Intraoperative Neuromonitoring: Electroencephalography

Intraoperative neuromonitoring using electroencephalography (EEG) enables anaesthesiologists to monitor the depth of anaesthesia. It is intended to reduce the occurrence of intraoperative wakefulness, postoperative delirium and postoperative cognitive deficits and to shorten process times in the operating room. This article shows how to interpret the raw EEG, spectrograms and processed indices for different age groups and anaesthetics and summarizes the resulting clinical benefits. While propofol and volatile anesthetics produce characteristic frontal EEG signatures with a high activity of coherent α- and δ-waves, ketamine triggers an increase in rapid γ-waves, which leads to incorrectly high indices (BIS, PSI, NI) despite deep anaesthetic levels.In children, frontal α-waves do not appear until the age of approx. 6 months and valid indices (BIS, PSI, NI) can only be derived starting at an age of approx. 12 months. Furthermore, children of preschool and elementary school age often show epileptiform discharges in the EEG during induction of anaesthesia, what is linked to emergence delirium. In adults, the intraoperative frontal α-power decreases significantly with increasing age and older patients tend to have an increased occurrence of burst suppression patterns during anaesthesia. Clinical benefits of EEG-based neuromonitoring comprise reduced doses of anaesthesia, shorter wake-up times after surgery and a lower incidence of intraoperative awareness during total intravenous anaesthesia. Moreover, anaesthesia guided by processed EEG indices can reduce the incidence of postoperative delirium and postoperative cognitive deficits in older patients. In-depth knowledge about intraoperative EEG changes that go beyond the interpretation of processed indices could lead to a further reduction in intra- and postoperative complications in the future.