Traditional pediatric anesthetic dosing using pharmacokinetic estimates based on age and weight is often imprecise, frequently leading to oversedation. Intraoperative electroencephalography (EEG) allows visualization of the brain's response to anesthetic agents in real time, facilitating precise titration of anesthetic drug doses optimized for the individual child. The goal of EEG-guided anesthesia management is to maintain an optimal state of hypnosis during various stages of the procedure while minimizing hemodynamic instability and other adverse effects of anesthesia. This is especially important in children with less predictable anesthetic requirements, such as children with atypical neurodevelopment, altered levels of consciousness before anesthesia, or those receiving total intravenous anesthesia, neuromuscular blockers, or a combination of anesthetic agents with different mechanisms of actions. Children with limited cardiorespiratory reserves and those undergoing high-risk procedures such as cardiopulmonary bypass also benefit from EEG guidance as they have a narrower therapeutic window for optimal anesthetic dosing. Various processed EEG (pEEG) monitors are available for intraoperative monitoring in children. These monitors display a pEEG index based on the manufacturer's algorithm, purportedly indicating the patient's hypnotic state. Due to differences in developmental neurophysiology and EEG dynamics in children, pEEG indices may not always reliably indicate the hypnotic state, especially in neonates and infants. Learning to interpret nonproprietary EEG parameters including the raw EEG, spectral-edge frequency 95% (SEF95), and density spectral array can prevent overreliance on pEEG indices. This review provides an overview of the advantages of EEG guidance during clinical anesthesia, including potential reduction in anesthetic dosage, prevention of EEG suppression, and reduction in peri-operative adverse events. We describe the use of nonproprietary EEG parameters in guiding anesthesia in children for various clinical end points including laryngoscopy, surgical incision, and maintenance of anesthesia, as well as sedation. We illustrate these principles with various case examples commonly encountered during pediatric anesthesia. Lastly, we discuss strategies to expand intraoperative EEG monitoring in children through education and training programs, as well as advocate for further research to assess clinical outcomes associated with EEG guidance to support its routine use in clinical care.

中文翻译：

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脑电图在指导儿童全身麻醉中的效用。


使用基于年龄和体重的药代动力学估计的传统儿科麻醉剂剂量通常不精确，经常导致过度镇静。术中脑电图 （EEG） 可以实时可视化大脑对麻醉剂的反应，有助于精确滴定针对个体儿童优化的麻醉药物剂量。脑电图引导麻醉管理的目标是在手术的各个阶段保持最佳催眠状态，同时最大限度地减少血流动力学不稳定和麻醉的其他不利影响。这对于麻醉需求不太可预测的儿童尤其重要，例如神经发育不典型、麻醉前意识水平改变的儿童，或接受全静脉麻醉、神经肌肉阻滞剂或具有不同作用机制的麻醉剂组合的儿童。心肺储备有限的儿童和接受体外循环等高风险手术的儿童也受益于脑电图引导，因为他们的治疗窗口较窄，可实现最佳麻醉剂剂量。各种经过处理的脑电图 （pEEG） 监测器可用于儿童的术中监测。这些监视器显示基于制造商算法的 pEEG 指数，据称指示患者的催眠状态。由于儿童发育神经生理学和脑电图动力学的差异，pEEG 指数可能并不总是可靠地指示催眠状态，尤其是在新生儿和婴儿中。学习解释非专有的 EEG 参数，包括原始 EEG、谱缘频率 95% （SEF95） 和密度谱阵列，可以防止过度依赖 pEEG 指数。 本综述概述了临床麻醉期间脑电图引导的优势，包括可能减少麻醉剂剂量、预防脑电图抑制和减少围手术期不良事件。我们描述了非专有脑电图参数在各种临床终点引导儿童麻醉中的应用，包括喉镜检查、手术切口和麻醉维持以及镇静。我们用儿科麻醉过程中常见的各种案例来说明这些原则。最后，我们讨论了通过教育和培训计划扩大儿童术中脑电图监测的策略，并倡导进一步研究以评估与脑电图指导相关的临床结果，以支持其在临床护理中的常规使用。