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54).29 Also of interest are several studies that have examined the relationship between low intraoperative BIS values and intermediate term postoperative mortality.31�C35 selleck chemicals Building on these a study has demonstrated that intraoperative EEG burst suppression specifically, especially when coinciding with hypotension, is associated with increased 90-day postoperative mortality.36 Despite the findings from these studies and recommendations from the National Institute for Health and Care Excellence in the UK that electroencephalography guidance of anaesthesia should be routine for vulnerable patients,37 intraoperative EEG monitoring has not become standard anaesthetic practice, and there is ongoing controversy about the utility of electroencephalography guidance of anaesthesia.38 For example, in the UK only 2% of anaesthesia practitioners routinely incorporate EEG monitoring in their practice,39 and it is possible that adoption is similarly low in the USA. The results of several clinical trials have led anaesthesia practitioners to question whether EEG-guidance meaningfully changes anaesthetic administration in real world settings,40�C42 and the mechanisms by which EEG-guidance could decrease postoperative delirium have not been clarified. In the USA, the American Society of Anesthesiologists in its Neratinib research buy most recent guidelines on brain monitoring does not recommend RVX-208 EEG monitoring as standard care for any patient population, procedure or anaesthetic technique.43 A pragmatic, randomised clinical trial would address this controversy and could help to inform the standard of care going forward. The plausibility for EEG guidance preventing postoperative delirium is that it might help practitioners to avoid excessive anaesthetic administration to vulnerable patients.44 During general anaesthesia, BIS values