Impact of Electroencephalography-guided Anesthesia in Cardiothoracic Surgery: A Systematic Review and Updated Meta-analysis of Randomized Controlled Trials.

Objective: To evaluate the impact of electroencephalography (EEG)-guided anesthesia versus non-EEG-guided anesthesia on postoperative delirium and adverse outcomes in patients undergoing cardiothoracic surgeries.

Design: A systematic review and meta-analysis were performed using PubMed, Embase, and Cochrane Library.

Setting: All randomized clinical trials (RCTs).

Participants: Eight RCTs with 2,666 patients: 1,304 received EEG-guided anesthesia and 1,362 received usual care.

Interventions: Anesthesia guided by EEG in cardiothoracic surgery.

Measurements And Main Results: Mean differences (MDs) were used to pool continuous outcomes while risk ratios (RRs) were used for binary outcomes, using 95% confidence intervals (CIs). A random-effects model was used to examine the treatment. Statistical analysis was performed using R Studio. EEG-guided anesthesia was associated with a trend toward reduced ventilatory support duration (MD: -25.08, 95% CI: -50.12 to -0.04, p = 0.05, I² = 0%). No significant differences were found in postoperative delirium (RR: 0.93, 95% CI: 0.79-1.09, p = 0.35, I² = 42.6%), hospital length of stay (MD: -0.22, 95% CI: -0.53 to 0.09, p = 0.17, I² = 4.7%), intensive care unit length of stay (MD: -0.24, 95% CI -0.59 to 0.12, p = 0.19, I² = 71.7%), mortality (RR: 0.82, 95% CI: 0.54-1.25, p = 0.36, I² = 42%), or intraoperative blood transfusion (RR: 0.96, 95% CI: 0.74-1.25, p = 0.79, I² = 0%).

Conclusions: The findings demonstrated that EEG-guided anesthesia was associated with a shorter duration of respiratory support. However, this study did not identify any significant comparative advantage over standard practices for the other outcomes analyzed.