Intraoperative EEG-based monitors: are we looking under the lamppost?

Area of Science:

• Anesthesiology and Neurophysiology
• Clinical Electrophysiology

Background:

• Electroencephalogram (EEG)-based depth of anesthesia monitors have limitations in detecting awareness under anesthesia (AUA) and reducing postoperative delirium (POD).
• Existing monitors may have a 'glass ceiling' effect, limiting their efficacy in certain anesthetic protocols or for specific complications like POD.
• Advances in electrophysiological monitoring offer potential breakthroughs beyond current limitations.

Approach:

• This review explores recent advances in electrophysiological monitoring.
• Focuses on attention-related processes measurable in real-time under anesthesia.
• Evaluates the theoretical rationale and early evidence for novel monitoring techniques.

Key Points:

• Prevailing depth of anesthesia monitors can prevent AUA and POD under specific anesthetic protocols.
• Efficacy of current monitors is limited in other settings, particularly for POD due to perioperative causes.
• Real-time electrophysiological markers of attention are emerging as feasible tools.

Conclusions:

• Attention-related monitoring presents a strong theoretical basis for preventing AUA and POD.
• This novel approach may also help prevent other postoperative outcomes like stroke and neurocognitive disorder.
• Initial supporting evidence suggests the potential of these advanced monitoring techniques.