- Intraoperative EEG accurately monitors anaesthetic depth.
- Using EEG to guide intraoperative depth may reduce both anaesthetic use and postoperative delirium.
- Reducing drug exposure and depth of anaesthesia probably has significant patient and societal benefits.
- All anaesthetists and anesthesiologists should be familiar with interpreting the raw EEG in the context of anaesthesia.
- While postoperative delirium is common in the over 65y age group (15-20%) and is associated with adverse outcomes, it is less clear that avoiding excessive depth reliably reduces postoperative delirium (some studies say yes, others...)
- Additionally, because post-op delirium is often used as (or at least inadvertently becomes) a surrogate marker for a range of adverse post-op events, then it follows that EEG monitoring should also be associated with reducing these events. This has not yet been shown.
Dexmedetomidine does not improve day 3 behaviour among 2-7 year olds after day case surgery.
Propofol-based TIVA may be associated with improved overall survival after cancer surgery than volatile anaesthesia.
Epidural analgesia for video-assisted thoracoscopic lung cancer surgery does not improve cancer recurrence or cancer-specific survival.
Older patients with low pre-operative cognitive performance may inadvertently be receiving a relative overdose during volatile general anaesthesia.
When used for post caesarean section analgesia, both intrathecal hydromorphone (75 mcg) and intrathecal morphine (150 mcg) are equally effective.
The erector spinae plane block has similar efficacy to paravertebral block for reducing post breast surgery pain, but is inferior to pectoralis nerve block.
Preoperative lymphopaenia is associated with increased postoperative mortality and morbidity.
Should the EEG and it'a processed derivatives be elevated to routine standard of care monitoring during general anaesthesia?
A compelling argument that the EEG and it's derivative monitors should be 'standard of care' during anaesthesia, contrasting this with the ECG, arguably a less useful, actionable or meaningful monitor, yet has been widely considered a routine monitor for three decades.
The authors' main thesis is that:
Note that the researchers used a relatively low sevoflurane target (MAC 0.5) enabled by concurrent use of remifentanil (0.3 mg/kg/min) and a surgical site readily amendable to local infiltration.