Processed EEG Artifacts and Pitfalls: A Narrative Review and a Troubleshooting Mnemonic

Area of Science:

• Anesthesiology
• Neuroscience
• Biomedical Engineering

Background:

• Processed electroencephalography (EEG) is crucial for monitoring anesthesia depth.
• Interference and artifacts in raw EEG data can lead to misinterpretation of quantitative EEG (qEEG) indices.
• This can result in suboptimal anesthesia levels or burst suppression.

Purpose of the Study:

• To review sources of interference and artifacts in qEEG used for anesthesia monitoring.
• To discuss paradoxical effects and potential pitfalls associated with qEEG interpretation.
• To provide a structured approach for troubleshooting qEEG anomalies.

Main Methods:

• Literature review of qEEG interference and artifact sources.
• Categorization of interference sources: pharmacological, electromagnetic/mechanical, pathophysiological, and model-related.
• Introduction of the "ANESTHESIA" mnemonic for artifact identification.

Main Results:

• Identified multiple interference sources affecting qEEG reliability.
• Highlighted the importance of acknowledging artifacts when artifact removal is not feasible.
• Emphasized the need for a systematic approach to qEEG analysis.

Conclusions:

• A systematic approach to identifying qEEG artifacts is essential for accurate anesthesia depth monitoring.
• Recognizing and addressing interference sources can enhance patient safety.
• The "ANESTHESIA" mnemonic offers a practical tool for clinicians.