EEG alpha power and delirium in the postanaesthesia care unit in older adults: the AlphaMax trial part 1 - effect of desflurane and fentanyl titration during maintenance

Gaskell, AL; Banerji, A; Pullon, RM; Termaat, J; García, PS; Sleigh, JW

doi:10.1016/j.bja.2025.07.045

EEG alpha power and delirium in the postanaesthesia care unit in older adults: the AlphaMax trial part 1 - effect of desflurane and fentanyl titration during maintenance

Br J AnaesthPublished 22 Sep 2025Randomised controlled trial

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Authors' conclusion

EEG-guided titration of fentanyl and desflurane anaesthesia had a limited enhancing effect on oscillatory alpha power with no appreciable difference in clinical outcomes.

Study context

Population: Patients aged ≥60 yr receiving standardised desflurane-fentanyl GA avoiding burst suppressionmean age 73 (SD 7) yr
Participants: 200 patients

Comparison: EEG-guided dose titration vs routine care
Primary endpoint: PACU delirium (assessed by blinded observers)

Methodological detailsblinded outcome assessment, sample size reduced for feasibility; underpowered for postanaesthesia care unit (PACU) delirium, Sample size reduced for feasibility reasons

Blinded outcome assessment
Sample size reduced for feasibility; underpowered for PACU delirium
Sample size reduced for feasibility reasons

Primary result

As reported in the abstract

PACU delirium incidence

Incidence of PACU delirium similar between groups (groups not named in the order printed)

37% vs 33%

P=0.553

Further findings

Fentanyl dose

P < 0.0001

Titrationmedian 650 μgIQR 500–850

Controlmedian 500 μgIQR 350–600

Maintenance end-tidal desflurane concentration

P < 0.0001

Titrationmean 3.9 vol%SD 0.7

Controlmean 4.4 vol%SD 0.8%

R

Outcome	Titration	Control	Difference (dB)	P value
Oscillatory alpha power · early after surgical incision			+0.8	P = 0.008
Desflurane-alpha correlation	−0.020 (95% CI −0.155–0.115)	−0.228 (95% CI −0.396–-0.059)

Oscillatory alpha power · early after surgical incision

Effect not sustained as surgery progressed

Desflurane-alpha correlation

Absent correlation with titration; negative association in control

Original publication

EEG alpha power and delirium in the postanaesthesia care unit in older adults: the AlphaMax trial part 1 - effect of desflurane and fentanyl titration during maintenance. Br J Anaesth. Published 22 September 2025. doi:10.1016/j.bja.2025.07.045

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