EEG in anesthesia: available, proven, ignored.
Carolina Frederico. MD, EDAIC
Anesthesiology & TIVA Specialist | 20+ Years of Clinical Practice | Passion for EEG & Anesthesia | Empowering Global Medical Education | Bridging Practice & Research
What would you choose? Brain monitor ON or OFF?
There’s something that’s been on my mind lately. It started with a comment from a colleague who told me:
"Now that I understand how to interpret the DSA, I can’t believe people don’t use it."
That’s exactly the question I’ve been asking myself for years.
I’ve worked in hospitals where resources are limited — yet efforts are made to integrate EEG monitoring, regardless of the brand, to improve patient care.
And I’ve also seen the opposite: hospitals with all the technology available… where it’s still a conscious choice not to use it. Clearly, this isn’t about cost; it’s about something else.
So I find myself wondering: Why does this happen?
Lack of training?
Disinterest?
Comfort zones?
Or are we still waiting for “more evidence”?
The knowledge is there. The tools are right in front of us. What’s the real reason? And what would it take for a colleague who decides not to use it… to change their mind?
My message to all those who doubt, avoid, or don’t trust it: Dare to look. Learn to read. Use this skill to protect the brain you’ve been entrusted with.
Evidence highlights:
EEG biomarkers during induction (alpha/beta power reduction, lower spectral edge frequency) can predict postoperative delirium with good accuracy (AUC 0.73)【Pollak et al., 2024】.
“Electroencephalography (EEG) is essential for modern anesthesia practice but remains underused due to limited training, perceived complexity, and cultural resistance”【Berger-Estilita et al., 2025】.
References
Pollak TA, Rafiq M, Hunt BA, Yeom SK, Kjaer TW, Møller K, et al. Electroencephalogram spectral edge frequency predicts postoperative delirium. Anesthesiology. 2024;140(5):765-778. doi:10.1097/ALN.0000000000004926.
Berger-Estilita J, Saxena S, Gisselbaek M. Advancing electroencephalography education in anesthesiology. Curr Opin Anesthesiol. 2025;38(1):XX-XX. doi:10.1097/ACO.0000000000001521.
Prof. Dr. med. Joana Berger-Estilita PhD, MMEd, DESA, EDIC, FESAIC Emery N. Brown Diego Patlis Milan Hrobský Mariano Santopinto Ignacio Cortinez Fernández Juan C. Pedemonte Cristian Muñiz Herrera Paulina Vallejos Silva Philippe Picard Philippe Richebé Dr. Matthias Kreuzer Carlos Rafael Ramirez-Paesano.M.D-EDAIC
Anesthesiologist
1moI would like to use it everyday in my practice but that's not possible yet in my hospital. It's a pity that having it doesn't lead to utilizing it in every patient. Thanks Carolina for your generous teachings
Anesteziolog ve společnosti Anesthesia s.r.o.
1moI think they need a "hero" or teamleader in each department who can be followed by non-experienced anesthesiologist. We should focus on young generation and using non-invasive techniques to show the way. No doubt that is tricky a needs time. Carolina Frederico. MD, EDAIC keep goin' !! 💪 the effort in essential.
Doktorand:in bei Klinikum rechts der Isar
1moBuying the EEG monitor is only the first step. We must continuously teach medical students, residents, attendings, and CRNAs, keeping them engaged with anesthesia’s true “target organ”: the 🧠. Until EEG expertise becomes mandatory in all levels of anesthesia training, we must educate, inspire, and hope.
Anaesthesiologist. Practices multimodal OFA. Interest in all airways including difficult airways. Embracer of innovative advanced technologies.
1moAnaesthesia definitely dropped the ball in 1930s regarding clinical EEG: In Anaesthesia we should have had EEG way before HR & ECG & that would have prevented countless mortalities under anaesthesia. Hope it does not make the same mistake in ensuring mandating the monitoring of the Anaesthesia Triad- Hypnosis- EEG/DSA no indexes allowed - Nociception -Muscle relaxation EEG became a proper medical tool in neurology. • 1934 – Adrian & Matthews confirm Berger’s findings, making EEG widely accepted. • 1935 – Herbert Jasper brings EEG to North America and advances its use in epilepsy research. • 1940s – EEG is used to diagnose epilepsy, brain tumors, sleep disorders, and coma states. • 1953 – Aserinsky & Kleitman discover REM sleep using EEG (and eye movement tracking).
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1moAll the excuses that you mention for not using it are probably right. There is also the fact that many institutions (like mine) don’t have good follow-up data to evaluate their various outcomes. When you don’t know your POD/POCD rates, its easy to think that you don’t have a problem. Many of our teaching institutions are in the situation that you describe : monitors are available but are not used 🙄