Pediatric anesthesia emergence delirium (PAED) remains a frequently encountered complication following general anesthesia in young children. While its exact cause remains unclear, excessive exposure to volatile anesthetics like sevoflurane is believed to be a contributing factor. Dr. Kiyoyuki W. Miyasaka and colleagues from the Department of Anesthesia at St. Luke’s International Hospital, Tokyo, Japan, and colleagues explored whether real-time EEG monitoring could be leveraged to fine-tune anesthetic depth, thereby reducing such adverse effects.
The single-center study was conducted between October 2021 and March 2023 at a leading pediatric hospital in Japan. It included 177 children aged between 1 and under 6 years undergoing general anesthesia for procedures involving reliable pain control. Participants were randomly assigned to receive either standard anesthesia with a 1.0 minimum alveolar concentration (MAC) of sevoflurane or EEG-guided titration aimed at minimizing exposure while maintaining adequate unconsciousness. The primary outcome assessed was the incidence of PAED, defined by a PAED score of 10 or higher.
The findings were encouraging and can be summarized as follows:
- Twenty-one percent of children in the EEG-monitored group developed PAED, compared to 35% in the control group, representing a 14% reduction.
- Children in the EEG group emerged from anesthesia an average of 21.4 minutes earlier.
- The EEG group spent approximately 16.5 minutes less in the postanesthesia care unit (PACU).
- EEG-guided anesthesia led to a reduction of 1.4 MAC-hours in sevoflurane exposure.
These results raise questions about current pediatric anesthesia practices that routinely use high concentrations of sevoflurane for induction and maintain 1.0-MAC levels during surgery. According to the researchers, such dosing may be excessive and could increase the risk of emergence-related complications.
However, the authors noted that their study had limitations. The trial was conducted in a single tertiary pediatric center with expert staff and a physician trained in EEG interpretation. As a result, replicating this approach in general hospital settings may present challenges.
Still, the broader implications are encouraging. EEG monitoring could offer a more refined, patient-specific approach to pediatric anesthesia, easing parental concerns and potentially reducing both clinical and environmental burdens associated with inhaled anesthetics.
The authors concluded, "The study provides strong evidence that EEG-guided anesthesia in children not only improves recovery profiles but also questions the necessity of traditional dosing standards, opening the door to more individualized and safer pediatric anesthesia protocols."
Reference:
Miyasaka KW, Suzuki Y, Brown EN, Nagasaka Y. EEG-Guided Titration of Sevoflurane and Pediatric Anesthesia Emergence Delirium: A Randomized Clinical Trial. JAMA Pediatr. 2025;179(7):704–712. doi:10.1001/jamapediatrics.2025.0517
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