EEG-Guided Anesthesia for the Prevention of Emergence Delirium in Children: A Systematic Review and Meta-Analysis

The potential benefits of using electroencephalography (EEG)-guided anesthesia for the prevention of emergence delirium in children remain unclear.

To determine whether the intraoperative use of EEG-guided anesthesia is associated with a lower incidence of emergence delirium in pediatric patients.

PubMed, Embase, and Cochrane databases were searched until July 2025. Searches followed PRISMA guidelines and were registered in PROSPERO.

From 185 studies screened by 2 authors, 9 randomized clinical trials met the inclusion criteria: patients aged 1 to 18 years undergoing general anesthesia, comparing EEG-guided anesthesia with standard practice. Included studies reported at least 1 of the following outcomes: emergence delirium, pediatric anesthesia emergence delirium score, postanesthesia care unit length of stay, end-tidal sevoflurane concentration, or burst suppression.

Data containing risk ratios (RRs) and mean differences (MDs) with 95% CIs were extracted from randomized clinical trials. Quality assessment and certainty of evidence were performed using the Risk of Bias 2 (RoB-2) tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively.

The primary outcome was the incidence of emergence delirium, a common postanesthesia psychomotor pediatric complication measured by pediatric anesthesia emergence delirium score greater than or equal to 10. This outcome was prespecified before data extraction and analysis.

A total of 1052 patients from 9 included studies were included in this analysis, of whom 535 (50.9%) underwent EEG-guided anesthesia. The incidence of emergence delirium was significantly lower in the EEG-guided group compared with the standard-practice group (27% vs 48%; RR, 0.56; 95% CI, 0.37-0.84; P = .005). Maximum pediatric anesthesia emergence delirium scores (MD, -0.87; 95% CI, -1.52 to -0.23; P = .008), end-tidal sevoflurane concentration (MD, -0.40; 95% CI, -0.58 to -0.22; P <.001), and length of stay in the postanesthesia care unit (MD, -8.20; 95% CI, -13.35 to -3.04; P = .002) were also significantly lower in the EEG-guided anesthesia group. There was no statistically significant difference in the number of burst suppression episodes between the 2 groups (12% vs 17%; RR, 0.69; 95% CI, 0.42-1.12; P = .14).

This systematic review and meta-analysis reveals that use of EEG-guided anesthesia was associated with a significantly lower risk of emergence delirium compared with standard practice in children.