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.
Highlights
What is already known
- Intraoperative EEG monitoring may be useful in optimizing anesthetic titration during pediatric general anesthesia, but its adoption remains variable due to limited pediatric-specific evidence, differing clinician familiarity, workflow considerations, and cost.
- Patient and family perspectives may influence the acceptability and implementation of perioperative monitoring technologies.
What new information this study adds
- In this single-center exploratory survey, most children and parents considered intraoperative EEG monitoring as important and useful, and reported that it would provide reassurance. Most respondents indicated a willingness to pay an additional cost for its use.
- Children and parents identified different concerns about general anesthesia: children more often reported concerns about intraoperative awareness and failure to awaken, whereas parents more often reported concerns about side effects and cost.
- These findings provide family-centered insights into the acceptability of EEG monitoring in a mixed public–private healthcare system. They may inform preoperative communication, shared decision-making, and institutional planning regarding the implementation and funding of EEG monitoring in routine pediatric perioperative care.