Intraoperative electroencephalographic burst suppression: a marker of underlying cognitive vulnerability rather than a modifiable cause of postoperative delirium. Comment on Br J Anaesth 2026; 136: 1843–54

This article comments on the work of Gruenbaum and colleagues, which re-evaluates intraoperative electroencephalographic (EEG) burst suppression. Burst suppression is now viewed as a biomarker of cortical energy imbalance, rather than a direct therapeutic target. However, the authors of the original work suggest that avoidable or prolonged burst suppression should be treated as a potentially modifiable factor. They propose a four-step management algorithm that begins only once suppression has appeared. The comment suggests that this approach might underestimate the important preoperative cognitive status of the patient. This preoperative condition could be a key variable contributing to the occurrence of burst suppression.