Background: Postoperative delirium may manifest in the immediate post-anaesthesia care period. Such episodes\nappear to be predictive of further episodes of inpatient delirium and associated adverse outcomes. Frontal\nelectroencephalogram (EEG) findings of suppression patterns and low proprietary index values have been\nassociated with postoperative delirium and poor outcomes. However, the efficacy of titrating anaesthesia to\nproprietary index targets for preventing delirium remains contentious. We aim to assess the efficacy of two\nstrategies which we hypothesise could prevent post-anaesthesia care unit (PACU) delirium by maximising the alpha\noscillation observed in frontal EEG channels during the maintenance and emergence phases of anaesthesia.\nMethods: This is a 2 * 2 factorial, double-blind, stratified, randomised control trial of 600 patients. Eligible patients\nare those aged 60 years or over who are undergoing non-cardiac, non-intracranial, volatile-based anaesthesia of\nexpected duration of more than 2 h. Patients will be stratified by pre-operative cognitive status, surgery type and\nsite. For the maintenance phase of anaesthesia, patients will be randomised (1:1) to an alpha power-maximisation\nanaesthesia titration strategy versus standard care avoiding suppression patterns in the EEG. For the emergence\nphase of anaesthesia, patients will be randomised (1:1) to early cessation of volatile anaesthesia and emergence\nfrom an intravenous infusion of propofol versus standard emergence from volatile anaesthesia only. The primary\nstudy outcomes are the power of the frontal alpha oscillation during the maintenance and emergence phases of\nanaesthesia. Our main clinical outcome of interest is PACU delirium.
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