EEG-guided anesthesia reduces the risk of delirium in children: JAMA

A new study published in the Journal of the American Medical Association showed that children who had electroencephalography (EEG)-guided anesthesia had a noticeably lower incidence of emerging delirium.

It is yet unknown whether EEG-guided anesthetic can avoid emerging delirium in children. Thus, this study evaluated if the use of EEG-guided anesthetic during surgery is linked to a decreased risk of emerging delirium in pediatric patients.

9 randomized clinical trials that compared EEG-guided anesthesia with normal treatment and included patients aged 1 to 18 years having general anesthesia met the inclusion criteria out of 185 papers. At least one of the following results was reported in the included studies: Post-anesthesia care, emergence delirium, and the pediatric anesthesia emergence delirium score unit duration of stay, burst suppression, or end-tidal sevoflurane concentration.

Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were taken from randomized clinical trials. The Grading of Recommendations evaluation, Development and Evaluation (GRADE) technique and the Risk of Bias 2 (RoB-2) instrument were used for the certainty of evidence and quality evaluation, respectively.

This analysis includes 1052 patients from 9 included trials, of whom 535 (50.9%) had anesthesia guided by EEG. The EEG-guided group had a considerably lower incidence of emerging delirium than the standard-practice group (27% vs. 48%; RR, 0.56; 95% CI, 0.37-0.84; P =.005).

The EEG-guided anesthesia group also had significantly lower maximum pediatric anesthesia emergence delirium scores (MD, −0.87; 95% CI, −1.52 to −0.23; P =.008), end-tidal sevoflurane concentration (MD, −0.40; 95% CI, −0.58 to −0.22; P =.001), and length of stay in the postanesthesia care unit (MD, −8.20; 95% CI, −13.35 to −3.04; P =.002).

The number of burst suppression episodes did not differ between the two groups in a way that was statistically significant. Overall, EEG-guided anesthesia was linked to a decreased incidence of ED in the pediatric population, according to the findings of this comprehensive review and meta-analysis. These results offer evidence that the use of EEG during pediatric general anesthesia may be a useful strategy to reduce the incidence of ED, despite the fact that it is a complex phenomena.

Source:

Haidar, L., Abadi, F., Sarieddine, T., Vitali, A., Zouein, F. A., & Massoud, G. (2026). EEG-guided anesthesia for the prevention of emergence delirium in children: A systematic review and meta-analysis. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2025.6005