Recovery, analgesia and delirium profiles at laparoscopic surgeries with proccesd EEG monitoring: Comparison of trendelenburg and reverse trendelenburg positions

Objective: The aim of this study was to evaluate the effects of processed electroencephalogram (pEEG) monitoring on recovery and extubation times, length of stay in the post-anesthesia care unit (PACU), postoperative pain, patient comfort, sedation, development of delirium, and length of hospital and intensive care unit stay in laparoscopic surgeries performed in the Trendelenburg (T) or reverse Trendelenburg (RT) positions. Materials and Methods: This prospective, randomized, single-center study included a total of 120 patients scheduled for elective laparoscopic surgery under general anesthesia. Patients were allocated into four groups according to surgical position (Group T or Group RT) and the use of processed electroencephalogram monitoring (Group TBIS and Group RTBIS). Intraoperative depth of anesthesia was maintained either by titration guided by processed electroencephalogram indices or according to standard clinical parameters. Extubation time, recovery time, length of stay in the PACU, postoperative pain scores, patient comfort, level of sedation, incidence of delirium, and lengths of hospital and intensive care unit stay were recorded. Results: Pairwise comparisons between groups showed statistically significant differences in extubation and recovery times between the RTBIS group and the T and RT groups (p<0.001 and p=0.016, respectively), and between the TBIS and T groups (p<0.009). The length of stay in the PACU was significantly different between the RTBIS group and the T, RT, and TBIS groups (p<0.001, p<0.001, and p=0.02, respectively), as well as between the T group and the TBIS and RT groups (p=0.009 and p=0.030, respectively). Desflurane consumption was significantly lower in the groups monitored with processed electroencephalogram (p<0.05). The morphine dose administered via patient-controlled analgesia at postoperative 6 hours (p=0.027) and patient comfort scores at postoperative 2 and 6 hours (p=0.035 and p=0.028, respectively) were significantly different, particularly between the Trendelenburg and reverse Trendelenburg groups. Statistically significant differences in Nu-DESC scores at PACU admission and discharge were also observed among the groups (p<0.01 and p=0.022, respectively). Conclusion: In laparoscopic surgeries performed in the Trendelenburg or reverse Trendelenburg positions, processed electroencephalogram monitoring shortens recovery and extubation times, reduces anesthetic agent consumption and postoperative delirium scores, and does not result in a significant change in postoperative pain, patient comfort, or side effects.