Summary: A innovative clinical test shows that using EEG to guide hypnosis in children drastically reduces the amount of analgesic needed while improving post-surgery treatment. By monitoring brains storm designs, anesthesiologists maintained healthy sleep with lower concentrations of sevoflurane, leading to faster awakening and fewer instances of post-anesthesia insanity.
Children in the EEG-guided party emerged from hypnosis over 20 minutes earlier and required less post-operative care period, with no incidents of attention during operation. The strategy not only enhances protection but also cuts medical costs and environmental impact from sedative gases.
Important Information:
- Reduced Drug Use: EEG monitoring lowered anesthetic doses by over 50 %.
- Improved Recovery: EEG-guided individuals woke 21. 4 days earlier and had fewer insanity situations.
- Lower Fees & Pollution: Better treatment saved~$ 750 per situation and reduced greenhouse gas usage.
Origin: Picower Institute at MIT
Recently published results of a randomized, controlled clinical trial in Japan among more than 170 children aged 1 to 6 who underwent operation, show that by using EEG readings of mental waves to observe unconsciousness, an anesthesiologist can significantly reduce the amount of the anesthesia administered to safely generate and support each patient’s anesthetized state.
On average the little patients experienced significant improvements in several post-operative outcomes, including quicker recovery and reduced incidence of delirium.
“ I think the main takeaway is that in kids, using the EEG, we can reduce the amount of anesthesia we give them and maintain the same level of unconsciousness, ” said study co-author Emery N. Brown, Edward Hood Taplin Professor of Medical Engineering and Computational Neuroscience at MIT and an anesthesiologist at Massachusetts General Hospital.
The study appeared April 21 in JAMA Pediatrics.
Yasuko Nagasaka, chair of anesthesiology at Tokyo Women’s Medical University, a former colleague of Brown ’s in the United States, designed the study. She asked Brown to train and advise lead author Kiyoyuki Miyasaka of St. Luke’s International Hospital in Tokyo on how to use EEG to monitor unconsciousness and adjust anesthesia dosing in children. Miyasaka then served as the anesthesiologist for all patients in the trial. Attending anesthesiologists not involved in the study were always on hand to supervise.
Brown ’s research has shown that a person’s level of consciousness under any particular anesthetic drug is discernible from patterns of their brain waves. Each child’s brain waves were measured with EEG, but in the control group Miyasaka adhered to standard anesthesia dosing protocols while in the experimental group he used the EEG measures as a guide for dosing.
The results show that when he used EEG, he was able to induce the desired level of unconsciousness with a concentration of 2 percent sevoflurane gas, rather than the standard 5 percent.
Maintenance of unconsciousness, meanwhile, only turned out to require 0. 9 percent concentration, rather than the standard 2. 5 percent.
Meanwhile, a separate researcher, blinded to whether EEG or standard protocols were used, assessed the kids for “pediatric anesthesia emergence delirium ” ( PAED), in which children sometimes wake up from anesthesia with a set of side effects including lack of eye contact, inconsolability, unawareness of surroundings, restlessness and non-purposeful movements.
Children who received standard anesthesia dosing met the threshold for PAED in 35 percent of cases ( 30 out of 86 ), while children who received EEG-guided dosing met the threshold in 21 percent of cases ( 19 out of 91 ). The difference of 14 percentage points was statistically significant.
Meanwhile, the authors reported that on average EEG-guided patients had breathing tubes removed 3. 3 minutes earlier, emerged from anesthesia 21. 4 minutes earlier, and were discharged from post-acute care 16. 5 minutes earlier than patients who received anesthesia according to the standard protocol. All of these differences were statistically significant. Also, no child in the study ever became aware during surgery.
The authors noted that the quicker recovery among patients who received EEG-guided anesthesia was not only better medically, but also reduced healthcare costs.
Time in post-acute care in the U. S. costs about$ 46 a minute so the average reduced time of 16. 5 minutes would save about$ 750 per case. Sevoflurane is also a potent greenhouse gas, Brown noted, so reducing its use is better for the environment.
In the study the authors also present comparisons of the EEG recordings from children in the control and experimental groups. There are notable differences in the “spectrograms ” that charted the power of individual brain wave frequencies both as children were undergoing surgery and while they were approaching emergence from anesthesia, Brown said.
For instance, among children who received EEG-guided dosing, there are well defined bands of high power at about 1-3 Hertz and 10-12 Hz. In children who received standard protocol dosing, the entire range of frequencies up to about 15 Hz are at high power.
In another example, children who experienced PAED showed higher power at several frequencies up to 30Hz than children who did not experience PAED.
The findings further validate the idea that monitoring brain waves during surgery can provide anesthesiologists with actionable guidance to improve patient care, Brown said.
Training in reading EEGs and guiding dosing can readily be integrated in the continuing medical education practices of hospitals, he added.
In addition to Miyasuka, Brown and Nagasaka, Yasuyuki Suzuki is a study co-author.
Funding: Funding sources for the study include The MIT-Massachusetts General Brigham Brain Arousal State Control Innovation Center, The Freedom Together Foundation, and The Picower Institute for Learning and Memory.
About this consciousness and anesthesia research news
Author: David Orenstein
Source: Picower Institute at MIT
Contact: David Orenstein – Picower Institute at MIT
Image: The image is credited to Neuroscience News
Original Research: Closed access.
“EEG-Guided Titration of Sevolfurane and Pediatric Anesthesia Emergence Delirium ” by Emery N. Brown et al. JAMA Pediatrics
Abstract
EEG-Guided Titration of Sevolfurane and Pediatric Anesthesia Emergence Delirium
Importance
Pediatric anesthesia emergence delirium ( PAED ) is a common complication of general anesthesia and has unknown etiology. Exposure to volatile anesthetics may contribute to PAED, and excessive exposure may occur frequently during routine pediatric anesthesia.
Objective
To examine whether use of electroencephalography ( EEG ) monitoring can reduce PAED by minimizing exposure to sevoflurane while maintaining a state of unconsciousness under anesthesia.
Design, Setting, and Participants
A single-center, parallel-group, 2-arm, superiority randomized clinical trial with a 1:1 allocation ratio was conducted from October 13, 2021, to March 18, 2023, at an academic tertiary pediatric hospital in Japan. The follow-up period was 24 ± 6 hours postoperatively or uneventful discharge to home, whichever came first.
The observer for the primary outcome was blinded to patient assignment. The trial included a convenience sample of children aged 1 to younger than 6 years undergoing general anesthesia for procedures for which reliable antinociception can be provided. Data analysis was performed in March 2023.
Intervention
EEG-guided titration of anesthesia to minimize sevoflurane exposure ( EEG-guided group ) vs standard 1. 0–minimum alveolar concentration ( MAC ) sevoflurane anesthesia ( control group ).
Main Outcomes and Measures
Proportion of patients who developed PAED, defined by a maximum PAED score of 10 or higher.
Results
Of the 177 participants who completed follow-up, 125 ( 71 % ) were male and 52 ( 29 % ) were female. The EEG-guided group included 91 participants ( mean [SD] age, 2. 9 [1. 5] years ), and the control group included 86 participants ( mean [SD] age, 2. 8 [1. 6] years ).
In the EEG-guided group, sevoflurane exposure was reduced by 1. 4 MAC-hours (96. 65 % CI, 1. 1 to 1. 6 MAC-hours ). A total of 30 ( 35 % ) in the control group and 19 ( 21 % ) in the EEG-guided group developed PAED ( difference, 14 %; 96. 65 % CI, −0. 0019 % to 28 %; 95 % CI, 0. 92 % to 27 %; P =. 04 ).
Children in the EEG-guided group emerged a mean of 21. 4 minutes (96. 65 % CI, 15. 4 to 27. 4 minutes ) earlier from general anesthesia and spent a mean of 16. 5 minutes less (96. 65 % CI, 10. 8 to 22. 3 minutes less ) in the postanesthesia care unit.
Conclusions and Relevance
EEG-guided management of general anesthesia reduced sevoflurane exposure and pediatric anesthesia emergence delirium in children, with faster emergence and shorter postanesthesia care unit stays.
The findings suggest that high concentrations of sevoflurane for induction followed by routine use of 1. 0-MAC sevoflurane for maintenance may be excessive.
Trial Registration
Japan Registry of Clinical Trials Identifier : jRCTs032210248
