Multimodal Brain Monitoring-Guided Anesthesia Management Improves Functional Connectivity, Enhances Recovery and Attenuates Postoperative Pain in Elderly Surgical Patients

Shuyi Yang,1,* Shuai Feng,1,* Hao Wu,2,* Chonglin Zhong,1 Shubin Zhan,1 Chunxiu Wang,3 Zan Chen,2 Yaxian Huang,1 Guanxu Zhao,1 Yue Zhang,1 Tianlong Wang,1 Wei Xiao1 1Department of Anesthesiology, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric, Beijing, People’s Republic of China; 2Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China; 3Department of Evidence-Based Medicine, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei Xiao, Department of Anesthesiology, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric, No. 45 Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China, Tel +86 138 1097 1299, Email [email protected] Tianlong Wang, Department of Anesthesiology, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric, No. 45 Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China, Tel +86 139 1052 5304, Email [email protected]: Perioperative neurocognitive disorder (PND) is common in elderly surgical patients and severely affects postoperative recovery. However, effective prevention is still lacking. Potential perioperative cerebral stressors (including inappropriate sedative/analgesic depth and imbalanced cerebral oxygen supply/demand) may be important contributing factors. We developed an anesthesia management protocol based on multimodal brain monitoring to achieve standardized, individualized, and real-time regulation of sedative/analgesic depth and cerebral oxygen saturation and investigated whether it could reduce the incidence of PND and its underlying mechanisms.Patients and Methods: Patients (aged ≥ 65 years) were randomized into Groups C (n=88) and E (n=93). Patients in Group E received multimodal brain monitoring-guided anesthesia management, and those in Group C received BIS-guided anesthesia management. The Montreal Cognitive Assessment (MoCA) was performed both before and seven days after surgery. The postoperative pain scores were recorded. Resting-state functional MRI data were analyzed to examine functional connectivity (FC).Results: Group E demonstrated a numerically lower incidence of PND (15.50% vs 21.59% in Group C), but this difference was not statistically significant. Patients in Group E had increased FC within the right pulvinar, right sub-gyral region, and right inferior parietal lobule (P < 0.05). Significantly lower pain scores were observed in Group E at rest (1h: P=0.04; 24h: P=0.04) and during movement (1h: P=0.03).Conclusion: These results suggest that multimodal brain monitoring-guided anesthesia management may protect neurocognition by enhancing FC within cognition-associated brain regions and attenuating postoperative acute pain. And multimodal brain monitoring-guided anesthesia management may confer a clinically relevant reduction in PND incidence compared to BIS-guided management in elderly surgical patients.Keywords: multimodal brain monitoring, elderly patients, perioperative neurocognitive disorders, functional connectivity, postoperative acute pain