Spinal Anesthesia with Targeted Sedation based on Bispectral Index Values Compared with General Anesthesia with Masked Bispectral Index Values to Reduce Delirium: The SHARP Randomized Controlled Trial. Article Swipe
Charles H. Brown
,
Charles C. Edwards
,
Charles Y. Lin
,
Emily Jones
,
Lisa R. Yanek
,
Melody Esmaili
,
Yara Gorashi
,
Richard Skelton
,
Daniel Kaganov
,
Ryan A. Curto
,
Noah L. Lessing
,
Stephanie Cha
,
Elizabeth Colantuoni
,
Karin J. Neufeld
,
Frederick E. Sieber
,
Clayton L. Dean
,
Charles W. Hogue
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1097/aln.0000000000004015
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1097/aln.0000000000004015
BACKGROUND: Reducing depth of anesthesia and anesthetic exposure may help prevent delirium, but trials have been conflicting. Most studies were conducted under general anesthesia or in cognitively-impaired patients. It is unclear whether reducing depth of anesthesia beyond levels consistent with general anesthesia reduces delirium in cognitively-intact patients. Our objective was to determine whether a bundled approach to reduce anesthetic agent exposure as determined by BIS values (spinal anesthesia with targeted sedation based on BIS values) compared with general anesthesia (masked BIS) reduces delirium. METHODS: Important eligibility criteria for this parallel-arm randomized trial were patients ≥65 years undergoing lumbar spine fusion. The intervention group received spinal anesthesia with targeted sedation to BIS>60–70. The control group received general anesthesia (masked BIS). The primary outcome was delirium using the Confusion Assessment Method daily through postoperative day 3, with blinded assessment. RESULTS: The median age of 217 patients in the analysis was 72 (interquartile range 69,77). Median BIS value in the spinal anesthesia with targeted sedation based on BIS values group was 62 (interquartile range 53,70) and in the general anesthesia with masked BIS values group was 45 (interquartile range 41,50, p<0.001). Incident delirium was not different in the spinal anesthesia with targeted sedation based on BIS values group (25.2%[28/111] vs. the general anesthesia with masked BIS values group (18.9%[20/106], p=0.259) (Relative Risk 1.22 [95%CI 0.85–1.76]). In pre-specified subgroup analyses, the effect of anesthetic strategy differed according to Mini-Mental State Examination, but not Charlson Comorbidity Index or age. Two strokes occurred among patients receiving spinal anesthesia and one death among patients receiving general anesthesia. CONCLUSIONS: Spinal anesthesia with targeted sedation based on BIS values compared with general anesthesia with masked BIS values did not reduce delirium after lumbar fusion.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://pubmed.ncbi.nlm.nih.gov/34666346
- OA Status
- green
- Cited By
- 27
- References
- 40
- Related Works
- 20
- OpenAlex ID
- https://openalex.org/W3207503229
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3207503229Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1097/aln.0000000000004015Digital Object Identifier
- Title
-
Spinal Anesthesia with Targeted Sedation based on Bispectral Index Values Compared with General Anesthesia with Masked Bispectral Index Values to Reduce Delirium: The SHARP Randomized Controlled Trial.Work title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2021Year of publication
- Publication date
-
2021-12-01Full publication date if available
- Authors
-
Charles H. Brown, Charles C. Edwards, Charles Y. Lin, Emily Jones, Lisa R. Yanek, Melody Esmaili, Yara Gorashi, Richard Skelton, Daniel Kaganov, Ryan A. Curto, Noah L. Lessing, Stephanie Cha, Elizabeth Colantuoni, Karin J. Neufeld, Frederick E. Sieber, Clayton L. Dean, Charles W. HogueList of authors in order
- Landing page
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https://pubmed.ncbi.nlm.nih.gov/34666346Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
-
https://www.ncbi.nlm.nih.gov/pmc/articles/8970606Direct OA link when available
- Concepts
-
Medicine, Interquartile range, Bispectral index, Anesthesia, Sedation, Delirium, Anesthetic, Randomized controlled trial, Emergence delirium, Surgery, Intensive care medicine, SevofluraneTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
27Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 4, 2024: 6, 2023: 6, 2022: 9, 2021: 2Per-year citation counts (last 5 years)
- References (count)
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40Number of works referenced by this work
- Related works (count)
-
20Other works algorithmically related by OpenAlex
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| referenced_works_count | 40 |
| abstract_inverted_index.a | 53 |
| abstract_inverted_index.3, | 133 |
| abstract_inverted_index.45 | 183 |
| abstract_inverted_index.62 | 168 |
| abstract_inverted_index.72 | 148 |
| abstract_inverted_index.In | 222 |
| abstract_inverted_index.It | 28 |
| abstract_inverted_index.as | 61 |
| abstract_inverted_index.by | 63 |
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| abstract_inverted_index.Our | 47 |
| abstract_inverted_index.The | 100, 111, 119, 138 |
| abstract_inverted_index.Two | 244 |
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| abstract_inverted_index.1.22 | 219 |
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| abstract_inverted_index.Risk | 218 |
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| abstract_inverted_index.this | 88 |
| abstract_inverted_index.were | 19, 92 |
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| abstract_inverted_index.53,70) | 171 |
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| abstract_inverted_index.Spinal | 261 |
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| abstract_inverted_index.Charlson | 239 |
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| abstract_inverted_index.analyses, | 225 |
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| abstract_inverted_index.p<0.001). | 187 |
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