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Why is this about kids? Do we already measure EEG for adults? Or not? If we do, why has it taken so long to do with kids? If not, is this a first step? Why sta

Why is this about kids? Do we already measure EEG for adults? Or not? If we do, why has it taken so long to do with kids? If not, is this a first step? Why start with kids rather than adults? This article provides shockingly little context.

quantumwoke 2y ago
My wife is a doctor and provided me (layperson) the following context. Apparently EEG is now used in most adult surgeries and has been increasing over time. It is used as a marker of how 'asleep' you are to guide how much medication you get. However, this is relatively recent and the use of EEG in kids (where the brainwaves are different) was not studied/used as much. It seems like this study pushes towards a future where EEGs are routine in most if not all surgeries to make them safer - especially as the next generation of anaesthetists are trained in it.
- cyanydeez 2y ago
  [flagged]
- bts327 2y ago
  I’m good here. Thanks.
  - quantumwoke 2y ago
    It obviously varies on place of practice and the way you were taught. My understanding is the evidence is pretty clear that it helps but happy to defer to your lived experience.
  - holowoodman 2y ago
    MAC doesn't indicate the depth of the anesthesia. It indicates the depth of the paralysis. Which is exactly the problem EEG monitoring is supposed to prevent: In some cases patients can have an insufficient response to analgesia (so they will feel pain) and hypnotics (so they are awake, aware and forming memories) but will respond to paralytics (so they are unable to move and communicate their predicament). So with this kind of practice, you create any patient's worst nightmare: being cut open, feeling everything, knowing everything, but unable to stop it. And you are unknowing, uncaring or too cheap to prevent that e.g. via EEG monitoring. Edit: Parent removed his comment. Roughly, from memory, there was some claim by him about being a professional anesthetist, having very rarely encountered EEG and only bi-spectral index monitoring (an EEG-derived computed measurement) in some IV cases, some claims about the unreliability of both and about the preference for MAC (minimum alveolar concentration) to monitor depth of anesthesia.
    - bts327 2y ago
      Good day to you.
      - holowoodman 2y ago
        Well... My textbook[0] says: > The minimum alveolar concentration (MAC) is the minimum concentration of an inhaled anesthetic at 1 atm of pressure that prevents skeletal muscle movement in response to a surgical incision in 50% of patients. So first, you do not measure the depth of anesthesia, you measure the concentration of the anesthetic. Second, you judge this concentration by the prevention of muscle movement. Called paralysis. Please tell me you are not really a doctor. [0] https://www.sciencedirect.com/topics/medicine-and-dentistry/minimum-alveolar-concentration https://www.sciencedirect.com/topics/medicine-and-dentistry/... Edit: In case you are wondering why this response doesn't really fit the parent comment, the parent saw fit to completely replace his comment without an indication that he did so. Originally there was a claim in the parent comment about "MAC being the primary indication of anesthetic depth being the textbook definition" or something to that effect. To which I responded. I guess I must have hit a nerve there ;)
        rscho 2y ago
        "MAC being the primary indication of anesthetic depth being the textbook definition" I am an attending anesthesiologist and this is true. MAC cannot be interpreted at face value, though. You've got other drugs on board (not accounted for in MAC), the patient might be frail or very old, etc. etc. All things changing MAC interpretation, which is why there are still anesthesia providers instead of robots ;-) We currently have no way of faithfully measuring the depth of anesthesia, and our understanding of consciousness/awareness is incomplete. Anesthesiologists have to rely mostly on know-how, even in 2025.
        bookofjoe 2y ago
        >Robotic Anesthesia: A Vision for 2050 https://journals.lww.com/anesthesia-analgesia/fulltext/2024/02000/robotic_anesthesia__a_vision_for_2050.4.aspx https://journals.lww.com/anesthesia-analgesia/fulltext/2024/...
  - mschuster91 2y ago
    What about people who routinely use drugs in heavier concentrations or who have higher tolerance from genetics? How is that detected?
    - rscho 2y ago
      You just crank it up until those people don't react. With experience, you can anticipate those pretty well.
bagels 2y ago
Doctors not too long ago would tell you that infants don't experience pain. There are a lot of not backed by science beliefs in the medical field that won't die until the doctors that believe them do. https://pubmed.ncbi.nlm.nih.gov/23548489/ https://pubmed.ncbi.nlm.nih.gov/23548489/
- Hydraulix989 2y ago
  An example is that thin people cannot possibly have sleep apnea, it only affects overweight people. Overly-confident Dunning-Kruger doctors adamantly declared this as "truth" to me enough times that it stalled me getting properly treated at least a decade.
- bookofjoe 2y ago
  'A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.' — Max Planck
  - mrguyorama 2y ago
    Which is a funny thing for someone who lived through and contributed to at least one entire upending of paradigms to say. PLENTY of science proceeds without anyone dying. Usually it just requires insanely entertaining loud arguments at large conventions. Go lookup the philosophical arguments about early thermodynamics and like statistical mechanics. Science advances one unexplainable datapoint at a time.
- baxtr 2y ago
  Too much protein is bad for your kidneys!!! PS: this has been debunked, still docs keep saying it.
  - leereeves 2y ago
    I've heard there is good evidence that weightlifters eating an appropriate (high) protein intake for hypertrophy don't harm healthy kidneys, though the sources seemed biased. But has that statement been debunked for sedentary people or people with kidney disease?
rscho 2y ago
We do it regularly in both kids and adults, and this is nothing new. It's just that a study confirms it's useful using statistics instead of common sense. We were already using EEG in both kids and adults 15 years ago.

quantumwoke 2y ago

My wife is a doctor and provided me (layperson) the following context. Apparently EEG is now used in most adult surgeries and has been increasing over time. It is used as a marker of how 'asleep' you are to guide how much medication you get. However, this is relatively recent and the use of EEG in kids (where the brainwaves are different) was not studied/used as much. It seems like this study pushes towards a future where EEGs are routine in most if not all surgeries to make them safer - especially as the next generation of anaesthetists are trained in it.

cyanydeez 2y ago
[flagged]
bts327 2y ago
I’m good here. Thanks.
- quantumwoke 2y ago
  It obviously varies on place of practice and the way you were taught. My understanding is the evidence is pretty clear that it helps but happy to defer to your lived experience.
- holowoodman 2y ago
  MAC doesn't indicate the depth of the anesthesia. It indicates the depth of the paralysis. Which is exactly the problem EEG monitoring is supposed to prevent: In some cases patients can have an insufficient response to analgesia (so they will feel pain) and hypnotics (so they are awake, aware and forming memories) but will respond to paralytics (so they are unable to move and communicate their predicament). So with this kind of practice, you create any patient's worst nightmare: being cut open, feeling everything, knowing everything, but unable to stop it. And you are unknowing, uncaring or too cheap to prevent that e.g. via EEG monitoring. Edit: Parent removed his comment. Roughly, from memory, there was some claim by him about being a professional anesthetist, having very rarely encountered EEG and only bi-spectral index monitoring (an EEG-derived computed measurement) in some IV cases, some claims about the unreliability of both and about the preference for MAC (minimum alveolar concentration) to monitor depth of anesthesia.
  - bts327 2y ago
    Good day to you.
    - holowoodman 2y ago
      Well... My textbook[0] says: > The minimum alveolar concentration (MAC) is the minimum concentration of an inhaled anesthetic at 1 atm of pressure that prevents skeletal muscle movement in response to a surgical incision in 50% of patients. So first, you do not measure the depth of anesthesia, you measure the concentration of the anesthetic. Second, you judge this concentration by the prevention of muscle movement. Called paralysis. Please tell me you are not really a doctor. [0] https://www.sciencedirect.com/topics/medicine-and-dentistry/minimum-alveolar-concentration https://www.sciencedirect.com/topics/medicine-and-dentistry/... Edit: In case you are wondering why this response doesn't really fit the parent comment, the parent saw fit to completely replace his comment without an indication that he did so. Originally there was a claim in the parent comment about "MAC being the primary indication of anesthetic depth being the textbook definition" or something to that effect. To which I responded. I guess I must have hit a nerve there ;)
      - rscho 2y ago
        "MAC being the primary indication of anesthetic depth being the textbook definition" I am an attending anesthesiologist and this is true. MAC cannot be interpreted at face value, though. You've got other drugs on board (not accounted for in MAC), the patient might be frail or very old, etc. etc. All things changing MAC interpretation, which is why there are still anesthesia providers instead of robots ;-) We currently have no way of faithfully measuring the depth of anesthesia, and our understanding of consciousness/awareness is incomplete. Anesthesiologists have to rely mostly on know-how, even in 2025.
        bookofjoe 2y ago
        >Robotic Anesthesia: A Vision for 2050 https://journals.lww.com/anesthesia-analgesia/fulltext/2024/02000/robotic_anesthesia__a_vision_for_2050.4.aspx https://journals.lww.com/anesthesia-analgesia/fulltext/2024/...
- mschuster91 2y ago
  What about people who routinely use drugs in heavier concentrations or who have higher tolerance from genetics? How is that detected?
  - rscho 2y ago
    You just crank it up until those people don't react. With experience, you can anticipate those pretty well.

bagels 2y ago

Doctors not too long ago would tell you that infants don't experience pain. There are a lot of not backed by science beliefs in the medical field that won't die until the doctors that believe them do. https://pubmed.ncbi.nlm.nih.gov/23548489/ https://pubmed.ncbi.nlm.nih.gov/23548489/

Hydraulix989 2y ago
An example is that thin people cannot possibly have sleep apnea, it only affects overweight people. Overly-confident Dunning-Kruger doctors adamantly declared this as "truth" to me enough times that it stalled me getting properly treated at least a decade.
bookofjoe 2y ago
'A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.' — Max Planck
- mrguyorama 2y ago
  Which is a funny thing for someone who lived through and contributed to at least one entire upending of paradigms to say. PLENTY of science proceeds without anyone dying. Usually it just requires insanely entertaining loud arguments at large conventions. Go lookup the philosophical arguments about early thermodynamics and like statistical mechanics. Science advances one unexplainable datapoint at a time.
baxtr 2y ago
Too much protein is bad for your kidneys!!! PS: this has been debunked, still docs keep saying it.
- leereeves 2y ago
  I've heard there is good evidence that weightlifters eating an appropriate (high) protein intake for hypertrophy don't harm healthy kidneys, though the sources seemed biased. But has that statement been debunked for sedentary people or people with kidney disease?

rscho 2y ago

We do it regularly in both kids and adults, and this is nothing new. It's just that a study confirms it's useful using statistics instead of common sense. We were already using EEG in both kids and adults 15 years ago.