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116
Review article
Available online 14 July 2026

Neuroprotection. Usefulness of processed electroencephalogram monitors in anesthesia and critical care

Protección cerebral. Utilidad de los monitores de electroencefalograma procesado en el ámbito de la anestesia y del paciente crítico
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Carlos Chamorro-Jambrinaa,
Corresponding author
, Carlos Chamorro-Falerob
a Servicio de Medicina Intensiva, HU Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
b Servicio de Anestesia, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Abstract

Processed electroencephalographic (EEG) monitoring has become established as a key tool for integrating brain function into the management of surgical and critically ill patients. The combined information from the raw EEG recording, processed indices, and the spectral density matrix helps guide anesthetic depth, optimize sedation, and enable early detection of states of excessive cortical depression, contributing to a neuroprotective strategy. Its use facilitates the identification of vulnerable brains, the prevention of delirium, and the individualization of treatment. It also allows recognition of subclinical epileptic activity, alterations in cerebral perfusion, and metabolic changes, favoring early interventions. Interpretation should be performed dynamically and integrated with the clinical context, as multiple factors can modify EEG patterns. Although processed EEG monitoring has technical limitations and does not replace conventional EEG, its incorporation into practice improves safety and decision-making, and promotes personalized brain monitoring in anesthesia and intensive care.

Keywords:
Processed electroencephalogram
Anesthesia
Sedation
Critically ill patient
Thalamocortical connectivity
Delirium
Cognitive impairment
Bispectral index
Electroencephalographic suppression
Status epilepticus
Resumen

La monitorización electroencefalográfica procesada se ha consolidado como una herramienta clave para integrar la función cerebral en el manejo del paciente quirúrgico y crítico. La información combinada del EEG crudo, los índices procesados y la matriz de densidad espectral permite guiar la profundidad anestésica, optimizar la sedación y detectar precozmente estados de depresión cortical excesiva, contribuyendo a una estrategia de protección cerebral. Su uso facilita la identificación de cerebros vulnerables, la prevención del delirium y la individualización del tratamiento. Asimismo, permite reconocer actividad epiléptica subclínica, alteraciones de perfusión cerebral y cambios metabólicos, favoreciendo intervenciones tempranas. La interpretación debe realizarse de forma dinámica e integrada con el contexto clínico, ya que múltiples factores pueden modificar los patrones electroencefalográficos. Aunque presenta limitaciones técnicas y no sustituye al EEG convencional, su incorporación a la práctica mejora la seguridad, la toma de decisiones y promueve una monitorización cerebral personalizada en anestesia y cuidados intensivos.

Palabras clave:
Electroencefalograma procesado
Anestesia
Sedación
Paciente crítico
Conexión tálamo/cortical
Delirium
Deterioro cognitivo
Índice biespectral
Supresión electroencefalográfica
Estado epiléptico

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