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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

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 1y ago
[flagged]
bts327 1y ago
I’m good here. Thanks.
- quantumwoke 1y 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 1y 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 1y ago
    Good day to you.
    - holowoodman 1y 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 1y 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 1y 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 1y ago
  What about people who routinely use drugs in heavier concentrations or who have higher tolerance from genetics? How is that detected?
  - rscho 1y ago
    You just crank it up until those people don't react. With experience, you can anticipate those pretty well.

cyanydeez 1y ago

[flagged]

bts327 1y ago

I’m good here. Thanks.

quantumwoke 1y 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 1y 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 1y ago
  Good day to you.
  - holowoodman 1y 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 1y 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 1y 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 1y ago
What about people who routinely use drugs in heavier concentrations or who have higher tolerance from genetics? How is that detected?
- rscho 1y ago
  You just crank it up until those people don't react. With experience, you can anticipate those pretty well.