle PagéCédric GodboutLouis-Philippe FortierDavid OgezGeneviève LétourneauStéphanie JarryAndré DenaultAnnik FortierMarie-Claude GuertinOlivier VerdonckPhilippe RichebéPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255852 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Louis Morisson Pascal Laferrière-Langlois François Martin Carrier Gabrielle Pagé Cédric Godbout Louis-Philippe Fortier David Ogez Geneviève Létourneau Stéphanie Jarry André Denault Annik Fortier Marie-Claude Guertin Olivier Verdonck Philippe Richebé Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).
description	<h4>Introduction</h4>The number of elderly patients undergoing major surgery is rapidly increasing. They are particularly at risk of developing postoperative neurocognitive disorders (NCD). Earlier studies suggested that processed electroencephalographic (EEG) monitors may reduce the incidence of postoperative NCD. However, none of these studies controlled for intraoperative nociception levels or personalized blood pressure targets. Their results remain unclear if the reduction in the incidence of postoperative NCD relates to avoidance of any electroencephalographic pattern suggesting excessive anesthesia depth.<h4>Objective</h4>The objective of this trial is to investigate-in patients ≥ 70 years old undergoing major non-cardiac surgery-the effect of EEG-guided anesthesia on postoperative NCD while controlling for intraoperative nociception, personalized blood pressure targets, and using detailed information provided by the EEG monitor (including burst suppression ratio, density spectral array, and raw EEG waveform).<h4>Material and methods</h4>This prospective, randomized, controlled trial will be conducted in a single Canadian university hospital. Patients ≥ 70 years old undergoing elective major non-cardiac surgery will be included in the trial. The administration of sevoflurane will be adjusted to maintain a BIS index value between 40 and 60, to keep a Suppression Ratio (SR) at 0%, to keep a direct EEG display without any suppression time and a spectrogram with most of the EEG wave frequency within the alpha, theta, and delta frequencies in the EEG-guided group. In the control group, sevoflurane will be administered to achieve an age-adjusted minimum alveolar concentration of [0.8-1.2]. In both groups, a nociception monitor will guide intraoperative opioid administration, individual blood pressure targets will be used, and cerebral oximetry used to tailor intraoperative hemodynamic management. The primary endpoint will be the incidence of NCD at postoperative day 1, as evaluated by the Montreal Cognitive Assessment (MoCA). Secondary endpoints will include the incidence of postoperative NCD at different time points and the evaluation of cognitive trajectories up to 90 days after surgery among EEG-guided and control groups.<h4>Study registration</h4>NCT04825847 on ClinicalTrials.gov.
format	article
author	Louis Morisson Pascal Laferrière-Langlois François Martin Carrier Gabrielle Pagé Cédric Godbout Louis-Philippe Fortier David Ogez Geneviève Létourneau Stéphanie Jarry André Denault Annik Fortier Marie-Claude Guertin Olivier Verdonck Philippe Richebé
author_facet	Louis Morisson Pascal Laferrière-Langlois François Martin Carrier Gabrielle Pagé Cédric Godbout Louis-Philippe Fortier David Ogez Geneviève Létourneau Stéphanie Jarry André Denault Annik Fortier Marie-Claude Guertin Olivier Verdonck Philippe Richebé
author_sort	Louis Morisson
title	Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).
title_short	Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).
title_full	Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).
title_fullStr	Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).
title_full_unstemmed	Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).
title_sort	effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: a trial protocol the poegea trial (poncd elderly general anesthesia).
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/491260d8b0b4422b983dcc56ea664d21
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Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia).

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