Trial reportAnesthesiology2020
Preoperative Cognitive Abnormality, Intraoperative Electroencephalogram Suppression, and Postoperative Delirium: A Mediation Analysis.
Trial report in Anesthesiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effect of intraoperative Electroencephalogram-guided anesthesia on postoperative cognitive function in elderly patients: a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials.BMC anesthesiology · 2025Pooled it
- The Association of Preoperative Cognitive Dysfunction to Common Intraoperative Electroencephalographic Parameters and Cerebral Hypoxia During Cardiac Surgery.Anesthesia and analgesia · 2026Trial
- Effect of raw electroencephalogram-guided anesthesia administration on postoperative outcomes in elderly patients undergoing abdominal major surgery: a randomized controlled trial.BMC anesthesiology · 2023Trial
- On the Robustness of Preoperative Intranasal Dexmedetomidine for Postoperative Delirium Prevention: Methodological Considerations [Letter].Drug design, development and therapy · 2026Article
- The relationship between cognitive function and quality of life in older hypertension patients: a parallel mediation effect of frailty and medication discrepancies.BMC geriatrics · 2025Article
- Age-specific electroencephalography dynamics during anesthesia: monitoring and neurocognitive implications.Anesthesia and pain medicine · 2025Review
- Article
- The intersection of delirium and long-term cognition in older adults: the critical role of delirium prevention.Journal of neurology · 2025Review
- The Impact of Electroencephalogram-Guided General Anesthesia on Postoperative Delirium and Recovery in Patients Over 60 with Hip Fractures: A Retrospective Cohort Study.Neuropsychiatric disease and treatment · 2025Article
- Effects of preoperative neoadjuvant chemotherapy on postoperative delirium in patients with gynecological tumor surgery: an observational study.Journal of cancer research and clinical oncology · 2024Observational
- The Prediction of Postoperative Delirium Using the Preoperative Assessments of Frailty and Cognitive Impairment in Aged Patients.Clinical interventions in aging · 2024Article
- The impact of perioperative enhanced recovery nursing model on postoperative delirium and rehabilitation quality in elderly patients with femoral neck fractures.BMC musculoskeletal disorders · 2023Article
- Electroencephalographic Biomarkers, Cerebral Oximetry, and Postoperative Cognitive Function in Adult Noncardiac Surgical Patients: A Prospective Cohort Study.Anesthesiology · 2023Observational
- Schnider and Eleveld Models for Propofol Target-Controlled Infusion Anesthesia: A Clinical Comparison.Life (Basel, Switzerland) · 2023Article
- Intraoperative electroencephalographic marker of preoperative frailty: A prospective cohort study.Journal of clinical anesthesia · 2023Article
- EEG microstate quantifiers and state space descriptors during anaesthesia in patients with postoperative delirium: a descriptive analysis.Brain communications · 2023Article
- EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults.Frontiers in aging neuroscience · 2023Article
- Quiescence during burst suppression and postictal generalized EEG suppression are distinct patterns of activity.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2022Article
- Spectral Entropy Monitoring Accelerates the Emergence from Sevoflurane Anesthesia in Thoracic Surgery: A Randomized Controlled Trial.Journal of clinical medicine · 2022Article
- Repurposing Propofol as a Prognostic Probe for Return of Consciousness.American journal of respiratory and critical care medicine · 2022Article
Corrections and comments
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Authors and funding
46 authors.
Funding
Abstract
backgroundPostoperative delirium is a common complication that hinders recovery after surgery. Intraoperative electroencephalogram suppression has been linked to postoperative delirium, but it is unknown if this relationship is causal or if electroencephalogram suppression is merely a marker of underlying cognitive abnormalities. The hypothesis of this study was that intraoperative electroencephalogram suppression mediates a nonzero portion of the effect between preoperative abnormal cognition and postoperative delirium.
methodsThis is a prespecified secondary analysis of the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) randomized trial, which enrolled patients age 60 yr or older undergoing surgery with general anesthesia at a single academic medical center between January 2015 and May 2018. Patients were randomized to electroencephalogram-guided anesthesia or usual care. Preoperative abnormal cognition was defined as a composite of previous delirium, Short Blessed Test cognitive score greater than 4 points, or Eight Item Interview to Differentiate Aging and Dementia score greater than 1 point. Duration of intraoperative electroencephalogram suppression was defined as number of minutes with suppression ratio greater than 1%. Postoperative delirium was detected via Confusion Assessment Method or chart review on postoperative days 1 to 5.
resultsAmong 1,113 patients, 430 patients showed evidence of preoperative abnormal cognition. These patients had an increased incidence of postoperative delirium (151 of 430 [35%] vs.123 of 683 [18%], P < 0.001). Of this 17.2% total effect size (99.5% CI, 9.3 to 25.1%), an absolute 2.4% (99.5% CI, 0.6 to 4.8%) was an indirect effect mediated by electroencephalogram suppression, while an absolute 14.8% (99.5% CI, 7.2 to 22.5%) was a direct effect of preoperative abnormal cognition. Randomization to electroencephalogram-guided anesthesia did not change the mediated effect size (P = 0.078 for moderation).
conclusionsA small portion of the total effect of preoperative abnormal cognition on postoperative delirium was mediated by electroencephalogram suppression. Study precision was too low to determine if the intervention changed the mediated effect.
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