Effects of Electroencephalogram Guided Anesthesia on Postoperative Delirium: A Systematic Review and Meta-analysis

Abstract Background: Postoperative delirium is a common complication characterized by confusion, inattentiveness and other mental symptoms. It is still unclear whether the use of electroencephalogram (EEG) monitoring during surgery can decrease the incidence of postoperative delirium. The purpose of this study was to evaluate the effectiveness of EEG guided anesthesia on postoperative delirium (POD) based on randomized controlled trials (RCTs). Methods: The electronic databases of Ovid MEDLINE, PubMed, EMBASE, Cochrane Library database, CNKI and other local databases were systematically searched for RCTs from their inception until October 2019. The odds ratios (ORs) and the mean differences (MDs) with a 95% confidence intervals (CIs) were calculated to evaluate the correlation between EEG and itemized categories and continuous variable, respectively. Results: Seven RCTs with 3859 patients were included in the final analysis. The summary OR indicated that patients receiving EEG monitoring had a lower incidence rate of postoperative delirium (OR: 0.65; 95% CI: 0.46- 0.92; P = 0.01). In addition, no significant difference was found between the EEG monitoring group and the routine care group with respects to the length of hospitalization (MD: -0.59; 95%CI: -1.26 to 0.07; P=0.08). Conclusions: The findings of this study indicated that intraoperative use of electroencephalogram monitoring could decrease the risk of postoperative delirium. But for high risk patients, we should take a multi-component strategy to prevent delirium. Further large-scale, randomized controlled trials should be conducted to verify the treatment effect of intraoperative use of electroencephalogram monitoring on patients.