Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass

Clin Neurophysiol. 2019 Jan;130(1):55-60. doi: 10.1016/j.clinph.2018.11.003. Epub 2018 Nov 16.


Objective: Electroencephalogram burst-suppression during general anesthesia is associated with post-operative delirium (POD). Whether burst-suppression causes POD or merely reflects susceptibility to POD is unclear. We hypothesized decreased intraoperative alpha (8-12 Hz) and beta (13-33 Hz) power prior to the occurrence of burst-suppression in susceptible patients.

Methods: We analyzed intraoperative electroencephalogram data of cardiac surgical patients undergoing cardiopulmonary bypass (CPB). We detected the incidence and duration of CPB burst-suppression with an automated burst-suppression detection algorithm. We analyzed EEG data with multitaper spectral estimation methods. We assessed associations between patient characteristics and burst-suppression using Binomial and Zero-inflated Poisson Regression Models.

Results: We found significantly decreased alpha and beta power (7.8-22.95 Hz) in the CPB burst-suppression cohort. The odds ratio for the association between point estimates for alpha and beta power (7.8-22.95 Hz) and the incidence of burst-suppression was 0.88 (95% CI: 0.79-0.98). The incidence rate ratio for the association between point estimates for power between the alpha and beta range and the duration of burst-suppression was 0.89 (95% CI: 0.84-0.93).

Conclusion: Decreased intra-operative power within the alpha and beta range was associated with susceptibility to burst-suppression during CPB.

Significance: This dynamic may be used to develop principled neurophysiological-based approaches to aid the preemptive identification and targeted care of POD vulnerable patients.

Keywords: Burst-suppression; EEG oscillations, alpha and beta oscillations; General anesthesia; Post-operative delirium.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Anesthesia, General / adverse effects
  • Anesthesia, General / trends*
  • Brain Waves / physiology
  • Cardiopulmonary Bypass / adverse effects
  • Cardiopulmonary Bypass / trends*
  • Electroencephalography / adverse effects
  • Electroencephalography / trends*
  • Female
  • Humans
  • Incidence
  • Intraoperative Complications / diagnosis
  • Intraoperative Complications / physiopathology
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / methods
  • Monitoring, Intraoperative / trends*
  • Predictive Value of Tests