Related Experiment Video
Updated: Jun 4, 2025
Author Spotlight: Assessing the Feasibility of Using Amplitude-Integrated EEG During Neonatal Transport
Published on: June 21, 2024
Electroencephalography and Anesthetic Depth in Children Under 2 Years of Age: A Prospective Observational Study
Soo-Bin Yoon1, Jung-Bin Park1, Pyoyoon Kang2
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
Processed electroencephalogram (EEG) indices can be unreliable in young children, showing false elevations during anesthesia. Analyzing raw EEG spectral parameters offers a more accurate assessment of anesthetic depth in this vulnerable population.
Area of Science:
- Anesthesiology and critical care
- Neuroscience
- Pediatric medicine
Background:
- Processed electroencephalogram (EEG) indices are commonly used to monitor anesthetic depth.
- Reliability of these indices is questionable in children under two years, often showing false elevations.
- Unexpectedly high processed EEG index values complicate anesthesia maintenance in this age group.
Purpose of the Study:
- Identify EEG spectral parameters linked to false positive elevations in processed EEG indices.
- Differentiate these false positive elevations from true positive elevations during emergence from anesthesia.
Main Methods:
- Prospective observational study of 50 children (4-24 months) undergoing general anesthesia.
- Continuous recording of raw EEG, Bispectral index (BIS), and patient state index (PSi).
- Defined false positives by elevated indices with stable vital signs and sevoflurane concentration (0.7-1.3 MAC); compared EEG spectra to emergence periods.
Main Results:
- False positives occurred in 70% of children, affecting 28% of the maintenance phase.
- False positives correlated with decreased delta and theta power, and increased alpha and beta power, elevating spectral edge frequency.
- EEG band power during false positives significantly differed from emergence periods (p < 0.001).
Conclusions:
- Processed EEG indices can yield false positive elevations during anesthesia maintenance in young children.
- Quantitative analysis of raw EEG spectral data can enhance anesthetic depth assessment in pediatric patients.
- Raw EEG analysis provides a more reliable measure of anesthetic depth in children under two years.
Background:
Processed electroencephalogram (EEG) indices are widely used to monitor anesthetic depth. However, their reliability in children under 2 years of age remains questionable. During anesthesia maintenance in this age group, processed EEG indices frequently exhibit unexpectedly elevated values that exceed the intended target range.
Aim:
This study aimed to identify EEG spectral parameters associated with false positive elevations in processed EEG indices and investigate their differences from true positive elevations during emergence.
Methods:
This prospective observational study included 50 children aged 4-24 months undergoing general anesthesia. Bispectral index (BIS), patient state index (PSi), and raw EEG were continuously recorded throughout anesthesia. False positive was defined as elevated processed EEG indices when end-tidal sevoflurane concentration was maintained at 0.7-1.3 minimum alveolar concentration, with heart rate and mean blood pressure between 80% and 120% of baseline values. We analyzed EEG power spectra and band power values during periods of false positives and compared them with those of true positives during emergence. Bonferroni-corrected p < 0.05 was considered significant.
Results:
False positives in processed EEG indices were observed in 35 (70%) of the children during anesthesia maintenance, occupying 28% of the maintenance phase. These false positives were associated with decreased power in delta (269-174 dB) and theta (115-97 dB) bands, but widespread increases in alpha and beta bands, resulting in elevated spectral edge frequency (19-22 Hz). Notably, EEG band power during false positives significantly differed from those observed during emergence (delta: 52 dB, theta: 38 dB) (all p < 0.001).
Conclusions:
Processed EEG indices may exhibit unexpectedly elevated values during anesthesia maintenance in children under 2 years of age. Quantitative assessments derived from raw EEG data may improve the evaluation of anesthetic depth in this population.
More Related Videos
08:38Electroretinogram Recording for Infants and Children under Anesthesia to Achieve Optimal Dark Adaptation and International Standards
Published on: September 3, 2020
05:58Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates
Published on: September 6, 2017