EEG
‐Guided Sevoflurane Anesthesia and Emergence Delirium in Children: A Randomized Controlled Trial
Ozlem Kocaturk, Sultan Keles ABSTRACT
Background
In pediatric anesthesia, minimum alveolar concentration (MAC) guides inhalational agent dosing but may not accurately reflect anesthetic depth. EEG‐guided anesthesia has shown benefits in adults but remains underused in children.
Aims
This study aims to evaluate the effect of EEG‐guided anesthesia with SedLine on emergence delirium (ED) and sevoflurane dose in behaviorally noncompliant children undergoing dental procedures under general anesthesia.
Methods
In this prospective, randomized controlled trial, 100 children aged 4–10 years were randomized to standard anesthesia guided by MAC and conventional clinical signs (standard group) or EEG‐guided anesthesia titrated to SedLine parameters (primary target: PSI 25–50; secondary parameter: SEF 10–15 Hz) (EEG‐S group). Primary outcome was ED incidence assessed by the Pediatric Anesthesia Emergence Delirium Scale (PAEDS). Secondary outcomes included mean EtSevo values, postoperative pain, rescue analgesia, nausea/vomiting, recovery time.
Results
Median PAEDS scores during the first 120 min postoperatively were significantly lower in the EEG‐S group compared with the Standard group (e.g., upon arrival to PACU: 4 [IQR 4] vs. 8 [IQR 4.5]). In addition, the incidence of ED upon arrival in the recovery room was significantly lower in the EEG‐S group (17% vs. 43%) and at 10 min postoperatively (17% vs. 37%). The mean end‐tidal sevoflurane concentration was statistically lower in the EEG‐S group (maintenance EtSevo 1.88 ± 0.25 vs. 1.98 ± 0.20; mean difference = 0.10, 95% confidence interval: 0.006–0.190; p = 0.036). Postoperative FLACC pain scores were also lower in the EEG‐S group, representing a potential confounding factor for ED outcomes.
Conclusion
EEG‐guided anesthesia was associated with lower PAEDS scores and reduced sevoflurane consumption compared with standard management. However, given small EEG‐derived differences and potential confounding by postoperative pain, these findings should be interpreted cautiously. Within the applied target ranges, EEG‐derived parameters were not independently associated with ED, and specific EEG targets predictive of ED could not be identified.
Trial Registration
This study was registered (Protocol Registration Receipt NCT06400706/OKocaturk/May 02 2024) at