Evidence map›Paper›PMID 34465469›Full record

Trial reportBritish journal of anaesthesia2021

Anaesthetic depth and delirium after major surgery: a randomised clinical trial.

Lisbeth A Evered, Matthew T V Chan, Ruquan Han, Mandy H M Chu, Benny P Cheng, David A Scott, Kane O Pryor, Daniel I Sessler, Robert Veselis, Christopher Frampton and 6 more

5 registry-linked trialsOpen access · greenAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in British journal of anaesthesia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 198 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
198citing papers in PubMed, 18 pooled it
31.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT05474872 unknown statusnot on this mapstarted 2022, after this paper: background citation

Postoperative Delirium: a Complex Prediction Model in Patients Undergoing Major Abdominal Surgery

TypeobservationalSponsorInstitutul Regional de Gastroenterologie & Hepatologie Prof. dr. Octavian FodorRan2022 to 2026Enrolled100ConditionsPostoperative Delirium, Cognitive ImpairmentArmsBIS monitoring
NCT06217341 unknown statusnot on this mapstarted 2023, after this paper: background citation

Bispectral Index and Emergence Agitation in Spinal Surgeries

Typeobservational_patient_registrySponsorBozok UniversityRan2023 to 2024Enrolled60ConditionsAnesthesia Recovery Periods, Anesthesia Complication, ElectroencephalographyArmsIn the study, bispectral index monitoring and follow-up will be applied to both groups.
NCT06268080 narecruitingnot on this mapstarted 2024, after this paper: background citation

Preserving Brain Health After Surgery: Does Light General Anesthesia Reduce Postoperative Delirium and Cognitive Decline Compared With Deep General Anesthesia in Older Adults?

TypeinterventionalSponsorAuckland City HospitalRan2024 to 2028Enrolled2,766ConditionsDelirium, Postoperative, Anesthesia, Surgery-Complications, Cognition DisorderArmsDepth of anesthesia titration using pEEG
NCT06334939 completednot on this mapstarted 2024, after this paper: background citation

Bispectral Index, Suppression Rate and Recovery Agitation in Spine Surgeries

TypeobservationalSponsorAhmet YuksekRan2024 to 2024Enrolled94ConditionsEmergence Agitation, Anesthesia Recovery, Bispectral Index MonitorArmsBispectral Index Monitoring
NCT07479719 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Anesthesia Maintenance With Target-controlled Infusion of Propofol and Remifentanil at Fixed Ratio on Neurocognitive Recovery in Older Patients After Surgery: a Randomized Trial

TypeinterventionalSponsorPeking University First HospitalRan2026 to 2027Enrolled200ConditionsElderly, Surgery, Depth of Anesthesia, Total Intravenous AnesthesiaArmsLight anesthesia, Deep anesthesia
3 · Its place in the literature

Who cites it

198 citing papers in PubMed, 18 syntheses or guidelines pooled it, 345 citations in OpenAlex.

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138 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 9 institutions in 5 countries.

Lisbeth A EveredDepartment of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Critical Care Medicine, University of Melbourne, Melbourne, VIC, Australia. Electronic address: lae4004@med.cornell.edu.
Matthew T V ChanDepartment of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Ruquan HanDepartment of Anesthesiology, Beijing Tiantan Hospital and Capital Medical University, Beijing, China.
Mandy H M ChuDepartment of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Benny P ChengDepartment of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
David A ScottDepartment of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Critical Care Medicine, University of Melbourne, Melbourne, VIC, Australia.
Kane O PryorDepartment of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Daniel I SesslerDepartment of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Robert VeselisDepartment of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Christopher FramptonDepartment of Medicine, University of Otago, Christchurch, New Zealand.
Matthew SumnerDepartment of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand.
Ade AyeniDepartment of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand.
Paul S MylesDepartment of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, VIC, Australia.
Douglas CampbellDepartment of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand; Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
Kate LeslieDepartment of Critical Care Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia.
Timothy G ShortDepartment of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand; Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
Auckland City Hospital · NZChinese University of Hong Kong · HKCornell University · USMonash University · AUCapital Medical University · CNCleveland Clinic · USSt Vincent's Hospital Melbourne · AUThe University of Melbourne · AUUniversity of Otago · NZ

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Hongbiao Carl Lekaye · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

backgroundPostoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia).

methodsThis multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary outcomes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression.

resultsThe incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38-0.88]; P=0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS ≤6 vs 20%; P<0.001).

conclusionsAmong patients undergoing major surgery, targeting light anaesthesia reduced the risk of postoperative delirium and cognitive impairment at 1 yr. CLINICAL

trial registrationACTRN12612000632897.

Indexed as

AgedAnesthesia, GeneralCognitionCognitive DysfunctionConsciousness MonitorsElectroencephalographyEmergence DeliriumFemaleFollow-Up StudiesHumansIntensive Care UnitsLength of StayMaleMiddle AgedPostoperative ComplicationsTime Factorsanaesthesiabispectral indexcognitive dysfunctiondeliriumelectroencephalographypostoperative delirium

Identifiers

PMID34465469
PMCPMC8579421
OpenAlexW3197314412

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.