Optimizing Anesthesia Management in Liver Transplantation With Use of Real Time Frontal Electroencephalogram

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-02-12 DOI:10.1111/ctr.70110

Gabriel Rice, Nicholas Douville, Sathish Kumar, Patricia Bloom

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Abstract

Background and Aims

Frontal electroencephalogram (fEEG) is a novel tool to monitor intraoperative sedation and may reduce anesthetic requirements. The utility of fEEG during liver transplantation has not been studied. The primary aim was to determine the association of fEEG with anesthetic requirement. Secondary aims included the effect of fEEG on intraoperative hemodynamics and postoperative outcomes.

Methods

We performed a single-center retrospective cohort study of first-time, liver-alone transplant patients. Anesthetic requirement was measured by the mean minimum alveolar concentration of inhaled anesthetic. Hemodynamics were assessed by mean arterial pressure and total norepinephrine equivalents. Postoperative outcomes included time to extubation, mean postoperative sedation score, and incidence of delirium within five days of transplant. Both univariable and multivariable analysis was used.

Results

There were 37 fEEG-guided and 40 standard-of-care patients included in analysis. fEEG was associated with a 15% decrease of mean minimum alveolar concentration compared to standard-of-care (p < 0.01). There was no association between fEEG and mean arterial pressure or total norepinephrine equivalents. fEEG-guided and standard-of-care patients had similar time-to-extubation (10 h vs. 10 h, p = 0.98) and incidence of post-operative delirium (19% vs. 10%, p = 0.43). fEEG was associated with a lower average postoperative sedation score (Beta = −0.2, p = 0.03).

Conclusions

Our study demonstrated an association of fEEG with a reduced anesthetic requirement while maintaining adequate sedation. Patients monitored with fEEG had lower postoperative sedation scores, but no changes in other postoperative outcomes. Future prospective studies are needed to better elucidate the role of fEEG in liver transplantation, its impact on patient outcomes, and its implications for healthcare costs.

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应用实时额叶脑电图优化肝移植麻醉管理

背景和目的额叶脑电图（fEEG）是一种监测术中镇静的新工具，可以减少麻醉需求。fEEG在肝移植中的应用尚未得到研究。主要目的是确定fEEG与麻醉需求的关系。次要目的包括fEEG对术中血流动力学和术后结果的影响。方法对首次单独肝移植患者进行单中心回顾性队列研究。麻醉需要量以吸入麻醉药平均最低肺泡浓度测定。通过平均动脉压和总去甲肾上腺素当量来评估血流动力学。术后结果包括拔管时间、平均术后镇静评分和移植后5天内谵妄的发生率。采用单变量和多变量分析。结果37例feeg引导患者和40例标准治疗患者纳入分析。与标准治疗相比，fEEG与平均最低肺泡浓度降低15%相关(p <；0.01)。fEEG与平均动脉压或总去甲肾上腺素当量之间没有关联。feeg引导和标准护理患者拔管时间相似（10小时vs 10小时，p = 0.98），术后谵妄发生率相似（19% vs 10%, p = 0.43）。fEEG与较低的平均术后镇静评分相关（Beta = - 0.2, p = 0.03）。结论：我们的研究表明fEEG与维持足够镇静的同时减少麻醉需求有关。用fEEG监测的患者术后镇静评分较低，但其他术后结局无变化。未来的前瞻性研究需要更好地阐明fEEG在肝移植中的作用，它对患者预后的影响，以及它对医疗费用的影响。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.