- 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.
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.
Use of the AnaConDa (Anaesthetic Conserving Device, Sedana Medical) is feasible for short procedures utilising open circuits & high FGF, and yet still allows low volatile consumption.
Intraoperative caffeine does not reduce postoperative morphine consumption after laparoscopic abdominal surgery.
In children undergoing general anaesthesia age 1-3 years & emergency procedures, are associated with increased incidence of regurgitation and aspiration. Significant clinical sequelae are nevertheless rare.
Shortening clear fluid fasting to 1 hour in children is not associated with increased aspiration incidence.
Use of succinylcholine is associated with an increased risk of post-operative respiratory complications in a dose-dependent manner.
Significant CO2 accumulation occurs during apneic oxygenation with high-flow nasal oxygen, potentially limiting safety during prolonged apnea.