Columbia University
The investigators intend to recruit 600 participants to see if alpha power during anesthesia is influenced by analgesic medication and associated with a reduction of delirium following surgery.
Postoperative delirium may manifest in the immediate post-anesthesia care period. Such episodes appear to be predictive of further episodes of inpatient delirium and associated adverse outcomes. Intraoperative monitoring of frontal electroencephalogram (EEG) has been associated with postoperative delirium and poor outcomes. However, the efficacy of titrating anesthesia medication to proprietary index targets for preventing delirium remains contentious. The investigators aim to assess the efficacy of two pharmacologic strategies which could prevent post-anesthesia care unit (PACU) delirium (1)…
Inclusion Criteria: * Adults aged 60 years or over * Has capacity to provide informed consent * Undergoing elective non-cardiac surgery, which does not involve the head or neck, with planned volatile-based general anesthesia of expected duration of at least 2 hours Exclusion Criteria: * Chronic pain with opioid requirement or concurrent use of enzyme inducers, e.g. carbamazepine, phenytoin, * Illicit substance use or excessive alcohol intake * Refusal by patient or case anesthesiologist responsible for patient's care
Intraoperative oscillatory EEG alpha optimization involves real-time acquisition of oscillatory alpha power from the frontal EEG with individualized titration of sevoflurane and opioid.
Infusion of .05 mcg/kg/h of propofol during the final 10-20 minutes of surgery.
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