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Age-dependent electroencephalogram alterations under remimazolam anesthesia.

Jayyoung Bae1, Myung Il Bae1, Dong Woo Han1

  • 1Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Korean Journal of Anesthesiology
|March 24, 2026
PubMed
Summary

Age impacts electroencephalogram (EEG) patterns during remimazolam anesthesia. Older adults show decreased alpha/beta power and frontal coherence, with increased delta/theta activity, affecting EEG monitoring.

Keywords:
AgedAgingConsciousness monitorsElectroencephalographyGeriatric anesthesiaMonitoring, intraoperativeRemimazolam.

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Area of Science:

  • Anesthesiology
  • Neuroscience
  • Medical Imaging

Background:

  • Remimazolam is a novel benzodiazepine anesthetic for total intravenous anesthesia (TIVA).
  • Its electroencephalographic (EEG) signatures, particularly in elderly patients, are not well understood.
  • This study investigates age-related EEG changes during remimazolam TIVA.

Purpose of the Study:

  • To evaluate the relationship between patient age and intraoperative EEG dynamics.
  • To characterize age-specific EEG alterations during remimazolam-based TIVA.
  • To assess how age influences EEG components like power, coherence, and spectral parameters.

Main Methods:

  • Prospective observational study of 69 adult patients undergoing remimazolam TIVA.
  • Analysis of intraoperative electroencephalogram (EEG) recordings.
  • Linear regression and Pearson correlation to assess age-related changes in EEG frequency bands, frontal coherence, aperiodic components, burst suppression ratio (BSR), patient state index (PSI), and spectral edge frequency (SEF).

Main Results:

  • Older age correlated with decreased absolute alpha, beta, and gamma power.
  • Increased relative delta and theta power, and decreased relative alpha and beta power were observed with age.
  • Frontal coherence of delta, theta, alpha, and beta oscillations significantly decreased as age increased.

Conclusions:

  • Older patients exhibit distinct EEG patterns under remimazolam anesthesia, including reduced alpha/beta power and frontal coherence, and increased delta/theta dominance.
  • These age-specific cortical dynamic alterations may influence the interpretation of EEG monitoring during remimazolam anesthesia.
  • The findings highlight the importance of considering age when utilizing EEG for anesthesia monitoring with remimazolam.