Perceptions of Intra-Operative EEG Brain Monitoring During Pediatric Anesthesia Among Children and Parents: An Exploratory Cross-Sectional Survey.

BACKGROUND

Electroencephalography (EEG) monitoring during pediatric anesthesia may improve perioperative safety by optimizing anesthetic titration and reducing adverse outcomes. However, little is known about patient and caregiver perceptions regarding this technology and its implementation into routine anesthesia care.

AIMS: This study evaluates perceived importance, utility, and extent of reassurance provided by intra-operative EEG monitoring among pediatric patients and their parents. Secondary aims include identifying concerns surrounding general anesthesia (GA), concerns surrounding EEG monitoring, cost and willingness to pay, and sociodemographic and medical factors shaping these attitudes.

METHODS

We conducted an exploratory cross-sectional survey at a tertiary pediatric hospital in Singapore between July 2022 and September 2025. Respondents were parents of children aged 1-18 years and children aged 12-18 scheduled for elective procedures under general anesthesia. A 16-item anonymized questionnaire assessed perceptions of intra-operative EEG monitoring, concerns about anesthesia, and attitudes regarding the cost of EEG monitoring.

RESULTS

Of 400 respondents (100 children, 300 parents), 83.5% rated intra-operative brain monitoring as "very" or "quite" important and 93% reported feeling more reassured by its use. Children were most concerned about intraoperative awareness and failure to awaken, whereas parents were most concerned about anesthetic side effects and dosage. Parents with higher education and whose children had prior anesthetic exposure reported greater reassurance from EEG monitoring. Cost was the leading concern regarding EEG monitoring, particularly among parents from families residing in public housing. Despite this, most parents (75%) and children (59%) expressed willingness to pay for EEG monitoring.

CONCLUSIONS

Pediatric patients and parents viewed intra-operative EEG monitoring as important and reassuring, and expressed willingness to support its implementation despite cost concerns. These findings suggest that families are unlikely to be a major barrier to EEG adoption and highlight the need for clinician- and system-level strategies to integrate EEG monitoring into family-centered pediatric anesthesia care.