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

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.