• Kristen K Thomsen, Daniel I Sessler, Linda Krause, Phillip Hoppe, Benjamin Opitz, Till Kessler, Viorel Chindris, Alina Bergholz, Moritz Flick, Karim Kouz, Christian Zöllner, Leonie Schulte-Uentrop, and Bernd Saugel.
• Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: science.thomsen@gmail.com.
• J Clin Anesth. 2024 Aug 1; 95: 111459111459.

Study ObjectiveProcessed electroencephalography (pEEG) may help clinicians optimize depth of general anesthesia. Avoiding excessive depth of anesthesia may reduce intraoperative hypotension and the need for vasopressors. We tested the hypothesis that pEEG-guided - compared to non-pEEG-guided - general anesthesia reduces the amount of norepinephrine needed to keep intraoperative mean arterial pressure above 65 mmHg in patients having vascular surgery.DesignRandomized controlled clinical trial.SettingUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany.Patients110 patients having vascular surgery.InterventionspEEG-guided general anesthesia.MeasurementsOur primary endpoint was the average norepinephrine infusion rate from the beginning of induction of anesthesia until the end of surgery.Main Result96 patients were analyzed. The mean ± standard deviation average norepinephrine infusion rate was 0.08 ± 0.04 μg kg-1 min-1 in patients assigned to pEEG-guided and 0.12 ± 0.09 μg kg-1 min-1 in patients assigned to non-pEEG-guided general anesthesia (mean difference 0.04 μg kg-1 min-1, 95% confidence interval 0.01 to 0.07 μg kg-1 min-1, p = 0.004). Patients assigned to pEEG-guided versus non-pEEG-guided general anesthesia, had a median time-weighted minimum alveolar concentration of 0.7 (0.6, 0.8) versus 0.8 (0.7, 0.8) (p = 0.006) and a median percentage of time Patient State Index was <25 of 12 (1, 41) % versus 23 (3, 49) % (p = 0.279).ConclusionpEEG-guided - compared to non-pEEG-guided - general anesthesia reduced the amount of norepinephrine needed to keep mean arterial pressure above 65 mmHg by about a third in patients having vascular surgery. Whether reduced intraoperative norepinephrine requirements resulting from pEEG-guided general anesthesia translate into improved patient-centered outcomes remains to be determined in larger trials.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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