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Table 1 Characteristics of included studies

From: Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis

Study Population The type of surgery Intervention Major outcome Assessment scales Conclusion
EEG
Wildes 2019 [18] 60 years or older Major surgery (cardiac = 459; non-cardiac =754) N = 1213
BIS-guided = 604
Routine care = 609
POD (postoperative day1 -day5) CAM/CAM-ICU There was no difference between two groups.
Christopher 2020 [34] 65 years or older Major Noncardiac Surgery N = 204
PSI- guided =102
Routine care =102
POD (postoperative day 1–3)
EEG suppression ratio
CAM The incidence of delirium was not found to be different between two groups.
Radtke 2013 [30] 60 years or older Non-cardiac surgery N = 1155
BIS-guided = 575
Routine care = 580
POD (postoperative day 1–7, twice a day)
POCD (postoperative 7 days and 3 months)
DSM IV
CANTAB
The routine care group had a higher incidence of POD compared with the BIS-guided group.
Zhou 2018 [31] 65–75 years old Resection of colon carcinoma N = 81
BIS-guided = 41
Routine care = 40
POD (postoperative day 1 -day5) CAM The incidence of POD was significantly lower in the BIS-guided group compared with the routine care group.
Qian 2016 [32] 65–85 years old Gastrointestinal surgery N = 180
BIS-guided = 90
Routine care = 90
POD (postoperative day 1 -day7) CAM General anesthesia under BIS monitoring can reduce the incidence and duration of POD
Li 2014 [33] 65–83 years old Upper abdominal operation N = 295
BIS-guided = 147
Routine care = 148
POD (postoperative day 1 -day3) DSM IV The use of BIS guidance reduced the incidence of postoperative delirium
Whitlock 2014 [27] 18 years or older Cardiac or thoracic surgery N = 310
BIS-guided = 149
ETAC-guided = 161
POD (twice daily until postoperative day 10 or ICU discharge) CAM-ICU There was no difference between two groups.
Jidenstal 2012 [28] 40–94 years old ENT surgery N = 32
AEP-guided = 16
Routine care = 16
POD (postoperative day1)
POCD (postoperative day 1 and 1 month)
CAM AEP-guided anesthesia decreased the risk of early POCD rather than early POD.
Chan 2013 [29] 60 years or older Major non-cardiac surgery N = 902
BIS-guided = 450
Routine care = 452
POD (in-hospital)
POCD (postoperative 1 week and 3 months)
CAM BIS-guided anesthesia reduced the risk of postoperative delirium.
Jidenstal 2011 [26] 18–92 years old Ophthalmic surgery N = 450
AEP-guided = 224
Routine care = 226
POCD (postoperative 1 day, 1 week or 1 month) MMT and CFQ) Patients with AEP-guided anaesthesia had a lower risk of early postoperative
cognitive decline.
Kunst 2020 [45] 64 years or older CABG N = 82
BIS and rSO2- guided =42
Routine care =40
POD (postoperative day 3–5)
POCD (postoperative day 3–5, 6 weeks)
CAM
MMSE
Optimizing both depth of anesthesia and rSO2 in elderly patients undergoing cardiac surgery resulted in a significant reduction in the postoperative delirium.
Ballard 2012 [44] 70 years or older Abdominal and Orthopaedic surgery N = 72
BIS and rSO2- guided =34
Routine care = 38
POCD (postoperative 1 week, 12 weeks, 52 weeks) MMSE Intraoperative monitoring of anaesthetic depth and cerebral oxygenation can reduce post-operative cognitive impairment.
Cerebral Oxygenation Monitoring
Casati 2005 [35] 65 years or older Major abdominal surgery N = 122
rSO2- guided =56
Routine care = 66
POCD (postoperative 1 week) MMSE Using rSO2 monitoring seems to result in less cognitive decline.
Colak 2015 [36] 40–80 years old CABG N = 190
rSO2- guided =94
Routine care = 96
POCD (postoperative 1 week)
POD (postoperative 1 week)
CTT and GP test The use of INVOS monitoring has a predictive value in terms of lower incidence of early postoperative cognitive decline.
Kara 2015 [39] CABG N = 79
rSO2- guided =43
Routine care = 36
POCD MoCA Intraoperative NIRS usage can decrease the incidence of POCD
Mohandas 2013 [40] Open heart surgery N = 100
rSO2- guided =50
Routine care = 50
POCD (postoperative 1 week and 3 months) MMSE, ASEM Intraoperative monitoring of rSO2 can significantly decrease the incidence of postoperative neurocognitive decline.
Murniece 2019 [42] 18 years or older Spinal Neurosurgery N = 34
rSO2- guided =23
Routine care = 11
POCD (postoperative 1 week and 3 months) MoCA Use of the NIRS-based clinical algorithm can help to avoid POCD in patients.
Slater 2009 [43] CABG N = 240
rSO2-guided = 125
Routine care = 115
POCD (postoperative 1 week and 3 months) MMSE, ASEM There was no difference between two groups on POCD.
Deschamps 2016 [38] 18 years or older High-risk Cardiac Surgery N = 201
rSO2- guided =102
Routine care = 99
POD (postoperative 3 months) DSM IV There was no difference between two groups on POD.
Lei 2017 [41] 60 years or older Cardiac surgery N = 249
rSO2- guided =123
Routine care = 126
POD (postoperative 12 h-7 days) CAM/CAM-ICU Three was no difference in the incidence of POD between the intervention group and control group.
Uysal 2020 [19] 18 years or older Cardiac surgery N = 125
rSO2- guided =59
Routine care = 66
POD-ICU (postoperative 24 h, 3 and 6 months Cognitive Stability Index HeadMinder Three was no difference in the incidence of POD between the intervention group and control group.
Cox 2018 [37] 18 and 85 years Arthroscopic shoulder surgery N = 40
rSO2- guided =20
Routine care = 20
POCD (postoperatively, before discharge; postoperative 2 weeks and 6 weeks) MoCA No difference between two groups.
  1. Abbreviations: EEG Electroencephalography, POD Postoperative delirium, BIS Bispectral index, AEP Auditory evoked potential, rSO2 Regional cerebral oxygen saturations, POCD Postoperative cognitive decline, ETAC End-tidal anesthetic concentration, ENT Ear, nose, and throat, CABG Coronary artery bypass graft surgery, CAM Confusion assessment method, DSM IV Diagnostic and Statistical Manual of Mental Disorders, MMSE Mini mental state examination, MoCA Montreal mognitive assessment, ASEM Antisaccadic eye movement test, CTT Color Trail Test, GP test Grooved-Pegboard Test, MMT The mini-mental test, CFQ Cognitive Failure Questionnaire