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Comment & Response
June 25, 2019

Electroencephalography-Guided Anesthetic Administration and Postoperative Delirium

Author Affiliations
  • 1Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
  • 2Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA. 2019;321(24):2470-2471. doi:10.1001/jama.2019.5149

To the Editor In a well-designed trial,1 EEG-guided anesthetic administration did not decrease the incidence of postoperative delirium. The authors concluded that their findings do not support the use of EEG-guided anesthesia for this indication.

Quantification of consciousness is a complicated endeavor because of the complexity of the underlying biology. Application to clinical practice warrants simplification, which is facilitated by limiting measurements of electroencephalographic oscillations to the frontal cortex with subsequent calculation of markers such as the bispectral index, which was introduced 25 years ago. However, simplified indices, such as the bispectral index, are limited in application to the multidimensional biology of the brain, and the relationship between anesthesia-induced unconsciousness and frontal electroencephalographic patterns has been challenged.2 Compared with the bispectral index, other EEG-based techniques might be more sensitive in detecting anesthesia-associated alterations in consciousness and differentiating signatures associated with increased risk for postoperative delirium. Therefore, we would like to raise caution when applying the results of the ENGAGES trial to the use of EEG-guided anesthesia.