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Association Between Entropy Monitoring, Burst Suppression and Early Postoperative Cognitive Dysfunction in Emergency
Liliana Mirea1,2, Ana Maria Dumitriu2, Cristian Cobilinschi1,2
1Faculty of Medicine, "Carol-Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Journal of Clinical Medicine
|February 13, 2026
Summary
Processed EEG monitoring in emergency surgery may optimize anesthesia and improve hemodynamics. However, intraoperative burst suppression, indicated by BSR, is linked to increased early postoperative delirium risk.
Area of Science:
- Anesthesiology
- Neuroscience
- Critical Care Medicine
Background:
- Emergency surgical patients face heightened risks of acute postoperative delirium.
- Processed electroencephalogram (EEG) monitoring, including entropy indices and burst suppression ratio (BSR), may refine anesthetic administration but is understudied in non-elective settings.
Purpose of the Study:
- To investigate the association between entropy monitoring, intraoperative burst suppression, and the incidence of early postoperative delirium within 72 hours after emergency surgery.
Main Methods:
- Retrospective cohort study of adult emergency surgery patients (March 2022-March 2024).
- Patients were divided into entropy-monitored (EG) and standard care (SG) groups.
- Cognitive function assessed using NEECHAM scores; analyzed anesthetic doses, burst suppression, and hemodynamics.
Main Results:
- Entropy-monitored patients received lower sevoflurane and fentanyl doses, with improved hemodynamic stability and reduced vasopressor needs.
- Higher incidence of early postoperative delirium (NEECHAM ≤ 24) observed in patients with intraoperative burst suppression.
- BSR > 15% or suppression duration > 6 minutes strongly correlated with 72-hour cognitive decline.
Conclusions:
- Entropy-guided anesthesia in emergency surgery facilitates precise anesthetic titration and hemodynamic stability.
- Intraoperative burst suppression patterns may indicate neurocognitive vulnerability rather than direct anesthetic effects.
- Processed EEG monitoring shows promise for emergency surgery, warranting further prospective investigation.
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