[Focus on the Brain Under Anesthesia: The Safe Brain Initiative's EEG Bootcamp].

Abstract

Abstract: In current anaesthetic practice, monitoring remains largely focused on cardiorespiratory parameters, while the brain, the primary target organ of anaesthesia, is insufficiently monitored. EEG-based neuromonitoring enables direct, continuous, and non-invasive evaluation of the cerebral effects of anaesthetics, yet its clinical application is often limited to numerical indices derived from proprietary algorithms. This simplification of a complex biosignal is prone to artifacts, delays, and systematic bias, particularly in elderly and frail patients.We argue that index-guided anaesthesia alone may fail to detect clinically relevant states such as burst suppression, even when values remain within recommended ranges. Age-related EEG changes, including reduced alpha activity and increased susceptibility to suppression, can result in falsely reassuring index values despite excessive anaesthetic depth. Importantly, both the occurrence and duration of burst suppression are associated with postoperative delirium and adverse cognitive outcomes.Visual interpretation of raw EEG and spectral patterns provides essential additional information, enabling individualized anaesthetic titration and avoiding overdosage. However, implementation is limited by insufficient training. Structured educational concepts, such as the Safe Brain Initiative EEG Bootcamp, are therefore critical to meaningfully integrate EEG-based monitoring into routine practice and advancing precision, patient-centred neuroprotective anaesthesia.