• Anesthetics
• Laparotomy
• Necrotizing enterocolitis
• New-born infant
• Pediatric anesthesia
• Perioperative care
• Premature infant

• Humans
• Enterocolitis, Necrotizing/surgery
• Europe
• Cross-Sectional Studies
• Infant, Newborn
• Infant, Premature
• Anesthesia, Intravenous/methods
• Anesthesia, Intravenous/statistics & numerical data
• Anesthesia/methods
• Health Care Surveys
• Surveys and Questionnaires/statistics & numerical data
• Anesthesiologists/statistics & numerical data
• Anesthesia, General/methods
• Practice Patterns, Physicians'/statistics & numerical data
• Practice Patterns, Physicians'/standards
• Preoperative Care/methods
• Preoperative Care/statistics & numerical data
• Preoperative Care/standards
• Anesthesia, Inhalation/methods
• Anesthesia, Inhalation/statistics & numerical data

• Depression
• Electroconvulsive therapy
• Electroencephalogram
• Nociception
• Propofol

• Anesthesia
• EEG
• Electroencephalogram
• Electroencephalography
• Pediatric anesthesia
• Pediatric.

• Humans
• Electroencephalography/methods
• Electroencephalography/drug effects
• Child
• Monitoring, Intraoperative/methods
• Infant
• Intraoperative Neurophysiological Monitoring/methods
• Anesthesia/methods
• Anesthetics/administration & dosage
• Anesthetics/adverse effects
• Child, Preschool

• Masimo Corp
• L70 DA057081 NIDA NIH HHS
• KL2 TR002558 NCATS NIH HHS
• KL2TR002558 Einstein-Montefiore CTSA
• UL1TR002556 Einstein-Montefiore CTSA
• K23 DA057499 NIDA NIH HHS
• NIH HHS
• UL1 TR002556 NCATS NIH HHS
• K23DA057499 Einstein-Montefiore CTSA

• Comfort scale
• Narcotrend index
• children
• depth of sedation
• midazolam
• procedural sedation
• propofol
• sedation monitoring

• Analgesia drugs
• Anesthesia, general
• Coma
• Dose response relationship
• Electrencephalogram (EEG)
• Hypnotic drugs
• Intraoperative neurophysiological monitoring

• Humans
• Anesthesia, General/adverse effects
• Anesthetics
• Electroencephalography
• Emergence Delirium
• Operating Rooms

• University of Bern

• Infant
• Adult
• Humans
• Child
• Adolescent
• Child, Preschool
• Anesthesia, General/adverse effects
• Anesthesiology
• Anesthetics
• Electroencephalography
• Hypotension

• ANAESTHETICS
• Adult anaesthesia
• Pain management

• Body temperature
• Cardiac surgery
• Delirium
• Depth of anesthesia
• EEG
• Heart–lung machine

• Humans
• Male
• Child
• Female
• Adolescent
• Emergence Delirium/diagnosis
• Sevoflurane
• Temperature
• Anesthesia
• Electroencephalography
• Cardiac Surgical Procedures/adverse effects

• Medizinische Hochschule Hannover (MHH) (3118)

To study the effect of Narcotrend monitoring on the incidence of early postoperative cognitive dysfunction (POCD) under different Bispectral Index (BIS) conditions and the effect of different depths of anesthesia on the incidence of POCD.

We performed a literature search of the PubMed, Embase, OVID (database system made by Ovid Technologies, USA), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP Chinese Sci-tech Journals Database, Wanfang Data, etc. from the date of establishment of the database until December 31, 2020.

In the end, eighty articles were included, with a total of 714 patients. The meta-analysis results showed that four articles (255 patients) compared the state of deep anesthesia (BIS 30–40) with conventional anesthesia (BIS 40–60 earlier) after POCD. Also, the incidence of POCD on the first day after deep anesthesia [Narcotrend stage (NTS): negative correlation is currently the most appropriate egg description; Nd can subdivide the original electroencephalogram (EEG) into six stages 15 levels (Nd Sg, NTS), or A (state of wakefulness), state B0–B2 (sedated state), state C0–C2 (light anesthetic state), state D0–D2 (general anesthesia), state E0–E2 (deep anesthesia state), and state F0–F2 (burst suppression state)] was significantly lower than that of conventional anesthesia (NTS D0–D1) [odds ratio (OR) =0.21, 95% confidence interval (CI): 0.13–0.35, P<0.00001]. Moreover, the incidence of POCD in deep anesthesia (NTS E1) at 7 days after surgery was significantly lower than that of conventional anesthesia (NTS D0) (OR =0.45, 95% CI: 0.23–0.91, P=0.03), while the incidence of POCD 7 days after NTS D2 in conventional anesthesia was significantly lower than that of NTS D0 (OR =0.42, 95% CI: 0.24–0.71, P=0.001).

POCDs are thought to be the result of a combination of physical defects and precipitating factors in patients with their own physical impairments, and despite potential adverse effects, there is currently no consensus on the incidence of POCDs in patients with tumor, current risk factors, causes, and prevention strategies. Moreover, the level of evidence is low, and the deviation between different studies cannot be ruled out.

• Bispectral Index value (BIS value)
• Depth of anesthesia
• Narcotrend monitoring
• meta-analysis
• postoperative cognitive dysfunction (POCD)

• Anesthesia
• EEG
• Electroencephalogram
• Propofol
• Sevoflurane

• EEG-derived monitor
• anaesthesia
• brain oxygenation
• depth of anaesthesia
• near-infrared-spectroscopy
• neuromonitoring
• paediatric

The development of general anesthesia techniques and anesthetic substances has opened new horizons for the expansion and improvement of surgical techniques. Nevertheless, more complex surgical procedures have brought a higher complexity and longer duration for general anesthesia, which has led to a series of adverse events such as hemodynamic instability, under- or overdosage of anesthetic drugs, and an increased number of post-anesthetic events. In order to adapt the anesthesia according to the particularities of each patient, the multimodal monitoring of these patients is highly recommended. Classically, general anesthesia monitoring consists of the analysis of vital functions and gas exchange. Multimodal monitoring refers to the concomitant monitoring of the degree of hypnosis and the nociceptive-antinociceptive balance. By titrating anesthetic drugs according to these parameters, clinical benefits can be obtained, such as hemodynamic stabilization, the reduction of awakening times, and the reduction of postoperative complications. Another important aspect is the impact on the status of inflammation and the redox balance. By minimizing inflammatory and oxidative impact, a faster recovery can be achieved that increases patient safety. The purpose of this literature review is to present the most modern multimodal monitoring techniques to discuss the particularities of each technique.

• bispectral index
• entropy
• general anesthesia
• hypnosis
• multimodal monitoring
• patient safety
• qCON
• qNOX
• surgical plethismographic index

• Anesthesia, General/adverse effects
• Delivery of Health Care
• Humans
• Hypnosis
• Monitoring, Intraoperative
• Nociception
• Patient Safety

Electroencephalography (EEG) monitoring has become technically feasible in daily clinical anesthesia practice. EEG is a sensitive method for detecting neurophysiological changes in the brain and represents an important frontier in the monitoring and treatment of patients in the perioperative period. In this review, we briefly introduce the essential principles of EEG. We review EEG application during anesthesia practice in the operating room, including the use of processed EEG in depth of anesthesia assessment, raw EEG monitoring in recognizing brain states under different anesthetic agents, the use of EEG in the prevention of perioperative neurocognitive disorders and detection of cerebral ischemia. We then discuss EEG utilization in the intensive care units, including the use of EEG in sedative level titration and prognostication of clinical outcomes. Existing literature provides insight into both the advances and challenges of the clinical applications of EEG. Future study is clearly needed to elucidate the precise EEG features that can reliably optimize perioperative care for individual patients.

• EEG
• cerebral ischemia
• cognitive function
• depth of anesthesia
• prognostication

To compare the clinical judgement of electroencephalogram (EEG)-naïve anesthesiologists with an EEG-based measurement of anesthetic depth (AD) using the Narcotrend® monitor.

In this prospective cohort study including 600 patients, AD during stable anesthesia was assessed by clinical judgement of the attending, EEG-blinded anesthesiologist (using a scale staging the AD as mid-adequate, adequate but fairly deep, or adequate but fairly light) and by simultaneously recorded Narcotrend measurements.

In 42% of patients (n = 250), the anesthesiologist’s clinical judgement was in agreement with anesthetic levels as measured by the Narcotrend monitor. In 46% of patients (n = 274), the anesthesiologist’s judgement and the Narcotrend monitor differed by one AD level (minor discordance). Major discordance was observed in 76 (13%) measurements (judged deeper than measured, n = 29 [5%]; judged lighter than measured, n = 47 [8%]). In 7% of patients (n = 44), the Narcotrend index was outside the limits of adequate AD (too deep, n = 28 [5%]; too superficial, n = 16 [3%]). The overall level of agreement between the anesthesiologist’s judgement and the Narcotrend monitor was not statistically significant (Cohen’s kappa, −0.039; P = 0.17). Using a random forests algorithm, age, mean blood pressure, the American Society of Anesthesiologists classification, body mass index, and frailty were the variables with the highest relative feature importance to predict the level of agreement.

These results suggest that clinical judgement of AD during stable anesthesia was not in agreement with EEG-based assessment of anesthetic depth in 58% of cases. Nevertheless, this finding could be influenced by the lack of validated scales to clinically judge AD.

www.clinicaltrials.gov (NCT02766894); registered 10 May, 2016.

• anaesthesia
• healthcare improvement and patient safety
• orthopaedic and trauma surgery

• Narcotrend®
• cardiopulmonary bypass
• children
• extracorporeal circulation
• minimal alveolar concentration
• postoperative ventilation time
• sevoflurane
• total intravenous anesthesia

Electroencephalographic density spectral array monitoring has been developed to facilitate the interpretation of unprocessed electroencephalogram signals. The primary aim of this prospective observational study, performed in a tertiary children's hospital, was to identify the clinical applicability and validity of density spectral array monitoring in infants and children during sevoflurane anaesthesia. We included 104 children, aged < 6 years, undergoing elective surgery during sevoflurane anaesthesia. We investigated the correlation between non‐steady state end‐tidal sevoflurane and the expression of the four electroencephalogram frequency bands β, α, θ and δ, representing density spectral array. Patients were divided into three age groups (< 6 months, 6–12 months, > 12 months). There was a significant correlation between end‐tidal sevoflurane and density spectral array in the age groups 6–12 months (p < 0.05) and 1–6 years (p < 0.0001). In infants < 6 months of age, the relative percentages of density spectral array did not correlate with end‐tidal sevoflurane. The main finding was that different end‐tidal concentrations of sevoflurane produce age‐dependent changes in the density spectral array power spectrum. In infants younger than 6 months‐old, α and β coherence are absent, whereas θ and δ oscillations have already emerged. In cases where anaesthesia was too deep, this presented as burst suppression on the electroencephalogram, θ disappeared, leaving the electroencephalographic activity in the δ range. Future research should address this issue, aiming to clarify whether the emergence of θ oscillations in infants helps to prevent sevoflurane overdosing.

• anaesthesia
• children
• density spectral array
• sevoflurane