EEG-Guided Anesthesia for the Prevention of Emergence Delirium in Children

Importance: The potential benefits of using electroencephalography (EEG)-guided anesthesia for the prevention of emergence delirium in children remain unclear. Objective: To determine whether the intraoperative use of EEG-guided anesthesia is associated with a lower incidence of emergence delirium in pediatric patients. Data Sources: PubMed, Embase, and Cochrane databases were searched until July 2025. Searches followed PRISMA guidelines and were registered in PROSPERO. Study Selection: From 185 studies screened by 2 authors, 9 randomized clinical trials met the inclusion criteria: patients aged 1 to 18 years undergoing general anesthesia, comparing EEG-guided anesthesia with standard practice. Included studies reported at least 1 of the following outcomes: emergence delirium, pediatric anesthesia emergence delirium score, postanesthesia care unit length of stay, end-tidal sevoflurane concentration, or burst suppression. Data Extraction and Synthesis: Data containing risk ratios (RRs) and mean differences (MDs) with 95% CIs were extracted from randomized clinical trials. Quality assessment and certainty of evidence were performed using the Risk of Bias 2 (RoB-2) tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. Main Outcomes and Measures: The primary outcome was the incidence of emergence delirium, a common postanesthesia psychomotor pediatric complication measured by pediatric anesthesia emergence delirium score greater than or equal to 10. This outcome was prespecified before data extraction and analysis. Results: A total of 1052 patients from 9 included studies were included in this analysis, of whom 535 (50.9%) underwent EEG-guided anesthesia. The incidence of emergence delirium was significantly lower in the EEG-guided group compared with the standard-practice group (27% vs 48%; RR, 0.56; 95% CI, 0.37-0.84; P = .005). Maximum pediatric anesthesia emergence delirium scores (MD, -0.87; 95% CI, -1.52 to -0.23; P = .008), end-tidal sevoflurane concentration (MD, -0.40; 95% CI, -0.58 to -0.22; P