Introduction: 

The incidence and quantification of inadvertent electroencephalographic burst suppression during total intravenous anesthesia (TIVA) for spine instrumentation surgery has not previously been reported.

Methods: 

The primary aim of this retrospective observational quality improvement project was to establish the prevalence of burst suppression during spine instrumentation surgery with TIVA. The secondary outcome was the incidence of postoperative delirium.

Results: 

One hundred twelve consecutive patients, aged between 20 and 88 years, underwent spinal instrumentation surgery. Seventy-eight (69.6%) patients experienced inadvertent burst suppression; the maximal degree of burst suppression ratio was 20% to 100%. Median (interquartile range [IQR]) time spent in burst suppression was 44 (77) minutes, and burst suppression was present for 22% (range: 2% to 93%) of the monitoring period. Average (±SD) propofol dose was lower in patients with burst suppression (87±19 vs. 93±15 µg/kg/min, P=0.04). Ten (8.9%) patients experienced postoperative delirium. Intraoperative burst suppression was more prevalent in those that experienced delirium (100% vs. 66.7%, P=0.03, relative risk: 1.5, 95% confidence interval: 1.3-1.7). The proportion of the monitoring period spent in maximal burst suppression (15.3 [25.9]% vs.11.7 [21.7]%) was similar between those that did, and did not, experience delirium.

Conclusions: 

High rates and prolonged periods of inadvertent burst suppression may be prevalent during spine instrumentation surgery with TIVA. Our findings suggest that usage of electroencephalography alone is incomplete without prompt interpretation and intervention, mandating close communication between neuromonitoring and anesthesia teams. The dose-response relationship between burst suppression, total time spent in maximal burst suppression, and their association with delirium warrants further evaluation.

中文翻译：

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112 例连续接受脊柱内固定手术的患者在全静脉麻醉期间的无意爆破抑制：一项回顾性观察质量改进项目

介绍： 

脊柱器械手术的全静脉麻醉 (TIVA) 期间无意脑电图爆发抑制的发生率和量化以前没有报道。

方法： 

这个回顾性观察质量改进项目的主要目的是确定在使用 TIVA 的脊柱器械手术期间爆裂抑制的普遍性。次要结果是术后谵妄的发生率。

结果： 

连续 112 名年龄在 20 至 88 岁之间的患者接受了脊柱器械手术。78 名 (69.6%) 患者经历了无意的爆发抑制；爆发抑制率最大程度为20%～100%。爆发抑制所花费的中位数（四分位距 [IQR]）时间为 44 (77) 分钟，监测期间 22%（范围：2% 至 93%）存在爆发抑制。爆发抑制患者的丙泊酚平均 (±SD) 剂量较低（87±19 对 93±15 µg/kg/min，P = 0.04）。10 名 (8.9%) 患者出现术后谵妄。术中爆发抑制在谵妄患者中更为普遍（100% vs. 66.7%，P= 0.03，相对风险：1.5，95% 置信区间：1.3-1.7)。在最大爆发抑制中花费的监测期比例（15.3 [25.9]% vs.11.7 [21.7]%）在经历谵妄和没有经历谵妄的患者之间相似。

结论： 

在使用 TIVA 的脊柱器械手术期间，高发生率和长时间的意外爆裂抑制可能很普遍。我们的研究结果表明，如果没有及时的解释和干预，单独使用脑电图是不完整的，需要神经监测和麻醉团队之间的密切沟通。爆发抑制、最大爆发抑制所花费的总时间以及它们与谵妄的关联之间的剂量反应关系值得进一步评估。