Processed electroencephalogram-guided anesthesia and its impact on postoperative delirium and perioperative efficiency: A systematic review and meta-analysis
In brief
Processed EEG monitoring cuts postoperative delirium risk by 27% across trials
Across 87 randomized trials involving 30,611 adults, processed EEG-guided anesthesia was linked to a 27% lower risk of delirium and reduced anesthetic use. Patients also reached extubation, wake-up, orientation, and discharge from recovery a few minutes sooner; however, results varied across studies, and evidence for benefits was most consistent with BIS monitoring.
- Journal
- Journal of clinical anesthesia (Q1)
- Published
- 30 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Anil Hormis, Zohn Centimole, Sita J Saunders, Youssef Ahmed, Juliane Hafermann, Rhodri Saunders, et al.
- PMID
- 42962495
- DOI
- 10.1016/j.jclinane.2026.112351
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 1 November 2026): Meta-analysis evaluates EEG-guided anaesthesia and postoperative delirium
Abstract
BACKGROUND: Processed electroencephalography (pEEG) provides quantitative indices for monitoring anesthetic depth and is recommended in international guidelines. Prior meta-analyses have assessed EEG-guided anesthesia but none have evaluated available evidence stratified by pEEG technology. METHODS: We performed a systematic literature review and meta-analysis of randomized controlled trials in adults undergoing surgical, endoscopic, or dental procedures comparing pEEG-guided with non-pEEG-guided anesthesia. Primary outcomes were anesthetic drug use (TIVA and volatile agents) and postoperative delirium (POD ≤10 days). Secondary outcomes were extubation time, wake-up time, time to orientation, and post-anesthesia care unit (PACU) length of stay. Searches (PubMed Central, MEDLINE) were conducted on 11 April 2025; the protocol was registered in PROSPERO (CRD420251067170). Random-effects models produced standardized mean differences (SMD), mean differences (MD), and risk ratios (RR) with 95% confidence interval (CI). RESULTS: Eighty-seven RCTs (30,611 patients; 13,586 pEEG; 17,025 non-pEEG) were included. pEEG significantly reduced propofol use (SMD -0.42, 95% CI -0.74 to -0.10; p = 0.01) and volatile anesthetic use (SMD -1.27, 95% CI -1.88 to -0.66; p < 0.01). The risk of POD decreased by 27% (RR 0.73, 95% CI 0.63 to 0.84; p < 0.01). Efficiency outcomes favored pEEG: extubation time (MD -2.90 min, 95% CI -3.64 to -2.16; p < 0.01), wake-up time (MD -1.83 min, 95% CI -2.42 to -1.25; p < 0.01), time to orientation (MD -4.11 min, 95% CI -6.99 to -1.23; p < 0.01), and PACU length of stay (MD -2.81 min, 95% CI -4.66 to -0.96; p < 0.01). Subgroup analyses suggested benefits were most consistently observed for BIS; estimates for Entropy and SEDLine were less precise due to fewer studies. Heterogeneity was substantial for several outcomes. CONCLUSIONS: Across 87 RCTs, pEEG-guided monitoring utilizing multiple device types improved perioperative efficiency and reduced POD compared with not using pEEG. Evidence is strongest for BIS; further well-reported trials are needed to delineate device-specific effects.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.