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Methods: This retrospective study included 140 adult patients undergoing elective craniotomy who received total intravenous anesthesia using a combination of propofol and dexmedetomidine infusions. Patients were equally matched to the spectrogram group (maintaining the robust EEG alpha power during surgery) or the index group (maintaining the BIS score between 40 and 60 during surgery) based on the propensity score of age and surgical type. The primary outcome was the propofol dose. Secondary outcome was the postoperative neurological profile.Results: Patients in the spectrogram group received significantly less propofol (1585 \u00b1 581 vs. 2314 \u00b1 810 mg, P &lt; 0.001). Fewer patients in the spectrogram group exhibited delayed emergence (1.4% vs. 11.4%, P = 0.033). The postoperative delirium profile was similar between the groups (profile P = 0.227). Patients in the spectrogram group exhibited better in-hospital Barthel\u2019s index scores changes (admission state: 83.6 \u00b1 27.6 vs. 91.6 \u00b1 17.1; discharge state: 86.4 \u00b1 24.3 vs. 85.1 \u00b1 21.5; group\u2013time interaction P = 0.008). However, the incidence of postoperative neurological complications was similar between the groups.Conclusions: EEG spectrogram\u2013guided anesthesia prevents unnecessary anesthetic consumption during elective craniotomy. This may also prevent delayed emergence and improve postoperative Barthel index scores.<\/jats:p>","DOI":"10.4097\/kja.23118","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T06:42:55Z","timestamp":1684737775000},"page":"122-132","update-policy":"https:\/\/doi.org\/10.4097\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Electroencephalographic spectrogram\u2013guided total intravenous anesthesia using dexmedetomidine and propofol prevents unnecessary anesthetic dosing during craniotomy: a propensity score\u2013matched 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