The investigators intend to recruit 600 participants to see if alpha power during anesthesia is influenced by analgesic medication and associated with a reduction of delirium following surgery.
Adults aged 60 years or over
Has capacity to provide informed consent
Undergoing elective non-cardiac surgery, which does not involve the head or neck, with planned volatile-based general anesthesia of expected duration of at least 2 hours
Chronic pain with opioid requirement or concurrent use of enzyme inducers, e.g. carbamazepine, phenytoin,
Illicit substance use or excessive alcohol intake
Refusal by patient or case anesthesiologist responsible for patient's care
Factorial
Alpha Optimization
Procedure/SurgeryIntraoperative oscillatory EEG alpha optimization involves real-time acquisition of oscillatory alpha power from the frontal EEG with individualized titration of sevoflurane and opioid.
Emergence from anesthesia with Dexmedetomidine
BehavioralInfusion of .05 mcg/kg/h of propofol during the final 10-20 minutes of surgery.
Change in Frontal Alpha Power
The EEG data collected during the study duration will be processed using a customized script. Frontal alpha power (i.e., the cumulative power in the EEG alpha range) will be extracted from the EEGs and analyzed to compare the groups for the differences in the frontal alpha power.
Incidence of PACU Delirium
3-Minute Diagnostic Interview for Confusion Assessment Method(3D-CAM), Confusion Assessment Method for the ICU (CAM-ICU), Speech / Language Assessment will be administered to check for signs of delirium.
Change in pain in PACU: numerical rating score (NRS)
The numerical rating score (NRS) requires the patient to rate their pain from 0-10 where 0 is no pain and 10 is the worst pain imaginable (high score indicates worse outcome).
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