Impact of Electroencephalography-guided Anesthesia in Cardiothoracic Surgery: A Systematic Review and Updated Meta-analysis of Randomized Controlled Trials.

OBJECTIVE

To evaluate the impact of electroencephalography (EEG)-guided anesthesia versus non-EEG-guided anesthesia on postoperative delirium and adverse outcomes in patients undergoing cardiothoracic surgeries.

DESIGN

A systematic review and meta-analysis were performed using PubMed, Embase, and Cochrane Library.

SETTING

All randomized clinical trials (RCTs).

PARTICIPANTS

Eight RCTs with 2,666 patients: 1,304 received EEG-guided anesthesia and 1,362 received usual care.

INTERVENTIONS: Anesthesia guided by EEG in cardiothoracic surgery.

MEASUREMENTS AND MAIN

RESULTS

Mean differences (MDs) were used to pool continuous outcomes while risk ratios (RRs) were used for binary outcomes, using 95% confidence intervals (CIs). A random-effects model was used to examine the treatment. Statistical analysis was performed using R Studio. EEG-guided anesthesia was associated with a trend toward reduced ventilatory support duration (MD: -25.08, 95% CI: -50.12 to -0.04, p = 0.05, I² = 0%). No significant differences were found in postoperative delirium (RR: 0.93, 95% CI: 0.79-1.09, p = 0.35, I² = 42.6%), hospital length of stay (MD: -0.22, 95% CI: -0.53 to 0.09, p = 0.17, I² = 4.7%), intensive care unit length of stay (MD: -0.24, 95% CI -0.59 to 0.12, p = 0.19, I² = 71.7%), mortality (RR: 0.82, 95% CI: 0.54-1.25, p = 0.36, I² = 42%), or intraoperative blood transfusion (RR: 0.96, 95% CI: 0.74-1.25, p = 0.79, I² = 0%).

CONCLUSIONS

The findings demonstrated that EEG-guided anesthesia was associated with a shorter duration of respiratory support. However, this study did not identify any significant comparative advantage over standard practices for the other outcomes analyzed.