Developing a Real-Time Electroencephalogram-Guided Anesthesia-Management Curriculum for Educating Residents: A Single-Center Randomized Controlled Trial

Abstract

BACKGROUND: Different anesthetic drugs and patient factors yield unique electroencephalogram (EEG) patterns. Yet, it is unclear how best to teach trainees to interpret EEG time series data and the corresponding spectral information for intraoperative anesthetic titration, or what effect this might have on outcomes. METHODS: We developed an electronic learning curriculum (ELC) that covered EEG spectrogram interpretation and its use in anesthetic titration. Anesthesiology residents at a single academic center were randomized to receive this ELC and given spectrogram monitors for intraoperative use versus standard residency curriculum alone without intraoperative spectrogram monitors. We hypothesized that this intervention would result in lower inhaled anesthetic administration (measured by age-adjusted total minimal alveolar concentration [MAC] fraction and age-adjusted minimal alveolar concentration [aaMAC]) to patients ≥60 old during the postintervention period (the primary study outcome). To study this effect and to determine whether the 2 groups were administering similar anesthetic doses pre-versus postintervention, we compared aaMAC between control versus intervention group residents both before and after the intervention. To measure efficacy in the postintervention period, we included only those cases in the intervention group when the monitor was actually used. Multivariable linear mixed-effects modeling was performed for aaMAC fraction and hospital length of stay (LOS; a non-prespecified secondary outcome), with a random effect for individual resident. A multivariable linear mixed-effects model was also used in a sensitivity analysis to determine if there was a group (intervention versus control group) by time period (post-versus preintervention) interaction for aaMAC. Resident EEG knowledge difference (a prespecified secondary outcome) was compared with a 2-sided 2-group paired t test. RESULTS: Postintervention, there was no significant aaMAC difference in patients cared for by the ELC group (n = 159 patients) versus control group

Implementation of an electroencephalogram‐guided propofol anesthesia education program in an academic pediatric anesthesia practice

“…Prior EEG training projects have focused only on training anesthesia residents, 19 interpreting EEG waveforms 20 or delivering didactic lectures without in-person intraoperative teaching, 21 and none have targeted pediatric patients or propofol TIVA specifically.…”

“…Prior EEG training projects have focused only on training anesthesia residents, 19 interpreting EEG waveforms 20 or delivering didactic lectures without in‐person intraoperative teaching, 21 and none have targeted pediatric patients or propofol TIVA specifically. We used a combination of didactic teaching sessions, intraoperative decision‐tree algorithms, tables, and one‐on‐one training, as well as verbal and written tests to deliver and evaluate EEG TIVA training in the pediatric setting.…”

A Real-Time Neurophysiologic Stress Test for the Aging Brain: Novel Perioperative and ICU Applications of EEG in Older Surgical Patients

“…Yet, the authors of this meta-analysis concluded their meta-analysis abstract by noting that, related particularly to the four study models listed above, “high clinical heterogeneity limits the inferences from this and any future meta-analyses” [ 108 ] on the effect of processed EEG-based anesthetic titration on postoperative delirium risk. To date, no published studies have examined the effect of anesthetic titration based on EEG alpha power on postoperative delirium risk, although one randomized trial found that anesthetic titration based on maximizing frontal alpha power led to decreased hospital length of stay (an exploratory outcome in this study [ 109 ]). An additional study comparing the effect of anesthetic titration to maximize EEG alpha power vs usual care on delirium outcomes is currently underway, with results expected in 2023 [ 110 , 111 ].…”