• Iris J de Heer, Hannah A C Raab, Joost de Vries, Gulhan Karaöz-Bulut, and Frank Weber.
• Department of Anesthesia, Erasmus University Medical Centre, Rotterdam, the Netherlands.
• Paediatr Anaesth. 2025 Jan 13.

BackgroundIn children, monitoring depth of anesthesia is challenging because of the still developing brain. Electroencephalographic density spectral array monitoring provides age- and anesthetic drug-specific electroencephalographic patterns, making it suitable for use in children. Yet, not much is known about the benefits of using density spectral array on post-operative recovery in children.AimIn this randomized controlled trial, the primary aim was to investigate the influence of density spectral array monitoring during general anesthesia on the speed of recovery after surgery.MethodsChildren aged 6 months-12 years scheduled for elective surgery under general anesthesia supplemented with caudal analgesia had either sevoflurane anesthesia titrated to maintain a characteristic density spectral array pattern or based on a predefined end-tidal sevoflurane concentration of 2.3% (standard care group). The time interval between the discontinuation of sevoflurane and the moment when discharge criteria from the operating room were met (Steward score of 3 or more) was defined as the primary outcome parameter of this trial.ResultsData from 96 children were analyzed. The time until discharge readiness from the operating room was shorter in group density spectral array (6 min. [13[4-16.8]]) than in group standard care (12 min. [18[6-24.3]]), with a difference between medians of 6 min (95% CI -7 to 0), p = 0.041. The mean end-tidal sevoflurane concentration during the surgical procedure was lower in group density spectral array, 1.8% (0.34) versus 2.3% (0.1) in group standard care (95% CI 0.4-0.7), p < 0.001.ConclusionThis randomized controlled trial provides initial evidence of an added value of density spectral array monitoring in terms of the speed of recovery and allows sevoflurane to be dosed 22% lower during maintenance than with a more traditional approach using a minimal alveolar concentration of 0.9.Trial RegistrationClinicalTrials.gov identifier: NCT05525104.© 2025 The Author(s). Pediatric Anesthesia published by John Wiley & Sons Ltd.

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