Abstract About 230 million general surgeries are performed worldwide every year in which efficient administering and

control of anesthesia is required. Balanced Anaesthesia has been defined as that state which ensures the suppression of the somatic and visceral sensory components and thus the perception of pain [1]. It is basically General Anesthesia (GA) that balances the depressing effects of the motor, sensory, reflex and mental aspects of nervous system. Anesthesiologists are multi-skilled physicians who apply their experience based knowledge of medicine to keep the patient in balanced anesthesia state throughout the surgery. Necessity to assess and monitor the Depth of Anesthesia (DoA) is obvious to ensure patients safety during surgery. In conventional methods, DoA is measured based on clinical assessment through empirical measurement of autonomic signs such as respiration pattern, blood pressure, body temperature, tearing, sweating, heart rate etc. These parameters do not prove to be good predictors of exact anesthetic state of the patient [2]. Moreover, modern anesthesia practice involves a number of other drugs such as vasodilators, vasopressors, neuromuscular blockers etc. Each one of them affects these clinical signs in its own manner making it difficult to associate these signs with anesthetic depth. Also, factors like induction agents, patient illness, age, general health, site and extent of surgical stimulus may modify these signs to a large extent [3]. As a result, the decisions made by anesthetists inside the operation theatre are heuristic [4] and cases of patient awareness during surgery with an average of 1:1000 and overdosing with anesthetic agents are major clinical concerns of anesthesia [5]. In addition to this, anesthesiologist has to perform other important tasks in the operation theater (OT) such as to achieve haemodynamic stability, airway management etc which create a lot of mental as well as physical pressure on anesthetist. The role of anesthesiologist is not limited to OT only. It extends to the Post Anesthetic Care Unit (PACU) for the management of postoperative pain. Statistics shows that 80% of the patients experience pain postoperatively and about 20% experience severe pain [6-8]. No such Gold standard is available for clinical assessment of pain. Despite the availability of different measures, analgesics and guidelines as per World Health Organisation (WHO) [9], negligible work has been done in this direction over the past decade. Pain associated with surgical and diagnostic procedures is a common occurrence in hospitals [5]. Pain intensity measures are based on physiological monitoring and a numeric rating is commonly used which classifies pain as mild, moderate or severe. Pain is a sensory and emotional experience. Intensity, pattern and perception of pain are subjective; therefore, psychological, physiological and patient ratings may not be true measures for assessment of pain intensity. Also when the patient is a pediatric or unconscious, these methods are not reliable [10-12]. Sensory receptors of pain (nociceptors) become sensitive and active after an injury (surgery or other disease) and communicate

sensations to the cerebral cortex (brain) [11]. Research establishes that 80% of human brain activity is related to sensation perception and being the target organ of different anesthetic agents, brain activity i.e. electroencephalogram (EEG) can be used as the best clinical monitoring tool for pain assessment. Although, extensive studies have been carried out on EEG of patients during surgery in the past [14-25], solution to the problem of maintaining the patient in desired balanced anesthetic state still remains elusive. The present study addresses the issues related to determination of EEG parameters which are correlated with hypnosis and analgesia components of balanced anesthesia, optimizing them and classifying them to estimate independent indices for the component of balanced anesthesia. Objective is to assist the anesthesiologist so that the actual condition of the patient can be assessed and drugs can be administered accordingly.