Artificial intelligence and EEG during anesthesia: ideal match or fleeting bond?

Artificial intelligence (AI) has shown considerable potential in perioperative monitoring, particularly in its application to electroencephalogram (EEG) analysis for assessing the depth of anesthesia. AI methods may enable the dynamic recognition of complex time-frequency EEG patterns and the adaptation of monitoring strategies to patient-specific brain responses. Convolutional neural networks, artificial neural networks, and hybrid deep learning models have reported encouraging results in detecting anesthetic states, estimating bispectral index values, and identifying relevant EEG features - such as alpha-delta shifts or burst suppression - without relying on manual feature engineering. Parallel efforts using virtual and augmented reality platforms suggest possible benefits for anesthesiologist training in EEG interpretation and pharmacologic titration. Despite these advances, important limitations constrain clinical translation. A major challenge is the absence of standardized EEG pattern definitions across anesthetic agents and patient groups, limiting model generalizability. Restricted interoperability between EEG monitors and electronic health records, coupled with proprietary data formats, reduces access to raw EEG signals and hampers large-scale development. Privacy and governance requirements add further barriers to data integration. Methodologically, many studies are affected by insufficient internal validation, suboptimal reporting, and testing in experimental rather than real-world conditions, reducing their translational value. While AI could eventually improve anesthetic precision and safety through EEG-guided approaches, realizing this potential will require transparent algorithms, multicenter and heterogeneous datasets, and robust interoperability and data-sharing standards. Only through such coordinated efforts can these tools evolve from promising research applications into reliable components of routine anesthetic care.