Masimo (NASDAQ: MASI) today announced the findings of a prospective study published in Frontiers in Aging Neuroscience in which Dr. Shuyi Yang and colleagues at Capital Medical University in Beijing investigated whether Masimo Root® with a multimodal brain monitoring algorithm to manage anesthesia during spinal surgery could improve postoperative cognitive function. In the first study of its kind, the algorithm incorporated measurements from Root, including Masimo SedLine® Brain Function Monitoring, Masimo O3® Regional Oximetry, and ANI® Analgesia Nociception Index. The researchers concluded that managing anesthesia based on the multimodal algorithm “may improve the post-operative cognitive function and brain function connectivity in elderly patients undergoing spinal surgery compared to routine anesthesia management.”
Noting that perioperative neurocognitive disorder (PND) is common in elderly patients undergoing surgery, and that PND has been associated with levels of sedation, analgesia, and cerebral oxygen saturation, the researchers sought to evaluate whether use of an algorithm designed around related parameters could help improve this population’s postoperative neurocognition. They enrolled 26 patients aged ≥ 65 scheduled to undergo spinal surgery and divided them randomly into an intervention group (n=14) and a control group (n=12). In the intervention group, anesthesia was managed using the algorithm, which incorporated Sedline Patient State Index (PSi) and Spectral Edge Frequency (SEF), O3 regional cerebral oxygen saturation (rSO2), ANI pain index, mean arterial pressure (MAP), end-tidal CO2 (PETCO2), hemoglobin (Hb), and temperature. The control group received routine anesthesia management. To evaluate whether the algorithm improved cognitive function, they a) compared the patients’ Montreal Cognitive Assessment (MoCA) score before and 7 days after surgery, b) analyzed the amplitude of low-frequency fluctuation (ALFF) and brain functional connectivity (FC) after MRI, c) measured serum C-reactive protein (CRP) and lipopolysaccharide levels, and d) analyzed the correlation between FC and changes in inflammatory marker levels.
The researchers found that the mean postoperative MoCA score was higher in the intervention group (24.80 ± 2.09) than in control group (22.56 ± 2.24) (p = 0.04), with no significant difference in the incidence of PND between the groups. (The MoCA score was also higher in the intervention group than in the control group preoperatively, but to a lesser degree than postoperatively.) They also found that patients in the intervention group had significantly increased ALFF values in several brain regions after surgery (p < 0.05) and enhanced FC between the left hippocampus and several regions (p < 0.05), which was negatively correlated with the change in serum CRP (pre- vs. post-intervention) (r = -0.58, p = 0.01).
The authors concluded that “anesthesia management based on multimodal brain monitoring under general anesthesia may improve the postoperative cognitive function and brain function connectivity in elderly patients undergoing spinal surgery compared to routine anesthesia management, as evidenced by increased brain activity (ALFF), enhanced FC, higher MoCA score, and reduced systemic inflammation. The extent of postoperative systemic inflammation was negatively associated with the FC enhancement and may be accompanied by a lower MoCA score. Our findings provide a basis for more effective management of elderly patients who undergo surgery to reduce the risk of cognitive disorders and improve brain function.
Michael A.E. Ramsay, MD, FRCA, Chair Emeritus of the Department of Anesthesiology and Pain Management at Baylor University Medical Center, commented, “Postoperative neurocognitive disorders (PNDs) are commonly seen in elderly patients, and may be very distressing to the patient and family. This small, prospective, randomized clinical study has demonstrated that precision multimodal monitoring of the brain intraoperatively can result in significantly improved mental status of surgical patients postoperatively. The study patients were maintained at a precise depth of anesthesia, cerebral oxygenation, analgesia, and temperature using the Masimo Root monitor. Postoperatively the MoCA score was statistically higher (p < 0.04) in the study group and the inflammatory marker levels in the brain were significantly reduced (p < 0.05), as well as inflammatory markers systemically (p < 0.01). A MoCA score of 25-30 represents normal cognition and 21-24, 10-20, and 9 and below, mild, moderate, and severe cognitive impairment, respectively.”
Dr. Ramsay continued, “This was a well implemented study, and while it may have been small, it has large implications regarding the value of precision monitoring during surgery and with the potential for application in the intensive care unit (ICU). This may represent a vital advance in the prevention of PND and also the prevention of delirium in ICU patients. Larger studies will be needed to confirm these preliminary data.”
Source: Company Press Release
