EEG-Guided Anesthesia Reduces Sevoflurane Use and Emergence Delirium in Children: JAMA
Japan: Researchers have found in a new study that electroencephalography (EEG)-guided management of general anesthesia in pediatric patients led to reduced sevoflurane exposure, lower incidence of emergence delirium, quicker emergence from anesthesia, and shorter postanesthesia care unit (PACU) stays. The study, published in JAMA Pediatrics, suggests that using high sevoflurane concentrations for induction and maintaining 1.0-MAC levels may be unnecessarily excessive.
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
