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Limitations of anaesthesia depth monitoring

Purpose of review We critically review brain function monitors based on the processed electroencephalogram with regards to signal quality, artefacts and other limitations in clinical performance. Recent findings Several studies have been showing that depth of anaesthesia monitors based on processed electroencephalogram has limitations that can lead to a wrong interpretation of the level of anaesthesia. Processed electroencephalogram indices can be altered by nonanaesthetic influences ranging from artefacts that affect signal quality and signal processing, adverse effects of some anaesthetic and nonanaesthetic drugs, neuromuscular blocking agents to conditions inherent to the patient such as cerebral tumours, brain ischemia and temperature. Summary Clinicians should be aware of the several limitations of the commercial devices intending to monitor the depth of anaesthesia, which may not reflect the real underlying level of unconsciousness.