EEG-Parameter-Guided Anesthesia for Prevention of Emergence Delirium in Children

Abstract

Background: Emergence delirium (ED) usually occurs in children after surgery with an incidence of 10−80%. Though ED is mostly self-limited, its potential injuries cannot be ignored. Whether electroencephalography (EEG)-parameter-guided anesthesia could reduce the incidence of ED in pediatric surgery has not been fully discussed to date. Methods: Fifty-four boys aged 2–12 years undergoing elective hypospadias surgery under sevoflurane anesthesia were selected. In the EEG-parameter-guided group (E group), sevoflurane was used for anesthesia induction and was maintained by titrating the spectral edge frequency (SEF) to 10–15 and combining the monitoring of density spectral array (DSA) power spectra and raw EEG. While in the control group (C group), anesthesiologists were blinded to the SedLine screen (including SEF, DSA, and raw EEG) and adjusted the intraoperative drug usage according to their experience. Patients with a Pediatric Anesthesia Emergence Delirium (PAED) score > 10 were diagnosed with ED, while patients with a PAED score > 2 were diagnosed with emergence agitation (EA). Results: Finally, a total of 37 patients were included in this trial. The incidence of ED in the E group was lower than in the C group (5.6% vs. 36.8%; p = 0.04), while the incidence of EA was similar in the two groups (61% vs. 78.9%; p = 0.48). Intraoperative parameters including remifentanil dosage and the decrease in mean arterial pressure (MAP) were not different between the two groups (p > 0.05), but the mean end-tidal sevoflurane concentration (EtSevo) was lower in the E group than in the C group (p > 0.05). Moreover, during PACU stay, the extubation time and discharge time of the groups were similar, while the PAED scores within 5 min from extubation and the Face, Legs, Activity, Cry, and Consolability (FLACC) scores within 30 min from extubation were lower in the E group than in the C group. Conclusion: EEG-parameter-guided anesthesia management reduced the incidence of ED in children. Studies with larger sample sizes are needed to obtain more convincing results.

Intraoperative pediatric electroencephalography monitoring: an updated review

“…EEG guidance also enabled greater appreciation of the higher anesthetic requirements in younger children aged 1–2 years compared to children aged > 2 years. Han et al [ 72 ] studied 54 children aged 2–12 years undergoing urological surgery and demonstrated that EEG-guided anesthesia management reduced the intraoperative sevoflurane dose and incidence of emergence delirium (ED). Weber et al [ 73 ] reported that in children aged 12–17 years underdoing deep sedation for gastrointestinal endoscopy, propofol dosing guided by the Narcotrend index led to faster recovery, lower propofol consumption, and fewer episodes of oversedation than propofol dosing according to clinical surrogate parameters of depth of hypnosis.…”

“…Three studies examined the association between EEG-guided anesthesia and the development of ED [ 72 , 80 , 81 ]. The first study compared the incidence of ED in children targeting anesthesia to an EEG SEF95 of 10–15 Hz vs. no EEG guidance [ 72 ].…”

“…Three studies examined the association between EEG-guided anesthesia and the development of ED [ 72 , 80 , 81 ]. The first study compared the incidence of ED in children targeting anesthesia to an EEG SEF95 of 10–15 Hz vs. no EEG guidance [ 72 ]. The investigators observed a significantly lower incidence of ED among the children who received EEG-guided anesthetic management than among those who did not (5.6% vs. 36.8%, P = 0.04).…”

Minimal Access in Pediatric Surgery: An Overview on Progress towards Dedicated Instrument Developments and Anesthesiologic Advances to Enhance Safe Completion of Procedures

“…Regional cerebral oxygenation can be monitored through Near Infrared Spectroscopy (NIRS), a technology that gives instant information needed for safeguarding brain function during surgery [ 66 ]. Also, cerebral activity during anesthesia and surgery is commonly evaluated with sedation monitors (BIS or Sedline, to cite some), which can show the presence of different waves instant by instant, allowing the titration of drugs to achieve the desired effects and reduce adverse events (delirium, for instance) [ 67 ] ( Figure 2 ).…”

Impact of Preoperative Sleep Disturbances on Postoperative Delirium in Patients with Intracranial Tumors: A Prospective, Observational, Cohort Study

“…Postoperative delirium (POD) is a self-limiting condition that occurs within hours to days after surgery. 1 , 2 It is marked by manifestations of brain dysfunction including acute disturbances in attention, cognitive function, and thought process. 3 POD occurs in 10–50% of patients after general surgery and is associated with a prolonged hospital stay, long-term cognitive impairment, poor quality of life, and increased mortality.…”