TOPLINE:

EEG-guided anesthesia reduced the incidence of delirium associated with general anesthesia in children and hastened emergence.

METHODOLOGY:

• Researchers in Japan conducted a randomized clinical trial in 177 children (age, 1 year to < 6 years; 71% boys) scheduled for elective surgery involving the lower abdomen or extremities to assess EEG-guided anesthesia.
• Participants were randomly assigned to EEG-guided (n = 91; mean age, 2.9 years) or control (n = 86; mean age, 2.8 years) groups to compare exposure to sevoflurane and the incidence of emergence delirium. Baseline delirium scores were assessed upon arrival in the operating room.
• The control group received a standard 1.0 minimum alveolar concentration (MAC) of sevoflurane for maintenance after induction, and the EEG-guided group received sevoflurane titrated to a minimum level to induce and maintain unconsciousness under general anesthesia.
• EEG monitoring was continuous from induction of anesthesia to emergence in the post-anesthesia care unit.
• The primary outcome was the difference in the proportion of patients with emergence delirium (defined by a maximum emergence delirium score of 10 or higher), assessed by a blinded researcher upon arrival at the post-anesthesia care unit and at 5, 10, 15, and 30 minutes thereafter and/or until emergence.

TAKEAWAY:

• The incidence of emergence delirium was 21% in the EEG-guided group and 35% in the control group (P = .04).
• Children who underwent EEG-guided anesthesia received significantly less sevoflurane than those in the control group (mean, 0.8 vs 2.1 MAC-hours; difference, 1.4 MAC-hours; 96.65% CI, 1.1-1.6).
• Compared with children in the control group, those in the EEG-guided group experienced earlier extubation (mean, 3.3 minutes), earlier emergence (mean, 21.4 minutes), and earlier discharge from the post-anesthesia care unit (mean, 16.5 minutes).

IN PRACTICE:

“With EEG monitoring, parents and guardians may be reassured that healthcare professionals can make an active effort to reduce and minimize a child’s exposure to anesthetic drugs,” the authors reported. “With general anesthesia, use of high concentrations of sevoflurane for induction followed by routine use of 1.0-MAC for maintenance may be excessive. EEG-guided titration reduced exposure to sevoflurane and lowered the incidence [delirium], possibly by providing a more favorable emergence trajectory,” they added.

“Now that reliable, processed EEG is commercially available, pediatric anesthesiologists worldwide using these devices are learning that the current standard practice is often dosing more drug than necessary and is often associated with adverse safety and outcomes, such as emergence delirium and intraoperative hypotension,” according to the authors of an editorial accompanying the journal article. “ While emergence delirium and hypotension are often temporary and treatable in healthy children, they can bring dire consequences in medically complex and sicker patients.”

SOURCE:

This study was led by Kiyoyuki Miyasaka, MS, MD, of the Department of Anesthesia at St. Luke’s International Hospital in Tokyo, Japan. It was published online on April 21, 2025, in JAMA Pediatrics.

LIMITATIONS:

The single-center design involved a pediatric hospital in Japan, which may have provided care that differed from that of a general hospital. The anesthesia was administered by a physician with specific EEG training, which may not be replicable in all institutions.

DISCLOSURES:

One author reported being supported in part by the JPB Foundation and Massachusetts Institute of Technology–Massachusetts General Brigham Brain Arousal State Control Innovation Center. EEG monitoring equipment (Root with SedLine) and sensors (RD SedLine EEG Pediatric Sensor) were provided by Masimo Corp. Two authors reported receiving nonfinancial support from Masimo Corp during the conduct of the study. Another author reported receiving nonfinancial support, being a founder and board member of PASCALL, receiving personal fees, and holding US patents with royalties paid from Masimo Corp outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.