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. 2021 Jan 6;7(1):5.
doi: 10.1186/s40981-020-00409-5.

Perioperative abnormal electroencephalography in a later-stage elderly with septic shock: a case report

Hirotaka Kinoshita  1 , Tetsuya Kushikata  2 , Daiki Takekawa  2 , Kazuyoshi Hirota  2
Affiliations

Perioperative abnormal electroencephalography in a later-stage elderly with septic shock: a case report

Hirotaka Kinoshita et al. JA Clin Rep. .

Abstract

Background: Patients with sepsis often exhibit abnormal patterns of electroencephalogram (EEG). We report an abnormal EEG pattern in a later-stage elderly patient with septic shock and EEG analysis results.

Case presentation: An 88-year-old woman with bowel perforation underwent emergency Hartmann surgery. On admission to the operating room, she exhibited septic shock. Her bispectral index value was 30 before anesthesia induction, and the EEG displayed slow waves without burst and suppression throughout the surgery. The relative slow-wave ratio [spectral power (0.5-8 Hz)/(0.5-30 Hz)] from anesthetic induction to the end of surgery was 95.1%, whereas the relative alpha frequency [spectral power (8-13 Hz)/(0.5-30 Hz)] was only 2.4%. Although without preoperative neurological abnormalities, she developed postoperative delirium after admission to the intensive care unit.

Conclusions: Intraoperative continuous EEG monitoring in elderly patients with sepsis may be useful to predict sepsis-associated encephalopathy. Therefore, continuous EEG monitoring may improve neurological outcomes.

Keywords: Electroencephalogram; Ketamine; Postoperative delirium; Sepsis; Sepsis-associated encephalopathy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Electroencephalogram before anesthetic induction. This EEG shows lower frequency dominance that is not observed in the healthy elderly
Fig. 2
Fig. 2
Anesthesia record. EEG waves and frequency analysis at each point. Anesthetic record is shown in (a). The BIS value remained from 30 to 40 throughout the perioperative period. Anesthesia was induced by intravenously injecting ketamine (20 mg) and rocuronium bromide (40 mg) at that period. The EEG at lower frequency below 8 Hz was dominant (b). The EEG pattern was continuous throughout the surgery (c, d). Abbreviations: HR, heart rate; sBP, systolic blood pressure; dBP, diastolic blood pressure; BIS, bispectral index; SEF95 (Hz), 95% spectral edge frequency; SR (%), suppression ratio
Fig. 3
Fig. 3
A frequency analysis for the EEG from anesthetic induction to end of surgery. A frequency analysis for the EEG from anesthetic induction to end of surgery is shown. The relative slow-wave ratio [spectral power (0.5–8 Hz)/spectral power (0.5–30 Hz)] from before anesthesia induction to the end of surgery was 95.1%, whereas the relative alpha frequency ratio [spectral power (8–13 Hz)/spectral power (0.5–30 Hz)] was only 2.4%
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