BACKGROUND Increased intraoperative electroencephalographic (EEG) burst suppression is associated with postoperative delirium. Cerebral desaturation is considered as one of the factors associated with burst suppression. Our study investigates the association between cerebral desaturation and burst suppression by analyzing their concurrence. Additionally, we aim to examine their association with cardiac surgical phases to identify potential for targeted interventions. METHODS We retrospectively analyzed intraoperative 1-minute interval observations in 51 patients undergoing cardiac surgery. Processed EEG and cerebral oximetry were collected, with the anesthesiologists blinded to the information. The associations between cerebral desaturation (defined as a 10% decrease from baseline) and burst suppression, as well as with phase of cardiac surgery, were analyzed using the Generalized Logistic Mixed Effect Model. The results were presented as odds ratio and 95% confidence intervals (CIs). A value of P < .05 was considered statistically significant. RESULTS The odds of burst suppression increased 1.5 times with cerebral desaturation (odds ratio [OR], 1.52, 95% CI, 1.11-2.07; P = .009). Compared to precardiopulmonary bypass (pre-CPB), the odds of cerebral desaturation were notably higher during CPB (OR, 22.1, 95% CI, 12.4-39.2; P < .001) and post-CPB (OR, 18.2, 95% CI, 12.2-27.3; P < .001). However, the odds of burst suppression were lower during post-CPB (OR, 0.69, 95% CI, 0.59-0.81; P < .001) compared to pre-CPB. Compared to pre-CPB, the odds of concurrent cerebral desaturation and burst suppression were notably higher during CPB (OR, 52.3, 95% CI, 19.5-140; P < .001) and post-CPB (OR, 12.7, 95% CI, 6.39-25.2; P < .001). During CPB, the odds of cerebral desaturation (OR, 6.59, 95% CI, 3.62-12; P < .001) and concurrent cerebral desaturation and burst suppression (OR, 10, 95% CI, 4.01-25.1; P < .001) were higher in the period between removal of aortic cross-clamp and end of CPB. During the entire surgery, the odds of burst suppression increased 8 times with higher inhalational anesthesia concentration (OR, 7.81, 95% CI, 6.26-9.74; P < .001 per 0.1% increase). CONCLUSIONS Cerebral desaturation is associated with intraoperative burst suppression during cardiac surgery, most significantly during CPB, especially during the period between the removal of the aortic cross-clamp and end of CPB. Further exploration with simultaneous cerebral oximetry and EEG monitoring is required to determine the causes of burst suppression. Targeted interventions to address cerebral desaturation may assist in mitigating burst suppression and consequently enhance postoperative cognitive function.

中文翻译：

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心脏手术患者并发脑饱和度下降和脑电图爆发抑制的发生率。


背景 术中脑电图 （EEG） 爆发抑制增加与术后谵妄有关。脑饱和度下降被认为是与爆发抑制相关的因素之一。我们的研究通过分析它们的并发性来调查脑饱和度下降与爆发抑制之间的关联。此外，我们旨在检查它们与心脏手术阶段的关联，以确定针对性干预的潜力。方法 我们回顾性分析了 51 例接受心脏手术的患者的术中 1 分钟间隔观察。收集处理后的脑电图和脑血氧饱和度，麻醉师对信息不知情。使用广义 Logistic 混合效应模型分析脑饱和度下降 （定义为从基线降低 10%） 与爆发抑制以及心脏手术阶段之间的关联。结果以比值比和 95% 置信区间 （CIs） 表示。P < .05 的值被认为具有统计学意义。结果 突发抑制的几率随着脑饱和度下降而增加 1.5 倍 （比值比 [OR]，1.52,95% CI，1.11-2.07;P = .009）。与体外循环前 （pre-CPB） 相比，CPB 期间脑饱和度下降的几率明显更高（OR，22.1,95% CI，12.4-39.2;P < .001） 和 CPB 后 （OR， 18.2， 95% CI， 12.2-27.3;P < .001）.然而，CPB 后突发抑制的几率较低 （OR，0.69,95% CI，0.59-0.81;P < .001） 与 CPB 前相比。与 CPB 前相比，CPB 期间并发脑饱和度下降和突发抑制的几率明显更高 （OR，52.3,95% CI，19.5-140;P < .001） 和 CPB 后 （OR，12.7,95% CI，6.39-25.2;P < .001）. 在 CPB 期间，脑饱和度下降的几率 （OR，6.59,95% CI，3.62-12;P < .001） 和并发脑饱和度下降和突发抑制 （OR，10,95% CI，4.01-25.1;P < .001） 在去除主动脉夹闭和 CPB 结束之间的期间较高。在整个手术过程中，随着吸入麻醉浓度的增加，爆发抑制的几率增加了 8 倍 （OR，7.81,95% CI，6.26-9.74;P < .001 每增加 0.1%）。结论 脑饱和度下降与心脏手术期间的术中爆发抑制相关，在 CPB 期间最为明显，尤其是在去除主动脉夹闭和 CPB 结束之间的期间。需要同时进行脑血氧饱和度和 EEG 监测的进一步探查，以确定爆发抑制的原因。解决脑饱和度下降的针对性干预措施可能有助于减轻爆发抑制，从而增强术后认知功能。