It is safe to say most anesthesiologists don't monitor the effect of their anesthetic technique on the brain. Minimum alveolar concentration (MAC) is simply a population average measure of the likelihood of movement to a surgical stimulus. The value is not intended to be a surrogate of consciousness, although anesthesiologists use it as such. During total intravenous anesthesia (TIVA) (without target-controlled infusion, or TCI), shunning electroencephalography (EEG) means running an anesthetic based on vital signs, one's clinical experience, and perception of anesthetic adequacy.
The intraoperative EEG story is one of many promises and dashed hopes. The massive uptake in EEG usage guided by the seductive simplicity of an index number met skepticism after the publication of several manuscripts (N Engl J Med 2008;358:1097-108; Anesth Analg 2003;97:488-91). These early studies represented the beginning of decades' worth of research and trials that are still ongoing. Published studies assessing the...
