Introducing Pediatric Anesthesia Learning Network for EEG Technologies (PALNET): How to learn EEG-Guided Pediatric Anesthesia
Greg Johnson, MD (The Hospital for Sick Children, Toronto), and Dean Kurth, MD (Children's Hospital of Philadelphia),
EEG has become a recurring subject in the PAAD, usually framed the same way: this is the direction our specialty is going, and we at PALNET agree. Like end-tidal gas and pulse oximetry before it, EEG is moving from novelty toward standard of care, and the evidence behind it keeps getting stronger. But there’s a real distance between a technology being promising and it being something we actually reach for. Most of us have never been taught to use EEG, so the monitors tend to sit in our ORs largely untouched. Closing that gap is the reason we started PALNET, and it’s what we’d like to introduce to the PAAD community today.
A short history
What PALNET teaches didn’t start as an education problem, but instead as a monitoring problem. Between 2000 and 2010, propofol became the anesthetic of choice for motor evoked potential monitoring, but dosing it well turned out to be genuinely difficult. Pediatric propofol pharmacokinetics were poorly understood, and there was no biomarker for how much propofol was in the brain.
From 2009 to 2016, anesthesiologists at the University of Florida and Cincinnati Children’s, working with the Evokes Inc, set out to solve that. They took what was known about pediatric propofol pharmacokinetics (a lot of it from Brian Anderson’s work) and paired it with the neuromonitoring device’s EEG features (the raw waveform, the density spectral array, and the spectral edge frequency) to read the brain’s response to propofol levels in real time and titrate the dose to the child on the table.
When EEG monitors for anesthesia that display those same features became commercially available in 2018, we piloted an EEG education and implementation program at CHOP and it worked. In 2022 that pilot became PALNET, founded with three departments: CHOP, Lucile Packard Children’s Hospital Stanford, and Children’s Medical Center Dallas.
Does the teaching actually work?
Two quality-improvement papers out of CHOP say yes, and they’re worth a look.
The first (Yuan, Missett, and colleagues, 2022) built the curriculum. The idea was a teacher–learner–teacher model: train a small group, and each of them trains the next. Around that went lectures, age-based dosing tables, decision-tree algorithms for induction, maintenance, and emergence, and knowledge checks. Over a year, 78.5% of the division got trained and EEG knowledge scores climbed from 38% to 59%.
The second (Jones Oguh and colleagues, 2023) asked the harder question: does training actually change what people do? EEG-guided TIVA in the main OR climbed from about 5% of cases to 75%, with no clinically meaningful change in emergence times and no rise in emergencies along the way. A key takeaway from the study is that didactic education (e.g. lectures and journal articles) was not enough to change clinical practice. The successful interventions relied on practical, hands-on strategies: intraoperative teaching on live cases, a teacher-learner mentorship model, and placing dosing tables and system reminders directly at the point of care. PALNET’s educational model is built specifically on these proven strategies.
What PALNET is
PALNET — the Pediatric Anesthesia Learning Network for EEG Technologies — is a clinician-led, vendor-neutral, 501(c)(3) nonprofit. It doesn’t own or sell anything, and it is not tied to any one monitor. PALNET teaches the fundamentals that hold up across different ages and EEG devices, so you can do EEG guided anesthesia using several commercially available devices.
After 2022 with those three departments, PALNET grew, almost entirely by word of mouth, to roughly 50 departments across 14 countries on four continents. And PALNET just launched an online home at pedseeg.com, where you can learn the basics and find your way in.
How to get involved
There are a few easy ways to get started:
● Visit pedseeg.com to learn the fundamentals and see who’s already involved.
● Attend a hands-on workshop — upcoming dates are posted on the site.
● Host a site visit, where PALNET faculty teach alongside your team on your own cases.
Adopting EEG guidance takes time and effort, but the value of a network is that you don’t have to start from zero. We’d be glad to have you join us.
Original articles
Yuan I, Missett RM, Jones-Oguh S, et al. Implementation of an electroencephalogram-guided propofol anesthesia education program in an academic pediatric anesthesia practice. Pediatric Anesthesia. 2022;32(11):1252–1261. doi: 10.1111/pan.14520.
Jones Oguh S, Iyer RS, Yuan I, et al. Implementation of an electroencephalogram-guided propofol anesthesia practice in a large academic pediatric hospital: a quality improvement project. Pediatric Anesthesia. 2024;34(2):160–166. doi: 10.1111/pan.14791.
Are you using EEG to guide the depth of anesthesia in your practice? Have you experienced PALNET in your practice and would like to comment on it? Send your thoughts and comments to Myron (myasterster@gmail.com) and he will post in a Friday reader response