In kids, EEG monitoring of consciousness safely reduces anesthetic use

https://news.mit.edu/2025/kids-eeg-monitoring-consciousness-safely-reduces-anesthetic-use-0429

by LorenDB • 1 year ago

139 82 1 year ago

news.mit.edu

Etheryte3• 1 year ago

If the reporting is accurate, which is really not a given with MIT, this is great news. For all its upsides, general anesthesia is still dangerous and very rough on you, and all these effects are always amplified for young patients.

louthy2• 1 year ago

very rough on you

How so?

Etheryte3• 1 year ago

To start, the article gives a few good examples:

children sometimes wake up from anesthesia with a set of side effects including lack of eye contact, inconsolability, unawareness of surroundings, restlessness, and non-purposeful movements

In general, a very simple mental model for general anesthesia is that it's an unnatural state for your body and your body will do its best to get rid of it, similar to say alcohol or drugs. This means systemic inflammation, stress on your cardiovascular system, liver and kidneys, brain, and so forth. Most all of these issues scale with how much anesthetic you receive, similar to a hangover being worse the more you drink.

In other words, general anesthesia is rough on you just like getting black out drunk is, it's just more controlled and we do our best to try and limit the downsides because it's invaluable for surgery where applicable.

aziaziazi2• 1 year ago

Rough like the roughest hangover you can have.

I had a general anesthesia at 21 for dental surgery. The come back was a nightmare: nausea, shaking, cold and hot alternating, terrible headache, cramps, exhausted and mentally depressed during ~2 days. I couldn't eat, I couldn't drink (but brute force myself to do it), I couldn't think or concentrate on anything but the pain. The only close experience I can remember is the wake up after a blackout hangover but it really wasn't that bad compare to the anesthesia.

6 years later a car crash required artificial coma during 3 days. They drug me along the week following my come back. The dreams during the last day of coma and that week took me through fascinating and terrifying experiences half real (intubation, interactions with family and medics...) and imaginary (ever-repeting-same-day, interns having a fireplace in the ICU floor with guitars, mind-controlled bed to move around the room...). They finally gradually stop the drug and I was only a bit angry and physically suffering from my injuries but not that bad.

Big up to the amazing Royal Perth Hospital team for that amazing care. They saved my life and made the process a confortable trip.

I always wonder what was that drug that produce so weird half-wake dreams with not much side effects. And why they don't always use that for dental surgery and everything else. I heard hypnosis can work instead of a classical general anesthesia and am keen to try if the funny Australian drug isn't an option. Everything but not the general anesthesia.

edit: wonder if both experiences could have been the same sedative drug but the second had a hypnotic wake-up parachute drug during the comeback.

nchase• 1 year ago

I had anesthesia for a surgery at age 15 and I was depressed for a year afterward.

I’m sure everyone’s experience is different, but it made me feel groggy in a way that was difficult to bounce back from.

holowoodman10• 1 year ago

"Kids don't need anesthetics. If they are young enough, they won't remember the pain, so you can just operate without anesthetics. They are also easier to restrain than adults."

This was state of the art in medicine for quite some time. I fear the general trend of "medication bad" will get us back to those dark times.

Btw, those dark times ended only as recently as 1987! https://www.newsweek.com/when-doctors-start-using-anesthesia...

throwanem3• 1 year ago

This research is aimed precisely at making it safe enough to administer general anesthesia in these populations for that to become standard of care.

Let me preempt one possible line here: I do not love the circumstances under which I would have been circumcised as a neonate in Mississippi in the very early 1980s, and I do not resent the result. Living that far tied up in the past is for men who can't figure out how to do anything else. I am not one of those and despite an essential sympathy with the theoretical basis of their position that no putative benefit remotely justifies the the risk of the intervention, I have a short way with "intactivists."

But if it had been possible safely to administer more than EMLA (perhaps!) for pain relief, not even in that place and time would anyone be so barbaric as to refuse it. Of course. And that, making possible that precise measure of mercy in the case where the intervention is not merely cosmetic, is exactly that at which this research is directed. So, to anyone looking to make a cause of the ghosts of a billion foreskins or whatever, I would say please do not attempt even by implication to recruit my argument in support of your position.

holowoodman10• 1 year ago

I didn't say anything about a foreskin anywhere. And my point is, they did not just do minor stuff like a circumcision (which I think is a barbaric, pointless and immoral practice to inflict on non-consenting minors in any case except to maybe cure phimosis).

They did major surgery. Like opening the cranium or abdomen. Like removing limbs. Like removing burnt skin by brushing it off and applying skin grafts. And no, they didn't even apply Lidocain, because children don't feel pain. At best, they gave muscle relaxants as chemical restraints and to make the tissue easier to cut.

watwut• 1 year ago

I really do not understand why did you felt the need to push for circumcisions here. Like, no one asked or discussed them one way or the other. Like ok, it is religious for Jews and Arabs, but no one else have to care.

quantumwoke4• 1 year ago

My wife is a doctor and looked into the history of this for a bit more context. Apparently, there were some cases in 1987 where premature neonates were paralysed but not given general anaesthesia due to risk of immediate death. This led to a position statement from the paediatric society at the time that nobody should be operated on without pain relief / general anaesthetic.

Note that this does not mean that general anaesthesia was not given at all to kids before 1987, but that there was a belief in the USA (and elsewhere) that newborns did not need pain relief during anaesthesia. Your use of 'kids' versus 'newborns' is a bit misleading in that respect.

holowoodman10• 1 year ago

https://www.sciencedirect.com/science/article/pii/S152659001...

textbooks at the time taught that [open heart] surgery [...] ‘‘could be safely accomplished with only oxygen and a paralytic’’ 69(p.580) when performed on infants.

Textbooks isn't "some doctors errorneously believed", it is what most doctors believed, taught and practiced.

infant surgery routinely conducted with no or minimal anesthesia well into the 1980s

"Routinely" isn't a few isolated cases, that's the word for "this is the usual thing to do".

https://pubmed.ncbi.nlm.nih.gov/20608214/

The study by McGraw (1941), although badly designed, convinced the vast majority of clinicians that infants do not feel pain and do not require analgesia. This theory, reinforced by the fear of using opioids in young children, dominated medical thinking for more than 30 years.

"Vast majority" and "dominated" also doesn't sound like just "some cases".

https://www.nytimes.com/1987/12/17/opinion/l-why-infant-surg...

surveys of medical professionals indicate that as recently as 1986 infants as old as 15 months were receiving no anesthesia during surgery at most American hospitals.

We can discuss the definition of "kid" and "newborn", but I would no longer call them "newborn" when they start walking. Also "most American hospitals" means the practice was very widespread even in 1986.

I think the whole situation is one of the medical community failing to recognize and admit their own mistakes. Instead, the obvious barbarism of the whole situation is played down, diminished and belittled. Thereby protecting their own feelings and standing at the cost of the victims' right to the truth. And thereby paving the way for a repetition of such gruesome mistakes. At which point I would argue, it might even be a little callousness or even intent...

Nifty3929• 1 year ago

This right here. Medicine is not bad in general. Mother Nature is a wicked mistress. Pain and suffering are her defaults, and glimmers of happiness fleeting.

Modern technology and medicine in particular have made our lives better and longer in ways our near ancestors could not have dreamed of or hoped for.

It's not hard to find counterexamples of course: opioid addiction, climate change, etc. But on balance we're a hellava lot better off now than 50 or 500 years ago.

Nice to use a bit less anesthesia for faster/better recovery and money savings. But for goodness sake - let's not go TOO far down that path.

thelaxiankey2• 1 year ago

Do notice that the comments about 'pain and suffering are mother nature's defaults' have very little to do with anything else you said, or with the discussion more broadly. I think these sorts of things are bad internet hygiene and promote an actively depressive state of mind. They can be memetic concepts, and should be treated with care. If you do actually feel this way about your own life, I'd encourage you to seek some kind of help. And besides, there's nothing natural about surgery...

I think the rest of what you're saying is fairly accurate, though.

throwaway173738• 1 year ago

Compare that with the whole “twilight sleep” way of delivering babies and you can see a whole misogynistic thread of not respecting natural systems and of trying to minimize or eliminate the behavioral symptoms of pain while doing little to actually ease the patient.

rscho10• 1 year ago

I fear the general trend of "medication bad" will get us back to those dark times.

I think this won't ever happen. Modern docs would absolutely not accept working under such conditions. Anesthesia is not only comfort for the patient, but also for care providers. As you can often see when surgeons advise patients on refusing local anesthesia or nurses demanding benzos for the screaming demented patient at 2 a.m.

tzs2• 1 year ago

Another medical horror story that only ended way more recently than it should have (mid 1950's probably): https://www.straightdope.com/21341781/in-medicine-what-s-the...

crazygringo• 1 year ago

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.

quantumwoke4• 1 year 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.

bts3272• 1 year ago

I’m good here. Thanks.

bagels• 1 year 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/

Hydraulix989• 1 year 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.

bookofjoe3• 1 year 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

baxtr3• 1 year ago

Too much protein is bad for your kidneys!!!

PS: this has been debunked, still docs keep saying it.

rscho10• 1 year 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.

Nezghul• 1 year ago

What is the level of unconsciousness during anesthesia? Is it "sleep-like" unconsciousness or "neurons do basically nothing" level? Whenever I read about anesthesia I am wondering if we are not accidentally killing people (and creating new ones) like in teletransportation paradox. https://en.wikipedia.org/wiki/Teletransportation_paradox

accrual• 1 year ago

Just anecdata, but I was under a few times as kid. It was like teleporting into the future. Last memory was being told to count backwards, next memory was waking up in the recovery room.

Apparently I had a small anesthetic overdose in the hospital as a kid and woke up a day or two later than expected, but from my perspective, nothing happened and I just went to sleep then woke up.

codr7• 1 year ago

Agreed, super weird.

Did it once for a back injury as an adult, also only remember the countdown.

But my system was flushed with opiates when I woke up, so I was in a pretty good mood at least.

holowoodman10• 1 year ago

Depends on the "kind" of anesthesia, on the medication used and on the specific reaction of the patient to that medication.

For example there is stuff like Ketamine, which in some cases can live up to its other use as a recreational drug and give the patient very colorful dreams. There are sedatives that just take away the capacity to form memories, but leave you awake and aware, just calmer. In cases like some knee surgeries, it is possible to leave the patient fully awake, just paralyze and numb the legs.

tzs2• 1 year ago

To add to the examples others have given there is also some that makes you not feel pain but you do remain semi-conscious and when so can still form permanent memories. This is called conscious sedation. They can adjust your level of consciousness as they go, so they can make you more aware if they have to ask questions or need to you do something like move a body part for them and make you less aware when they don't need any interaction.

It combines a sedative from the benzodiazepine family with a synthetic opioid painkiller. This is the most common sedation for colonoscopies. I had a colonoscopy using this, with fentanyl as the opioid and probably midazolam for the benzodiazepine (if not that probably diazepam).

I was aware of the doctor starting the procedure and felt something cold. I could feel pushing sometimes. But nothing hurt or was even annoying (except that cold right at the start). I remember being asked how I was doing and answering. I remember the doctor talking about the quality of my prep--the laxatives had not been as effective as they could have been--and noting that it was still good enough to allow them to continue.

There are some gaps so I think at some points I was more out of it.

I had an earlier colonoscopy with deep sedation using propofol. Here's the experience with that: (1) they start it and I have maybe 10 seconds of memories after that point. At this point I wasn't even in the procedure room. I was in a bed in a waiting area. (2) My next memory is waking up, in the same waiting area, with a nurse telling me they are done, putting the basket with my pants and glasses and phone on the bed, and telling me I could put my pants on.

I've got no memory of being wheeled into the procedure area, or of anything that happened there, or being wheeled back.

That doesn't necessarily mean I didn't feel anything during the procedure. When we were going over the sedation options when arranging for that colonoscopy I asked if deep sedation means you don't feel anything at all, and all the doctor would say is that I would not have any memories of anything.

That isn't exactly reassuring.

If someone offered to pay me a large amount of money to undergo a couple of hours or horrible torture with a guarantee that they would give me a drug to prevent forming long term memories of that torture I would not accept. I would be too worried that there could be other negative persistent effects of such mental trauma than just the formation of long term recallable memories and that the memory preventing drug would not stop those other effect.

siavosh• 1 year ago

Any relation to integrated information theory (IIT, Koch et al)?

HocusLocus• 1 year ago

Why is there a sense that kids simply "don't remember" the pain of surgery if they are lightly anesthetized?

Do they think the nervous system is "turned off" in kids and "turns on" later? Likewise with the formation of memories. A human consciousness that is dealt searing pain under paralysis for an eon of thought-time, might trigger a life long psychosis that impairs living and learning.

Or a thirst for revenge.

rscho10• 1 year ago

The theory wasn't about remembering, it was mostly about babies supposedly having a nervous system too immature to interpret pain as in adults. This is not the current opinion at all anymore.

holowoodman10• 1 year ago

You are correct. But there is also the aspect that in current opinion, children below the age of 2 to 3 years do not form episodic memory. Which can reinforce the misconception about the necessity of anesthetics in children, because they are unable to recall and tell about the pain.

riskassessment• 1 year ago

Anaesthetics are far from harmless. Using the minimal amount necessary is a good thing, actually.

Gravityloss• 1 year ago

I used to work in this field decades ago. It was relatively straightforward. You could see it with your plain eyes in the EEG, but also you could calculate metrics from it. One really fun way was to listen to the sped up EEG signal when a person is put into anesthesia. It sounded like you went underwater.

The key thing is that when people are given muscle relaxants, you need an independent method to measure consciousness directly.

I haven't followed this in decades so it's a total surprise to me if it isn't mainstream yet.

You could buy a module for your anesthesia monitor for this, no need to use a separate device.

rscho10• 1 year ago

It is mainstream. We have modules. It's useful, but unfortunately not a magic wand either.

kilimounjaro3• 1 year ago

Paediatric anaesthesiologist here.

We mostly use propofol/remifent for maintenance of anaesthesia, and there is (some) reasonable evidence that this leads to less emergence delirium than sevoflurane. We use EEG-like monitors in all paralysed patients over a few months old.

Annoyingly I can’t access the full study, but would be interested to know why the kids in the low sevoflurane use group weren’t moving or coughing with surgical stimulation. The commonly used doses of sevoflurane are used because they are supposed to inhibit movement in response to noxious stimulus. So presumably these patients are all being paralysed or given a lot of opioid to stop them moving?

Using sevoflurane instead of propofol for maintenance if you are trying to reduce PAED is not really standard of care and makes me suspicious they are trying to overstate the effectiveness of their device.

robbiep• 1 year ago

Here you go: https://drive.google.com/file/d/1y3_fgi0prAUjLugQWUDylZL_TN8...

kilimounjaro3• 1 year ago

Many thanks!!

tapoxi• 1 year ago

My family has a history of malignant hyperthermia, so I was recently put under without inhaled anesthetics and they put an EEG on me. It was wild, zero delerium, nausea, or grogginess. I just snapped back into full consciousness.

kilimounjaro3• 1 year ago

Propofol is great isn’t it! I worked with some old guys who did some of the original studies demonstrating safety of propofol anaesthesia in MH. The world is much better for people with MH than it was 30 years ago, as long as they have a way to inform their doctors of the condition.

sillysaurusx• 1 year ago

Annoyingly I can’t access the full study

If you post on https://www.reddit.com/r/scholar you’ll get access within 15 minutes or so. This is true of basically any paywalled academic article.

Just make sure you include a link to the actual paywall rather than just the doi.

bobowzki• 1 year ago

Always nice to see another anesthesiologist on hackernews, we're quite a few it seems. I have done research in this area and also worked a bit with Emery. Which/what brand EEG monitor do you use?

slicerdicer2• 1 year ago

Hi :) Yes I think the combination of quite a bit of phone time during the work day and also being frustrated tech people makes HN good for us.

I use SedLine but have used entropy and BIS in the past.

Interestingly the study uses 1mg/kg roc in 40% of the patients and a lot of sugammadex, as well as a pretty decent dose 0.5mcg/kg/min remifent infusion.

dr_dshiv• 1 year ago

I was surprised when my 7 year old son received a minor eye surgery (he had a random fleck of metal on the sclera) and they gave him a large dose of ketamine.

He remained conscious but was immobilized. I asked him what it was like afterwards and he said “dad, everything turned into legos!!”

sawjet• 1 year ago

I was given ketamine as a 15 year old for a broken ankle that needed to be re-set. The nurse didn't tell what it was but I could read the label when she was filling up the syringe. It definitely didn't put me to sleep.

In kids, EEG monitoring of consciousness safely reduces anesthetic use

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