EEG-guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Non- cardiac Surgery: A meta-analysis of randomized controlled trials

EEG-guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Non- cardiac Surgery: A meta-analysis of randomized controlled trials | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article EEG-guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Non- cardiac Surgery: A meta-analysis of randomized controlled trials Junyi Li, Kui Gao, Qian Li, Wang Niu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6663785/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: Pediatric anesthesia emergence delirium (PAED) is a common complication after general anesthesia, but its specific mechanism of occurrence is not yet clear. Sevoflurane is the most commonly used inhalation anesthetic drug for general anesthesia in children and its use may increase the risk of PAED. The utilization of electroencephalography (EEG) monitoring can permits anesthesiologists to titrate and achieve desired depth of anesthesia. Thus, the aim of this meta-analysis is to examine whether EEG-guided monitoring can reduce emergence delirium by reducing exposure to sevoflurane in pediatric patients undergoing elective non-cardiac surgery. Methods: A literature search for meta-analysis was performed using the PubMed, EMbase, Ovid Medline, Cochrane Library, WanFang Data and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trial (RCT) until May 1, 2025 by two investigators who independently screened and reviewed studies for inclusion and performed data extraction. Our primary outcome was the average end-tidal sevoflurane concentration. The secondary outcomes were (1) incidence of emergence delirium; (2) incidence of burst suppression detected; (3) PAED total score; (4) time to extubation; (5) length of PACU stay. Heterogeneity was assessed by the I2 and chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. The risk of bias was assessed using the Cochrane methodology. Meta-analysis was carried out by using RevMan 5.3 software. Results: Of 233 articles retrieved, 7 RCTs (involving 902 pediatric patients undergoing elective non-cardiac surgery) were included in the final analysis. Compare with standard anesthesia administration, the utilization of EEG-guided sevoflurane administration reduced the average end tidal sevoflurane concentration (MD= -0.90, 95% CI: -1.24~-0.57, P ＜ 0.00001) and incidence of emergence delirium (OR=2.73, 95% CI:1.80~4.14, P ＜0.00001) in pediatric patients. However, no diference was found in PAED total score (MD= 1.36, 95% CI: -1.34~4.15, P=0.34), incidence of burst suppression detected (OR=0.64, 95% CI:0.38~1.09, P=0.1), time to extubation (MD= -1.65, 95% CI: -4.65~1.25, P=0.26) and length of PACU stay (MD= -5.90, 95% CI: -12.27~0.47, P=0.07 ) between EEG-guided group and control group. Conclusions: In pediatric participants, EEG-guided monitoring of anesthesia depth and titrating the use of sevoflurane accordingly may reduce exposure of inhalation anesthetics and incidence of PAED. However, there is no evidence suggesting that sevoflurane titration guided by EEG has advantages in other outcome indicators in pediatric patients undergoing elective non-cardiac surgery. In the future, larger sample sizes and rigorously designed RCTs are still needed for further discussion. PROSPERO registration number: CRD420251046992 EEG Pediatric anesthesia emergence delirium End-tidal of sevoflurane concentration Full Text Additional Declarations No competing interests reported. Supplementary Files S1Theinformationontheoutcomeindicatorscontainedineachstudy.png Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviews received at journal 17 Jul, 2025 Reviewers agreed at journal 13 Jul, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviews received at journal 08 Jul, 2025 Reviewers agreed at journal 02 Jul, 2025 Reviewers invited by journal 24 Jun, 2025 Editor assigned by journal 18 Jun, 2025 Editor invited by journal 23 May, 2025 Submission checks completed at journal 22 May, 2025 First submitted to journal 22 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6663785","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476174370,"identity":"63e9305d-72b2-49b0-9c42-809050d02726","order_by":0,"name":"Junyi Li","email":"","orcid":"","institution":"Operating Room, Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, 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Sevoflurane is the most commonly used inhalation anesthetic drug for general anesthesia in children and its use may increase the risk of PAED. The utilization of electroencephalography (EEG) monitoring can permits anesthesiologists to titrate and achieve desired depth of anesthesia. Thus, the aim of this meta-analysis is to examine whether EEG-guided monitoring can reduce emergence delirium by reducing exposure to sevoflurane in pediatric patients undergoing elective non-cardiac surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA literature search for meta-analysis was performed using the PubMed, EMbase, Ovid Medline, Cochrane Library, WanFang Data and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trial (RCT) until May 1, 2025 by two investigators who independently screened and reviewed studies for inclusion and performed data extraction. Our primary outcome was the average end-tidal sevoflurane concentration. The secondary outcomes were (1) incidence of emergence delirium; (2) incidence of burst suppression detected; (3) PAED total score; (4) time to extubation; (5) length of PACU stay. Heterogeneity was assessed by the I2 and chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. The risk of bias was assessed using the Cochrane methodology. Meta-analysis was carried out by using RevMan 5.3 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of 233 articles retrieved, 7 RCTs (involving 902 pediatric patients undergoing elective non-cardiac surgery) were included in the final analysis. Compare with standard anesthesia administration, the utilization of EEG-guided sevoflurane administration reduced the average end tidal sevoflurane concentration (MD= -0.90, 95% CI: -1.24~-0.57, P ＜ 0.00001) and incidence of emergence delirium (OR=2.73, 95% CI:1.80~4.14, P ＜0.00001) in pediatric patients. However, no diference was found in PAED total score (MD= 1.36, 95% CI: -1.34~4.15, P=0.34), incidence of burst suppression detected (OR=0.64, 95% CI:0.38~1.09, P=0.1), time to extubation (MD= -1.65, 95% CI: -4.65~1.25, P=0.26) and length of PACU stay (MD= -5.90, 95% CI: -12.27~0.47, P=0.07 ) between EEG-guided group and control group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eIn pediatric participants, EEG-guided monitoring of anesthesia depth and titrating the use of sevoflurane accordingly may reduce exposure of inhalation anesthetics and incidence of PAED. However, there is no evidence suggesting that sevoflurane titration guided by EEG has advantages in other outcome indicators in pediatric patients undergoing elective non-cardiac surgery. 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