EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults

Melody Reese; Soren Christensen; Harel Anolick; Kenneth C Roberts; Megan K Wong; Mary Cooter Wright; Leah Acker; Jeffrey N Browndyke; Marty G Woldorff; Miles Berger; MADCO-PC and INTUIT Investigators

doi:10.3389/fnagi.2023.1229081

EEG pre-burst suppression: characterization and inverse association with preoperative cognitive function in older adults

Front Aging Neurosci. 2023 Aug 30:15:1229081. doi: 10.3389/fnagi.2023.1229081. eCollection 2023.

Authors

Melody Reese^#^{1

2}, Soren Christensen^#³, Harel Anolick^#⁴, Kenneth C Roberts⁵, Megan K Wong⁶, Mary Cooter Wright¹, Leah Acker¹, Jeffrey N Browndyke⁷, Marty G Woldorff^{5

7

8}, Miles Berger^{1

2

5

9}; MADCO-PC and INTUIT Investigators

Collaborators

MADCO-PC and INTUIT Investigators:
O Akinyemi, C L Amundsen, P Avasarala, M Barber, R Beach, S Bengali, E Bennett, A Berchuck, M F Berry, D G Blazer, M P Bolognesi, R Brassard, B E Brigman, J N Browndyke, M Bullock, T Bunning, A Burke, V Cai, J Carter, J Chapman, C Chen, V Cheong, S Christensen, H J Cohen, B Colin, C Colon-Emeric, M Cooter, M Cox, D Crabtree, B Davidson, J K DeOrio, M Devinney, T A D'Amico, M E Easley, E Ehieli, T Ellett, D Erdmann, R M Esclamado, M Ferrandino, B Funk, J Gadsden, J Gardner, G Garrigues, C Giattino, D T Gold, S Grant, R Greenup, J Guercio, D K Gupta, A Habib, R K Hallows, D H Harpole, S M Harris, M G Hartwig, L Havrilesky, T Henley, C Holland, S T Hollenbeck, J Hu, R Huang, E Iboaya, B A Inman, D W Jang, J Kaisen, A Kawasaki, A Khan, J Klapper, S Lagoo-Deenadayalan, D T Laskowitz, P S Lee, W T Lee, J Lemm, H Levinson, M E Lipkin, H Litchfield, C R Mantyh, E Marlor, K T Martucci, J Mathew, C Maxwell, D L McDonagh, J Migaly, S K Mithani, E Moretti, P Mosca, J Moul, D Murdoch, M F Newman, K Ni, T Novick, B Ohlendorf, S Olson, M W Onaitis, D Oyeyemi, T N Pappas, G L Pellom, A N Perez, A C Peterson, A Podgoreanu, T J Polascik, P Potash, G M Preminger, R Previs, Q Quinones, E N Rampersaud, A Ray, A Renne, K Roberts, C N Robertson, S A Roman, S Runyon, E Sanders, A Sandler, F Sbahi, C D Scales, R P Scheri, K Seymour, S Smani, S K Smith, M Stang, S Stanley, K Sweeney, A Syed, A Szydlowska, L Talbot, N Terrando, Jkm Thacker, J Thomas, B C Tong, Y Toulgoat-Dubois, A Tu, S N Vaslef, N Waldron, X Wang, D S Warner, K Weinhold, S S Wellman, H Whitson, T Wickenheisser, D Williams, M Woldorff, M K Wong, C Young, S Zani

Affiliations

¹ Department of Anesthesiology, School of Medicine, Duke University, Durham, NC, United States.
² Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, United States.
³ Trinity College, Duke University, Durham, NC, United States.
⁴ Pratt School of Engineering, Duke University, Durham, NC, United States.
⁵ Center for Cognitive Neuroscience, Duke University, Durham, NC, United States.
⁶ School of Medicine, Duke University, Durham, NC, United States.
⁷ Department of Psychiatry, Duke University, Durham, NC, United States.
⁸ Department of Psychology and Neuroscience, Duke University, Durham, NC, United States.
⁹ Alzheimer's Disease Research Center, Duke University, Durham, NC, United States.

^# Contributed equally.

Abstract

The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) - electroencephalography (EEG) with repeated periods of suppression (very low-voltage brain activity). However, BSup has modest sensitivity for predicting POD. We hypothesized that a brain state of lowered EEG power immediately precedes BSup, which we have termed "pre-burst suppression" (preBSup). Further, we hypothesized that even patients without BSup experience these preBSup transient reductions in EEG power, and that preBSup (like BSup) would be associated with preoperative cognitive function and delirium risk. Data included 83 32-channel intraoperative EEG recordings of the first hour of surgery from 2 prospective cohort studies of patients ≥age 60 scheduled for ≥2-h non-cardiac, non-neurologic surgery under general anesthesia (maintained with a potent inhaled anesthetic or a propofol infusion). Among patients with BSup, we defined preBSup as the difference in 3-35 Hz power (dB) during the 1-s preceding BSup relative to the average 3-35 Hz power of their intraoperative EEG recording. We then recorded the percentage of time that each patient spent in preBSup, including those without BSup. Next, we characterized the association between percentage of time in preBSup and (1) percentage of time in BSup, (2) preoperative cognitive function, and (3) POD incidence. The percentage of time in preBSup and BSup were correlated (Spearman's ρ [95% CI]: 0.52 [0.34, 0.66], p < 0.001). The percentage of time in BSup, preBSup, or their combination were each inversely associated with preoperative cognitive function (β [95% CI]: -0.10 [-0.19, -0.01], p = 0.024; -0.04 [-0.06, -0.01], p = 0.009; -0.04 [-0.06, -0.01], p = 0.003, respectively). Consistent with prior literature, BSup was significantly associated with POD (odds ratio [95% CI]: 1.34 [1.01, 1.78], p = 0.043), though this association did not hold for preBSup (odds ratio [95% CI]: 1.04 [0.95, 1.14], p = 0.421). While all patients had ≥1 preBSup instance, only 20.5% of patients had ≥1 BSup instance. These exploratory findings suggest that future studies are warranted to further study the extent to which preBSup, even in the absence of BSup, can identify patients with impaired preoperative cognition and/or POD risk.

Keywords: EEG; anesthesia; burst suppression; non-cardiac surgery; perioperative; postoperative delirium; pre-burst suppression; preoperative cognition.

Abstract

Grants and funding