Observational studyBritish journal of anaesthesia2017
Burst-suppression ratio underestimates absolute duration of electroencephalogram suppression compared with visual analysis of intraoperative electroencephalogram.
Observational study in British journal of anaesthesia, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
57 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Investigating how electroencephalogram measures associate with delirium: A systematic review.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2021Pooled it
- Early risk stratification for progression to death by neurological criteria following out-of-hospital cardiac arrest.Resuscitation · 2022Trial
- Effect of electroencephalogram-guided anaesthesia administration on 1-yr mortality: follow-up of a randomised clinical trial.British journal of anaesthesia · 2021Trial
- ADAPT-2: A Randomized Clinical Trial to Reduce Intraoperative EEG Suppression in Older Surgical Patients Undergoing Major Noncardiac Surgery.Anesthesia and analgesia · 2020Trial
- Trial
- Making brain monitoring routine: why processed EEG monitoring should be standard practice.Journal of clinical monitoring and computing · 2026Article
- Consensus document on electroencephalography education in anaesthesiology: defining learning outcomes: A modified four-round Delphi study.European journal of anaesthesiology · 2026Article
- Deep learning based depth of anaesthesia monitoring using EEG: a 4-layer CNN model with PSD and BSR correlation features.Physical and engineering sciences in medicine · 2026Article
- Validation of intraoperative processed electroencephalography and cerebral oximetry for prediction of postoperative delirium in cardiac surgery: a prospective observational study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026Observational
- The Perioperative Neurocognitive Disorder Prediction Based on AI-Assisted EEG Dynamic Features in Anesthetized Mice.Diagnostics (Basel, Switzerland) · 2026Article
- From index to insight: clinical perspectives on electroencephalographic spectrogram-guided anesthesia-a narrative review.Korean journal of anesthesiology · 2026Review
- The effect of personalized perioperative blood pressure management on intraoperative cerebral oxygen saturation, burst suppression ratio and postoperative neurological outcomes in patients having major non-cardiac surgery: an observational substudy of the IMPROVE-pilot randomized controlled trial.Journal of clinical monitoring and computing · 2026Observational
- Intraoperative Hemodynamic Management and Cerebral Protection During Awake Craniotomy: Evidence-Based Approaches.Anesthesiology research and practice · 2026Review
- Evaluating the performance of the NarcotrendBMC anesthesiology · 2025Article
- Introducing the Safe Brain Initiative's EEG boot camp for anaesthesia for standardised training on how to use the electroencephalogram for perioperative care.BMC anesthesiology · 2025Article
- Quantitative Variables Derived from the Electroencephalographic Signal to Assess Depth of Anaesthesia in Animals: A Narrative Review.Animals : an open access journal from MDPI · 2025Review
- Synchronicity of pyramidal neurones in the neocortex dominates isoflurane-induced burst suppression in mice.British journal of anaesthesia · 2025Article
- Article
- Rescue-like behavior in a bystander mouse toward anesthetized conspecifics promotes arousal via a tongue-brain connection.Science advances · 2025Article
- Influence of anesthetic agent and burst suppression on postoperative delirium in elderly patients: a prospective cohort study with automated EEG analysis.Frontiers in aging neuroscience · 2025Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundMachine-generated indices based on quantitative electroencephalography (EEG), such as the patient state index (PSI™) and burst-suppression ratio (BSR), are increasingly being used to monitor intraoperative depth of anaesthesia in the endeavour to improve postoperative neurological outcomes, such as postoperative delirium (POD). However, the accuracy of the BSR compared with direct visualization of the EEG trace with regard to the prediction of POD has not been evaluated previously.
methodsForty-one consecutive patients undergoing non-cardiac, non-intracranial surgery with general anaesthesia wore a SedLine ® monitor during surgery and were assessed after surgery for the presence of delirium with the Confusion Assessment Method. The intraoperative EEG was scanned for absolute minutes of EEG suppression and correlated with the incidence of POD. The BSR and PSI™ were compared between patients with and without POD.
resultsVisual analysis of the EEG by neurologists and the SedLine ® -generated BSR provided a significantly different distribution of estimated minutes of EEG suppression ( P =0.037). The Sedline ® system markedly underestimated the amount of EEG suppression. The number of minutes of suppression assessed by visual analysis of the EEG was significantly associated with POD ( P =0.039), whereas the minutes based on the BSR generated by SedLine ® were not associated with POD ( P =0.275).
conclusionsOur findings suggest that SedLine ® (machine)-generated indices might underestimate the minutes of EEG suppression, thereby reducing the sensitivity for detecting patients at risk for POD. Thus, the monitoring of machine-generated BSR and PSI™ might benefit from the addition of a visual tracing of the EEG to achieve a more accurate and real-time guidance of anaesthesia depth monitoring and the ultimate goal, to reduce the risk of POD.
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