Education

The PALNET curriculum.

A curated video curriculum and primary literature on EEG-guided pediatric anesthesia — free to view, designed for clinicians who want to start reading the brain in the operating room today.

Video curriculum

Our recommended starting point is the EEG for Anesthesia YouTube channel — a concise, evidence-based introduction to the EEG signal and how anesthetic drugs shape it. PALNET's in-OR teaching and workshops build directly on this foundation.

About the channel

Current standards for assessing depth of anesthesia rely on indirect measures — heart rate, blood pressure, muscle tone, and presumed drug interactions. Modern systems-level neuroscience now lets us link recognizable EEG signatures to the anesthetic states produced by most commonly used drugs. Familiarity with these signatures helps anesthesia clinicians make more detailed and accurate assessments of the anesthetic state of their patients. These videos provide a brief, accessible introduction to the EEG signal as it relates to altered states of arousal caused by anesthesia.

Watch on YouTube →

Interactive simulations

Three browser-based simulations built by SmartTIVA, a PALNET collaborator. Unlike a video or a paper, these let you change the inputs and watch the signal respond — the learning is active rather than passive. Nothing to install, and they run on a laptop or a phone.

Start here

Sine wave combinator

Sum four sine waves in real time and change their frequencies to watch a composite trace separate into the rhythms underneath it. This is the idea every spectrogram rests on, and the quickest way to make it concrete.

Open the simulation →

Next

3D DSA rotation grid

Rotate a spectrogram in three dimensions to see how the familiar flat heat map is built — frequency, time and power stacked into a single surface. Useful for anyone reading the vertical DSA used in neuromonitoring.

Open the simulation →

When ready

Raw EEG & artifact sandbox

Signal and noise, grounded in Ohm's law, with the clinical scenarios that degrade a trace in theatre. Artifact is one of the hardest things to teach at the bedside — here you can generate it deliberately and see what it does.

Open the simulation →

The order above is a suggestion — the artifact sandbox makes most sense once you can recognise a normal trace. These simulations are hosted by SmartTIVA and open in a new tab; PALNET does not control their content.

Quick-reference tables

PALNET's smart-phone reference tables — built to keep on your phone or print for the OR. Each is an educational aid; always verify against your institution's protocols and the individual patient.

Propofol dosing for pediatric age groups

Propofol dosing for pediatric age groups

Bolus (mg/kg) and infusion rates (µg/kg/min) by age group and effect-site target (Ce, µg/ml), to 3 Ce levels.

After a sevoflurane mask induction, the bolus dose should be infused over minutes — allowing the sevoflurane level to decrease to prevent hypotension.

Educational reference only. Verify all dosing against your institution's protocols, current drug references, and the individual patient.

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PALNET · pedseeg.com · Smart-phone reference tables (June 2026)

Propofol Ce for anesthesia and sedation: effect-site concentration over time for target Ce 3 vs 4.5 across bolus, maintenance infusion, and emergence

Propofol Ce for anesthesia & sedation

Effect-site concentration (Ce) across a case — bolus, maintenance infusion, and emergence — for a target Ce of 3 vs 4.5 µg/ml.

Educational reference only. A conceptual illustration; verify dosing and targets against your institution's protocols and the individual patient.

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PALNET · pedseeg.com · Smart-phone reference tables (June 2026)

ComponentMonitorDrugs
Hypnosis (no consciousness)EEGSevoflurane, propofol, ketamine, dexmedetomidine
Anti-nociception (no pain)HR, BPOpioid, sevoflurane, regional/local, ketamine
Immobility (no movement)None — TOFSevoflurane, remifentanil, paralytics
Amnesia (no awareness)NoneSame as hypnosis

Anesthesia state — components, monitors, drugs

The anesthetic state has four components; probability of awareness relates to the depth of hypnosis.

Educational reference only. EEG interpretation must be made in the full clinical context; verify against your institution's protocols and the individual patient.

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PALNET · pedseeg.com · Smart-phone reference tables (June 2026)

Clinical stateCe (µg/ml)Waveform / DSASEF
awake<2Beta > Alpha> 20
emergence “sedation”2Beta = Alpha17–20
anesthesia “hypnosis”3Alpha = Delta13–16
anesthesia “hypnosis + some analgesia”4.5Delta > Alpha9–12
anesthesia “overdose”>5Delta, isoelectric<8

EEG parameters for propofol depth

By effect-site concentration (Ce, µg/ml).

Educational reference only. EEG interpretation must be made in the full clinical context; verify against your institution's protocols and the individual patient.

Download PDFDownload image

PALNET · pedseeg.com · Smart-phone reference tables (June 2026)

Clinical stateWaveform / DSASEF
awakeBeta > Alpha> 20
emergence “sedation”Beta = Alpha17–20
anesthesia “hypnosis + analgesia”Alpha = (Theta + Delta)13–16
anesthesia “hypnosis + anti-nociceptive”(Delta + Theta) > Alpha9–12
anesthesia “overdose”Delta, isoelectric<8

EEG parameters for sevoflurane depth

Educational reference only. EEG interpretation must be made in the full clinical context; verify against your institution's protocols and the individual patient.

Download PDFDownload image

PALNET · pedseeg.com · Smart-phone reference tables (June 2026)

Clinical stateWaveform / DSASEF
awakeBeta > Alpha> 20
emergence “sedation”Beta = Alpha17–20
anesthesia “hypnosis” (prop)
+ “analgesia” (sevo)		Alpha = Delta (prop)
Alpha = Theta + Delta (sevo)		13–16
anesthesia +
“analgesia” (prop)
“anti-nociception” (sevo)		Delta > alpha (prop)
(Delta + Theta) > Alpha (sevo)		9–12
anesthesia “overdose”Delta, isoelectric<8

EEG parameters — hypnotic depth

Age > 3 mo, with alpha-beta waves.

Educational reference only. EEG interpretation must be made in the full clinical context; verify against your institution's protocols and the individual patient.

Download PDFDownload image

PALNET · pedseeg.com · Smart-phone reference tables (June 2026)

Clinical stateWaveform / DSASEF
awakeDelta + Theta5–8
emergence “sedation”Delta3–5
anesthesia “hypnosis + analgesia”Theta + Delta = Isoelectric1–3
anesthesia “hypnosis + anti-nociceptive”Isoelectric > Delta + Theta0–2
anesthesia “overdose”Isoelectric0

EEG parameters — hypnotic depth

Age < 3–6 mo, or older without alpha-beta waves (genetic syndromes, neurodevelopmental delay, cyanotic congenital heart).

Educational reference only. EEG interpretation must be made in the full clinical context; verify against your institution's protocols and the individual patient.

Download PDFDownload image

PALNET · pedseeg.com · Smart-phone reference tables (June 2026)

Surgery case time?
> 2 hrCe 3
< 2 hrCe 4.5
Surgical stimulus / pain?
severeCe 3 + remifentanil / regional
mildCe 4.5 + fentanyl / local
Absolute immobility needed?
yesCe 3 + muscle relaxant
noCe 3 or 4.5

Algorithm — picking a propofol target Ce (3 vs 4.5 µg/ml)

A quick decision aid for selecting the propofol effect-site target.

Educational reference only. EEG interpretation must be made in the full clinical context; verify against your institution's protocols and the individual patient.

Download PDFDownload image

PALNET · pedseeg.com · Smart-phone reference tables (June 2026)

Primary literature

PALNET's official reading list — curated and vetted by our PALNET teachers and used over the past year. These articles are frequently cited in PALNET's own publications. Citations link to the publisher (DOI) where available.

Why EEG-guided anesthesia
  • Morgan PG, Sleigh JW. Are We Anesthetizing the Heart or the Brain (or Ourselves)? Anesthesiology 2025;143:491–2.
  • Moody OA, et al. The Neural Circuits Underlying General Anesthesia and Sleep. Anesthesia & Analgesia 2021;132(5):1254–1264.
Reviews of EEG anesthesia
  • Purdon PL, et al. Clinical Electroencephalography for Anesthesiologists. Part I: Background and Basic Signatures. Anesthesiology 2015;123:937–60. · DOI
  • Guay CS, et al. Clinical Electroencephalography for Anesthesiologists and Intensivists. Part 2: Physiologic Signatures and Active Management. Anesthesiology 2025;143(6):1595–1618. · DOI
  • Constant I, Sabourdin N. Monitoring depth of anesthesia: from consciousness to nociception. A window on subcortical brain activity. Paediatric Anaesthesia 2015;25(1):73–82.
Reviews of EEG-guided pediatric anesthesia
  • Bong C, Yuan I. The Utility of Electroencephalography in Guiding General Anesthesia in Children. Anesthesia & Analgesia 2026;142(6):1155–1168. · DOI
  • Constant I, Sabourdin N. The EEG signal: a window on the cortical brain activity. Pediatric Anesthesia 2012;22:539–552.
  • Yuan I, et al. Using Electroencephalography (EEG) to Guide Propofol and Sevoflurane Dosing in Pediatric Anesthesia. Anesthesiology Clinics 2020;38(3):709–725. · DOI
  • Bong C, et al. Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children. Anesthesia & Analgesia 2023;137:108–23. · DOI
  • Yuan I, et al. Intraoperative pediatric electroencephalography monitoring: an updated review. Korean Journal of Anesthesiology 2024;77(3):289–305. · DOI
EEG age dependency
  • Akeju O, et al. Age-dependency of sevoflurane-induced electroencephalogram dynamics in children. British Journal of Anaesthesia 2015;115:i66–76.
  • Lee JM, et al. A Prospective Study of Age-dependent Changes in Propofol-induced Electroencephalogram Oscillations in Children. Anesthesiology 2017;127:293–306. · DOI
  • Schultz B, et al. EEG monitoring during anesthesia in children aged 0 to 18 months: amplitude-integrated EEG and age effects. BMC Pediatrics 2022;22:156.
  • Yuan I, et al. Quantitative electroencephalogram in term neonates under different sleep states. Journal of Clinical Monitoring and Computing 2023;38(3):591–602.
  • Markus M, et al. Peri- and intraoperative EEG signatures in newborns and infants. Clinical Neurophysiology 2021;132:2959–64.
Safety & outcomes
  • Kurth CD, et al. EEG-Guided Pediatric Anesthesia — A Quality Innovation? JAMA Pediatrics 2025;179(7):695–697. · DOI
  • Miyasaka KW, et al. EEG-guided titration of sevoflurane and pediatric anesthesia emergence delirium: a randomized clinical trial. JAMA Pediatrics 2025;179(7):704–712.
  • Frelich M, et al. Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: a prospective randomized controlled trial. Anaesthesia Critical Care & Pain Medicine 2024;43(1):1–6.
  • Han Y, et al. EEG-parameter-guided anesthesia for prevention of emergence delirium in children. Brain Sciences 2022;12(9):1195.
  • Yuan I, et al. Isoelectric Electroencephalography in Infants and Toddlers during Anesthesia for Surgery: An International Observational Study. Anesthesiology 2022;137(2):187–200.
  • Shen F, et al. Effect of Intravenous, Inhalational, or Combined Anesthesia Maintenance on Postoperative Respiratory Adverse Events in Children Undergoing Adenotonsillectomy: A Multicenter Randomized Clinical Trial. Anesthesiology 2025;143:1484–96.
Cost & sustainability
  • Weber F, et al. The impact of Narcotrend EEG-guided propofol administration on the speed of recovery from pediatric procedural sedation — a randomized controlled trial. Paediatric Anaesthesia 2018;28(5):443–449.
  • Kurth CD, et al. Multi-site analysis of annual cost and sustainability for EEG-guided pediatric anesthesia. Society for Pediatric Anesthesia abstract 2026.
TIVA in pediatrics
  • Patak LS, Puglia M, et al. Propofol or Sevoflurane for Maintenance of Pediatric Anesthesia: An Outcome-Focused Perspective. Anesthesia & Analgesia 2026 (advance online publication). · DOI
  • Anderson BJ, et al. Practicalities of Total Intravenous Anesthesia and Target-controlled Infusion in Children. Anesthesiology 2019;131(1):164–185. · DOI
  • Yuan I, et al. Electroencephalographic Indices for Clinical Endpoints during Propofol Anesthesia in Infants: An Early-phase Propofol Biomarker-finding Study. Anesthesiology 2024;141:353–64.
  • Xu T, et al. An approach to using pharmacokinetics and electroencephalography for propofol anesthesia for surgery in infants. Pediatric Anesthesia 2020;30:1299–1307. · DOI
  • Rigby-Jones AE, et al. Population pharmacokinetics of remifentanil in critically ill post-cardiac neonates, infants and children. British Journal of Anaesthesia 2005;95:578–79.
Sevoflurane in pediatrics
  • Rigouzzo A, et al. EEG profiles during general anesthesia in children: a comparative study between sevoflurane and propofol. Pediatric Anesthesia 2019;29:250–257.
  • Karam O, et al. Respiratory Adverse Events After LMA Mask Removal in Children: A Randomized Trial Comparing Propofol to Sevoflurane. Anesthesia & Analgesia 2023;136:25–33.

Other articles — AI-assembled, pending vetting

Additional papers organized by topic. Click any heading to expand. These have not been endorsed by PALNET leadership and are listed here only as background for human review.

Pediatric EEG across development4 papers
EEG fundamentals (deeper dive)4 papers
Clinical practice & implementation5 papers
Outcomes & safety7 papers

PALNET links to canonical publisher pages rather than hosting PDFs directly, in keeping with academic publishing licenses. If a paper is available open-access through the journal or PubMed Central, the DOI link will resolve to that version automatically.

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