The investigators aim to identify preoperative Electroencephalogram (EEG) markers indicating patients at risk to develop postoperative delirium (POD), so that the anesthetist may adjust medications and dosages in order to avoid POD. Second, the investigators aim to specify intraoperative EEG signatures and EEG states that are related to POD and long-term cognitive dysfunction, again to enable physicians to adapt their procedure. Third, the investigators aim to identify EEG signatures during stay in the recovery room that is directly related to POD, and may therefore be used as diagnostic tool, as well as a predictor for the development of long-term cognitive deficits (POCD).
The investigators conduct this observational study to identify pre-, intra- and postoperative Electroencephalogram (EEG) signatures / intraoperative EEG states related to postoperative delirium (POD) and postoperative cognitive deficit (POCD) in elderly patients \> 70 years. This includes the following tasks at five different time-points 1. Pre-operative frontal EEG recording during anesthesia evaluation one day before surgery / anesthesia to develop an EEG marker to predict the development of POD. This includes the stratification of EEG data related to age, gender, and pre-operative cognitive function. Pre-operative POCD assessment (CANTAB connect, word pair recognition test, Mini Mental State Test, and Trail Making Test A and B) to classify cognitive capacity of each patient before start of anesthesia. 2. Intra-operative frontal EEG recording from start of anesthesia procedure until discharge to the recovery room to identify EEG signatures / EEG states to predict the development of POD / POCD. This includes the stratification of EEG data related to age, gender, pre-medication, anesthetics, and analgesics used during anesthesia procedure. 3. Post-operative frontal EEG recording during the recovery room stay to develop an EEG marker / identify EEG signatures to diagnose POD and predict POCD. This includes the stratification of EEG data related to age, gender, anesthesia procedure, and analgesics administered during the recovery room stay. POD will be assessed during stay in the recovery room by the NuDesc Score and DSM V criteria. 4. Follow-up POD assessments until the 5th postoperative day, where the patient will be visited twice daily (8a.m.-10a.m. and 5p.m.-7p.m.) and assessed via DSM V / NuDesc criteria on the peripheral ward, or via Confusion Assessment Method for intensive Care Unit (CAM-ICU) criteria during an intensive care unit stay. 5. Follow-up POCD assessments one day before and 3 months after surgery, where the patient will undergo a \~1 hour cognitive testing with the CANTAB connect.
Study Type
OBSERVATIONAL
Enrollment
348
Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin
Berlin, Germany
Incidence of Postoperative Delirium- Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
Postoperative delirium rate, defined according to Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
Time frame: Patients will be follow until hospital discharge, or maximal until postoperative day 5
Incidence of Postoperative Delirium - Nursing Delrium Scale (Nu-DESC)
Postoperative delirium rate, defined according to ≥ 2 cumulative points in the nursing Delirium Screening Scale (Nu-DESC)
Time frame: Patients will be follow until hospital discharge, or maximal until postoperative day 5
Incidence of Postoperative Delirium - Intensive Care Unit (CAM-ICU)
Postoperative delirium rate, defined according to positive Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score
Time frame: Patients will be followed on intensive care unit until hospital discharge, or maximal until postoperative day 5
Incidence of Postoperative Delirium - Confusion Assessment Method (CAM)
Postoperative delirium rate, defined according to positive Confusion Assessment Method (CAM)
Time frame: Patients will be followed on peripheral ward until hospital discharge, or maximal until postoperative day 5
Incidence of postoperative cognitive deficit (POCD) - CANTAB
POCD will be measured by a defined Cambridge Neuropsychological Test Automated Battery (CANTAB) on the day before the operation and after 3 months
Time frame: Up to 3 months
Incidence of postoperative cognitive deficit (POCD) - MMSE
POCD will be measured by Mini Mental State Examination (MMSE) on the day before the Operation, on day 5 and after 3 months
Time frame: Up to 3 months
Incidence of Neurocognitive disorder
Neurocognitive Disorder is evaluated according to DSM-V (postoperative cognitive deficit, activities of daily living, instrumental activities of daily living, subjective memory sensing.
Time frame: Up to 3 months
Incidence of postoperative cognitive deficit (POCD) - Word pair recognition test
POCD will be measured by Nürnberger-Altersinventar-Test - word pair recognition test on the day before the operation, day 1 ,3 and 5
Time frame: Up to 5 days
Post-operative, bi-frontal alpha-band power
Bi-frontal EEG recording with surface electrodes (Fp1, Fp2, F7 and F8), Spectral analysis by Matlab code
Time frame: Up to discharge from the recovery room
Bi-frontal overall EEG band power
Postoperative bi-frontal EEG recording with surface electrodes (Fp1, Fp2, F7 and F8), Spectral analysis by Matlab code
Time frame: Up to discharge from the recovery room
Burst suppression duration
Intraoperative bi-frontal EEG recording with surface electrodes (Fp1, Fp2, F7 and F8), raw EEG analysis
Time frame: During anesthesia procedure
Pain monitoring
Intraoperative pain monitoring is measured by Nociception Level Index (NOL
Time frame: During anesthesia procedure
Duration of Delirium (DSM-V)
Postoperative duration of delirium, defined according to Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
Time frame: Participants will be followed for the duration of hospital stay, or maximal until postoperative day 5
Duration of Delirium (Nu-DESC)
Postoperative duration of delirium, defined according to Nursing Delirium Screening Scale (Nu-DESC)
Time frame: Participants will be followed for the duration of hospital stay, or maximal until postoperative day 5
Duration of Delirium (CAM-ICU)
Postoperative duration of delirium, defined according to Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)Confusion Assessment Method (CAM), Chart Review
Time frame: Participants will be followed for the duration of hospital stay, or maximal until postoperative day 5
Duration of Delirium (CAM)
Postoperative duration of delirium, defined according to Confusion Assessment Method (CAM)
Time frame: Participants will be followed for the duration of hospital stay, or maximal until postoperative day 5
Intensive care unit length of stay
Intensive care unit length of staywill be assessed by chart review at hospital discharge.
Time frame: Participants will be followed for the duration of intensive care unit stay, an expected average of 5 days
Hospital length of stay
Hospital length of stay will be assessed by chart review at 3 months.
Time frame: Participants will be followed for the duration of hospital stay, an expected average of 7 days
Mortality
Mortality will be assessed by chart review at 3 months.
Time frame: Up to 3 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.