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Intraoperative use of processed electroencephalogram in a quaternary center: a quality improvement audit

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Abstract

Although intraoperative electroencephalography (EEG) is not consensual among anesthesiologists, growing evidence supports its use to titrate anesthetic drugs, assess the level of arousal/consciousness, and detect ischemic cerebrovascular events; in addition, intraoperative EEG monitoring may decrease the incidence of postoperative neurocognitive disorders. Based on the known and potential benefits of intraoperative EEG monitoring, an educational program dedicated to staff anesthesiologists, residents of Anesthesiology and anesthesia technicians was started at Cleveland Clinic Abu Dhabi in May 2022 and completed in June 2022, aiming to have all patients undergoing general anesthesia with adequate brain monitoring and following international initiatives promoting perioperative brain health. All the surgical cases performed under General Anesthesia at 24 daily locations were prospectively inspected during 15 consecutive working days in March 2023. The use or absence of a processed EEG monitor was registered. Of 379 surgical cases distributed by 24 locations under General Anesthesia, 233 cases (61%) had processed EEG monitoring. The specialty with the highest use of EEG monitoring was Cardiothoracic Surgery, with 100% of cases, followed by interventional Cardiology (90%) and Vascular Surgery (75%). Otorhinolaryngology (29%), Gastrointestinal Endoscopy (25%), and Interventional Pulmonology (20%) were the areas with the lowest use of EEG monitoring. Of note, in the Neuroradiology suite, no processed EEG monitor was used in cases under General Anesthesia. We identified a reasonable use of EEG monitoring during general anesthesia, unfortunately not reaching our target of 100%. The educational and support program previously implemented within the Anesthesiology Institute needs to be continued and improved, including workshops, online discussions, and journal club sessions, to increase the use of EEG monitoring in underused areas.

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Authors and Affiliations

  1. Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE

    Zahra Moaiyeri, Jumana Mustafa, Massimo Lamperti & Francisco A Lobo

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  1. Zahra Moaiyeri
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  2. Jumana Mustafa
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Contributions

ZM, FAL and ML designed the Quality Improvement Project ZM and JM collected the data ZM, FAL and ML wrote the main manuscript text JM organized the References. All the authors reviewed and approved the manuscript.

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Correspondence to Francisco A Lobo.

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Francisco A Lobo is the Editor-in-Chief of the Journal of Clinical Monitoring and Computing ; he had no interference and access to the Editorial Review Process. Massimo Lamperti is member of the General Editorial Board of the Journal of Clinical Monitoring and Computing; he had no interference and access to the Editorial Review Process. As Quality Improvement Project, it was waived from Research Ethics Committee approval per the Institutional research guidelines.

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Moaiyeri, Z., Mustafa, J., Lamperti, M. et al. Intraoperative use of processed electroencephalogram in a quaternary center: a quality improvement audit. J Clin Monit Comput (2024). https://doi.org/10.1007/s10877-024-01189-4

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