SynthesisBMC anesthesiology2025
Effect of intraoperative Electroencephalogram-guided anesthesia on postoperative cognitive function in elderly patients: a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials.
Synthesis in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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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
1 citing paper in PubMed.
- Comparing signal concordance of needle electrodes and conventional bispectral index sensors in anesthesia monitoring: a prospective pilot study.Journal of clinical monitoring and computing · 2026Article
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3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundPostoperative cognitive dysfunction (POCD) is a common complication in elderly surgical patients and has been associated with excessive anesthetic depth. Electroencephalogram (EEG)-guided anesthesia provides real-time cerebral monitoring (e.g., bispectral index [BIS]), but its effect on POCD remains inconclusive across randomized controlled trials (RCTs).
methodsWe conducted a systematic review and meta-analysis following PRISMA guidelines, searching PubMed, Embase, Cochrane Library, and Web of Science for RCTs evaluating EEG-guided anesthesia versus standard care in elderly surgical patients. Primary outcome was POCD incidence; secondary outcomes included cognitive scores across acute (1–7 days), subacute (1–3 months), and chronic (≥ 6 weeks) phases. Risk of bias was assessed using the Cochrane Tool. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated with fixed/random-effects models. Trial sequential analysis (TSA) and sensitivity analyses validated evidence robustness; funnel plots and Egger’s test evaluated publication bias.
resultsTen RCTs (4,367 patients) were included. EEG-guided anesthesia significantly reduced POCD incidence by 22% (pooled OR = 0.78, 95% CI: 0.69–0.90, P < 0.001, I2 = 0.0%), with TSA confirming conclusive evidence after reaching the required information size (3,437 patients) and crossing the efficacy boundary. Subacute follow-ups (1–3 months) showed improved verbal fluency (WMD = 1.2, P = 0.009) and delayed recall (WMD = 0.8, P = 0.03) in EEG-guided groups, primarily with BIS monitoring, while acute-phase scores were heterogeneous and long-term (≥ 6 weeks) global cognitive scores did not differ. Sensitivity analyses and funnel plots indicated no significant publication bias or result instability. Non-cardiac surgeries demonstrated consistent benefits, whereas cardiac surgery data were limited.
conclusionsIntraoperative EEG-guided anesthesia—particularly using BIS monitoring—reduces POCD incidence and improves subacute cognitive outcomes in elderly patients, likely by avoiding excessive anesthetic depth and optimizing hemodynamics. While long-term effects on global cognition remain unproven, these findings support EEG monitoring as a valuable adjunct in high-risk populations, particularly for major non-cardiac surgery. Standardized POCD assessment, personalized strategies, and long-term follow-ups are needed to refine clinical guidelines and understand persistent cognitive trajectories.
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