In the Literature

Summary of "EEG-Guided Titration of Sevoflurane and Pediatric Anesthesia Emergence Delirium: A Randomized Clinical Trial"

Summary published April 13, 2026

Summary by Jeffrey Huang, MD

JAMA Pediatrics | April 2025

Miyasaka KW, Suzuki Y, Brown EN, Nagasaka Y. EEG-Guided Titration of Sevoflurane and Pediatric Anesthesia Emergence Delirium: A Randomized Clinical Trial. JAMA Pediatr. 2025 Apr 21;179(7):704–12. doi: 10.1001/jamapediatrics.2025.0517. Epub ahead of print. PMID: 40257811; PMCID: PMC12013357.

doi: https://doi.org/10.1001/jamapediatrics.2025.0517

  • Pediatric anesthesia emergence delirium (PAED) is a common complication following surgical procedures in pediatric patients. While general anesthesia appears to be a risk factor for PAED, the etiology of PAED remains unknown.
  • In adults, a prior study found that EEG-guided anesthesia aimed at minimizing EEG suppression did not reduce the incidence of postoperative delirium when compared with usual care.
  • This single-center, parallel-group, 2-arm, superiority randomized clinical trial examined whether EEG-guided anesthetic management could reduce the incidence of emergence delirium in children.
  • Children aged 1 to 5 years, scheduled for elective surgery requiring at least 30 minutes of general anesthesia, were eligible for enrollment in this study.
  • Patients were randomized to receive general anesthesia either with sevoflurane titrated to EEG patterns (EEG-guided group), or with sevoflurane delivered at a fixed concentration of 1.0 MAC (control group). In the EEG-guided group, sevoflurane was titrated to the lowest concentration required to maintain EEG patterns consistent with unconsciousness, defined by a stable, continuous alpha and slow-delta EEG pattern.
  • Patients were assessed for PAED upon PACU arrival and at 5, 10, 15, and 30 minutes, and/or until full emergence and recovery from anesthesia.
  • 177 children were included in the primary analysis (71% male; 29% female), with 91 randomized to the EEG-guided group and 86 to the control group.
  • EEG-guided management reduced sevoflurane exposure by 4 MAC-hours (96.65% CI, 1.1–1.6 MAC-hours).
  • PAED occurred in 30 children (35%) in the control group compared with 19 children (21%) in the EEG-guided group (absolute difference, 14%; P = 0.04).
  • Children in the EEG-guided group fully emerged from anesthesia 4 minutes earlier (96.65% CI, 15.4–27.4 minutes) and spent 16.5 fewer minutes in the PACU (96.65% CI, 10.8–22.3 minutes).
  • The authors concluded that, in children, EEG-guided general anesthesia reduced sevoflurane exposure and the incidence of PAED, while also promoting faster emergence and shorter PACU stays.
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