Current practices, attitudes and demands of Chinese anesthesiologists regarding depth of anesthesia monitoring

Rationale, aims and objectives: To determine current practices, attitudes and demands of Chinese anesthesiologists regarding depth of anesthesia (DoA) monitoring. Method: An anonymous online survey was randomly distributed to 8,556 anesthesiologists. Results: The overall response rate was 47% (4,037 respondents). Only 9.1% (95% confidence interval, 8.2%-10.0%) of the respondents routinely use DoA monitors. The main factors influencing the utility of DoA monitors were poor anti-interference ability (56.0%, 54.5%-57.6%), inability to bill insurance or high cost (55.5%, 54.0%-57.0%), limited accuracy (47.9%, 46.3%-49.4%) and inability to monitor analgesic effects (35.7%, 34.2%-37.1%). Academic respondents (91.5%, 90.3%-92.7%) primarily used DoA monitoring to prevent awareness, whereas nonacademic respondents (88.8%, 87.4%-90.2%) primarily used DoA monitoring to guide the delivery of anesthetics. In total, the respondents who had not used a DoA monitor and experienced awareness (61.7%, 57.8%-65.6%) was significantly greater than those who had used one or several DoA monitors (51.5%, 49.8%-53.2%). However, most respondents (95.7%, 95.1%-96.3%) demanded improvements in the accuracy of the monitors for DoA monitoring and a broad application in patients of all ages (86.3%, 85.2%-87.4%), analgesia monitoring (80.4%, 79.2%-81.6%) and all types of anesthetics (75.6%, 74.3%-76.9%). In total, 65.0% (63.6%-66.5%) of the respondents believed that DoA monitors should be combined with EEG and vital sign monitoring, and 53.7% (52.1%-55.2%) believed that advanced DoA monitors should include artificial intelligence. Conclusions: Academic anesthesiologists primarily use DoA monitoring to help prevent awareness, whereas nonacademic anesthesiologists use DoA monitoring to guide the delivery of anesthetics. Regardless of whether a DoA monitor is used, anesthesiologists believe that DoA monitoring could help to reduce the incidence of awareness. Anesthesiologists demand high-accuracy DoA monitors incorporating signals of EEG, multiple vital signs and antinociceptive indicators. DoA monitors with artificial intelligence may represent a new direction for future research on DoA monitoring.