Neuromonitoring in the elderlyKoch, Susanne; Spies, ClaudiaCurrent Opinion in Anesthesiology: February 2019 - Volume 32 - Issue 1 - p 101–107 doi: 10.1097/ACO.0000000000000677 GERIATRIC ANESTHESIA: Edited by Rainer Kiefmann Buy SDC Abstract Author InformationAuthors Article MetricsMetrics Purpose of review To summarize recent recommendations on intraoperative electroencephalogram (EEG) neuromonitoring in the elderly aimed at the prevention of postoperative delirium and long-term neurocognitive decline. We discuss recent perioperative EEG investigations relating to aging and cognitive dysfunction, and their implications on intraoperative EEG neuromonitoring in elderly patients. Recent findings The incidence of postoperative delirium in elderly can be reduced by monitoring depth of anesthesia, using an index number (0–100) derived from processed frontal EEG readings. The recently published European Society of Anaesthesiology guideline on postoperative delirium in elderly now recommends guiding general anesthesia with such indices (Level A). However, intraoperative EEG signatures are heavily influenced by age, cognitive function, and choice of anesthetic agents. Detailed spectral EEG analysis and research on EEG-based functional connectivity provide new insights into the pathophysiology of neuronal excitability, which is seen in elderly patients with postoperative delirium. Summary Anesthesiologists should become acquainted with intraoperative EEG signatures and their relation to age, anesthetic agents, and the risk of postoperative cognitive complications. A working knowledge would allow an optimized and individualized provision of general anesthesia for the elderly. Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany Correspondence to Claudia Spies, Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Tel: +49 30 450 651 001; e-mail: firstname.lastname@example.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.