Anesthesia Research

Background: Epidural analgesia (EA) is widely used in pancreatic surgery but is associated with hypotension and delayed recovery. The shift towards minimally invasive surgery has led to the exploration of alternative multimodal analgesia strategies. Methadone, with its unique pharmacological properties, may further optimize recovery. Methods: This retrospective cohort study included 213 patients undergoing pancreatic resection, receiving EA (n = 63), multimodal analgesia without methadone (MA; n = 92), or with methadone (MM; n = 58). MA and MM included intravenous ketamine, lidocaine and continuous wound infiltration. Primary outcome was maximum daily postoperative pain scores. Secondary outcomes included opioid consumption, vasopressor use, mobilization, bowel recovery, urinary catheter duration, and ICU/hospital stay. Results: Compared with EA, pain scores were slightly higher in MM (mean difference 2.22; 95% CI 1.22–3.90; p = 0.01) and in MA (mean difference 2.06; 95% CI 0.99–4.30; p = 0.06). Opioid use was comparable between MM and EA (OR 0.99, 95% CI [0.98, 1.00], p = 0.20), and significantly lower in MA (OR 0.97, 95% CI [0.96, 0.98], p < 0.001). Both MA and MM demonstrated reduced vasopressor requirements (both 0 vs. 2.0 median days) and shorter urinary catheterization durations (MA 1.2 MM 1.9 vs. EA 4.0 median days). MA improved mobilization (0 vs. 1 median days; OR 0.52, p = 0.03) and bowel recovery (OR 0.76, p = 0.02). ICU stay was longer in EA due to routine ICU admission for open surgery. Conclusions: Multimodal analgesia, with or without methadone, offers alternative strategies in pancreatic surgery. While EA provides superior pain control, multimodal regimens are associated with improved functional recovery. Full article

Background: Postoperative cognitive dysfunction (POCD) is a significant complication following thoracic surgery. One-lung ventilation (OLV) during these procedures can lead to cerebral desaturation, potentially contributing to POCD. This study investigated the correlation between intraoperative cerebral oximetry, measured by near-infrared spectroscopy (NIRS), and neurocognitive function changes in patients undergoing thoracic surgery. Methods: In this prospective, observational pilot study, 54 adult patients undergoing OLV for thoracic surgery were enrolled. Cerebral oxygen saturation (rScO₂) was monitored continuously using NIRS. Patients were categorized into two groups: Group N (normal NIRS values) and Group D (decreased NIRS values, defined as a drop of ≥20% from baseline or an absolute value <50%). Neurocognitive function was assessed preoperatively, on the 3rd postoperative day, and at 3 months using the Addenbrooke’s Cognitive Examination-Revised (ACE-R) battery. The correlation between intraoperative rScO₂ values, postoperative complications, and neurocognitive outcomes was analyzed. Results: A significant association was found between intraoperative cerebral desaturation and a decline in ACE-R scores. Group D showed a significant decrease in ACE-R scores on the 3rd postoperative day and at 3 months compared to their baseline, while Group N showed no significant change. The most pronounced decline in Group D was observed in the “Fluency” cognitive domain. Interestingly, there was a significant difference in ICU admission rates (p = 0.004) between the two groups, with more admissions in Group D, despite no significant difference in intraoperative hypotension or peripheral desaturation. Patients with pre-existing hypertension were more likely to experience cerebral desaturation. Conclusion: Intraoperative cerebral desaturation, as detected by NIRS, is a strong predictor of both early and late postoperative neurocognitive decline and increased postoperative morbidity in thoracic surgery patients. This underscores the value of NIRS as a sensitive monitoring tool to identify patients at risk and guide timely interventions. These findings suggest a need for further research, including larger randomized controlled trials, to confirm these associations and evaluate the impact of a protocol-driven NIRS intervention strategy on patient outcomes. Full article

Damage-associated molecular patterns (DAMPs) are endogenous molecules released during cellular stress or injury that trigger sterile inflammation. In perioperative settings, common triggers include surgical trauma, ischemia–reperfusion injury, cardiopulmonary bypass, blood transfusion, and mechanical ventilation. When released extracellularly, DAMPs activate innate immune receptors such as Toll-like receptors (TLRs) and the receptor for advanced glycation end products (RAGE), initiating signaling cascades that amplify inflammation, disrupt endothelial integrity, and promote coagulation and metabolic imbalance. This sterile inflammatory response may extend local tissue injury into systemic organ dysfunction, manifesting clinically as acute lung injury, acute kidney injury, myocardial dysfunction, disseminated intravascular coagulation, and perioperative neurocognitive disorders. Recognizing the central role of DAMPs reframes these complications as predictable consequences of endogenous danger signaling rather than solely as results of infection or hemodynamic instability. This understanding supports the use of established strategies such as protective ventilation and restrictive transfusion to minimize DAMP release. Emerging evidence also suggests that anesthetic agents may influence DAMP-mediated inflammation: propofol and dexmedetomidine appear to exert anti-inflammatory effects, whereas volatile anesthetics show variable results. Although clinical data remain limited, anesthetic choice and perioperative management may significantly affect systemic inflammatory burden and recovery. Future research validating DAMPs as biomarkers and therapeutic targets may inform precision anesthetic strategies aimed at modulating sterile inflammation, ultimately enhancing perioperative outcome. Full article

The assessment of a conduction block following regional anaesthesia involves the clinical examination of motor and sensory neural pathways. Motor assessment includes the subjective evaluation of power, while sensory function is assessed using subjective perceptions of touch, cold and pain. There are considerable subjectivities and variabilities in the assessment of regional anaesthesia. Regional anaesthesia results in a blockade of not only somatosensory and motor nerve fibres but also sympathetic fibres. This results in vasodilation and an increase in blood flow, which leads to an increase in skin temperature. Multiple studies have demonstrated a high correlation between conduction block success and skin temperature changes at 10 min, detected using infrared thermography with a higher sensitivity and specificity and positive and negative predictive values up to 100%. Infrared thermography (IRT) is a non-invasive imaging tool which measures surface temperature. The role of IRT in assessing conduction blocks has been evaluated. We reviewed the literature to characterise the role of IRT in determining the onset of a conduction block following regional anaesthesia. This narrative review article synthesises the current evidence on the application of IRT in the evaluation of conduction block onset. In conclusion, IRT is a reliable tool to assess early block success as compared to routine assessment methods (touch, cold and pain perception). However, the limited studies and effects of environmental factors highlight the need for standardised protocols and multicentre studies to integrate into routine clinical practice. With further validation and integration into clinical practice, it has the potential to improve both patient safety and the reliability of block assessment. Full article

Background/Objectives: Chemogenetic excitation of a distinct subset of “effector-neurons” in the brainstem mesopontine tegmental anesthesia area (MPTA) is pro-anesthetic. GABAergic general anesthetics are believed to engage these neurons by disinhibition, thereby inducing loss-of-consciousness (LOC) and enabling pain-free surgery. The transition from wakefulness to LOC, however, does not occur intrinsically within the MPTA. Rather, evidence indicates that LOC is brought about (effected) by ascending and descending axonal projections of MPTA effector-neurons that terminate in a variety of downstream brain targets which, together, generate the various components of anesthesia. Previously we used anterograde and retrograde tracing to delineate the overall axonal trajectories of MPTA projection-neurons, to which targets they project. Effector-neurons, however, represent only a fraction of this neuronal pool. Which of these targets are also innervated by MPTA projecting effector-neurons? Methods: Here we marked MPTA effector-neurons with the adeno-associated virus (AAV) used in the discovery of this neuronal type, with retrograde labelling from the previously identified MPTA target structures, to establish which downstream brain structures receive direct input from effector-neurons. Results: Effector-neurons proved to contribute to all six of the major MPTA projection-targets: the prefrontal cortex, basal forebrain, intralaminar thalamus, zona incerta, rostro-ventromedial medulla and spinal cord. Conclusions: We conclude that a discrete population of projecting effector-neurons, probably representing only about 6% of all MPTA neurons, drive the multiple functional endpoints of surgical anesthesia: analgesia, atonia, amnesia and LOC. Further, we propose that these same neurons, via their associated axonal pathways, may also contribute to endogenous instances of LOC such as natural sleep, fainting, concussion, coma and hibernation. Full article

Background: Hip fracture surgery in elderly patients carries significant risks of both bleeding and thrombotic complications. Anaesthetists frequently face a dilemma between neuraxial anaesthesia, which may reduce thrombotic risk but is often limited by contraindications, and general anaesthesia, which is widely applicable but may exacerbate bleeding. Previous reviews have not specifically addressed bleeding and thrombotic outcomes, leaving a critical gap that this meta-analysis seeks to answer. Study objective: To evaluate the effect of neuraxial anaesthesia compared to general anaesthesia on the incidence of bleeding and thrombotic complications in acute neck of femur fracture surgery. Methods: Relevant studies comparing neuraxial and general anaesthetic for hip fracture surgery were searched for through Medline, Embase, Scopus, CINAHL and PubMed. Inclusion criteria were randomised control trials of hip fracture surgery patients aged >16 years with relevant outcome data. In total, 24 randomised control trials were included, with 5479 patients. A meta-analysis was performed using RevMan 5.4 software. The study was registered with PROSPERO ID: CRD42022348039. Outcome measurement: Primary outcomes were intra-operative blood loss, intra- or post-operative blood transfusion and post-operative deep vein thrombosis. Secondary outcomes were post-operative pulmonary embolism, post-operative myocardial infarction and post-operative stroke. Results: Neuraxial anaesthesia reduced deep vein thrombosis incidence by 45% and reduced blood loss by 58 mL, both of which reached statistical significance (p < 0.05). Albeit not reaching statistical significance, neuraxial anaesthesia also had a 35% relative risk reduction in myocardial infarction, and a 35% relative decrease in stroke in current studies published after 2010. Despite practise evolution over the decades, protective neuraxial trends have remained. Conclusions: Patients undergoing acute hip fracture surgery under general anaesthesia have higher volumes of blood loss, without requiring increased blood transfusion. General anaesthesia is also associated with higher thrombotic complications, with a 45% increased relative risk of deep vein thrombosis, compared to neuraxial anaesthesia. Multi-modal thromboprophylaxis is important, as up to a third of DVT cases occur in the non-operative leg. In frail patients with a low cardiopulmonary reserve for bleeding or in high-thrombotic-risk patients, extra consideration and optimisation for neuraxial technique is advised. Future studies on comorbidities and operation type may reveal a subgroup of patients which would benefit from a specific anaesthetic type. Full article

Sepsis is a life-threatening syndrome marked by a dysregulated host response to infection, resulting in systemic inflammation, organ dysfunction, and high mortality globally. Despite advancements in supportive care, effective immunomodulatory therapies remain elusive, necessitating exploration of novel biological pathways and subsequent therapeutic development. The endocannabinoid system (ECS), which regulates immune function and homeostasis, has emerged as a key modulator of immunological and metabolic pathways central to sepsis pathophysiology. The ECS mediates its effects through endogenous ligands, G-protein-coupled cannabinoid receptors (CB1 and CB1), and regulatory enzymes that control its synthesis and degradation. Following PRISMA-ScR guidelines, this scoping review synthesizes current evidence on the mechanistic roles of ECS components in experimental and clinical models of sepsis, identifies knowledge gaps, and delineates future areas of work. A comprehensive literature search across multiple databases without restrictions on date or publication type was executed to ensure broad coverage of original studies investigating ECS mechanisms and their intersection with sepsis and septic shock. Across 53 studies, CB2 receptor activation was consistently associated with anti-inflammatory process, organ-protective outcomes, and increased survival rates against septic challenges in preclinical rodent models. CB1 receptor activation trends, however, showed context dependent outcomes. Central antagonism improved hemodynamics and survival rate, but peripheral effects varied with cell type and timing. Non-canonical ECS components (TRPV1, GPR55, PPAR-α, FAAH, MAGL) also contributed to neuroimmune and metabolic regulation. Limited clinical data linked ECS lipid profiles and gene expression with sepsis severity and outcomes. Collectively, ECS modulation, particularly CB2 agonism, TRPV1 activation, and FAAH/MAGL inhibition, shows promise in mitigating sepsis-induced inflammation and organ dysfunction. However, complex, context-dependent effects, especially involving CB1, highlight the need for precision-targeted therapeutic approaches. Further preclinical research is needed to expand generalizable trends to allow translational research to refine ECS-based interventions for sepsis management. Full article

Background: Sepsis is a life-threatening syndrome caused by a dysregulated host response to infection leading to organ dysfunction. Distinguishing sepsis from localized infection is crucial, as it guides clinical decision-making and biomarker interpretation. Biomarkers may support diagnosis, prognosis, and therapeutic choices, but their integration into practice remains debated. Methods: This narrative review was conducted in accordance with the SANRA (Scale for the Assessment of Narrative Review Articles) guidelines. A comprehensive literature search was performed in PubMed, Embase, and Cochrane CENTRAL (January 2000–September 2025). Studies evaluating sepsis-related biomarkers for diagnosis, prognostication, shock assessment, antimicrobial stewardship, and post-acute follow-up were considered. Findings: Established biomarkers such as procalcitonin (PCT), C-reactive protein (CRP), and lactate remain widely used for diagnosis, monitoring of inflammatory response, and assessment of severity. Emerging candidates include pancreatic stone protein (PSP), neutrophil gelatinase-associated lipocalin (NGAL), and monocyte HLA-DR (mHLA-DR), which may provide insights into infection dynamics, renal injury, and immune suppression, respectively. However, limitations in standardization and heterogeneous evidence hinder routine implementation. Interleukin-6 (IL-6), despite extensive study, shows limited specificity and inconsistent clinical applicability. Renin has been proposed as a marker of shock severity rather than infection. Comparative evidence highlights the need for stage-specific biomarker use across prehospital, emergency, ICU, and recovery phases. Conclusions: No single biomarker is universally applicable in sepsis. Their utility depends on timing, clinical setting, and patient phenotype. Combining classical and emerging biomarkers with point-of-care technologies and dynamic monitoring may enhance personalized management. Limitations include heterogeneity of evidence and lack of standardized thresholds. Future research should validate biomarker panels, integrate them into stewardship strategies, and explore their cost-effectiveness in clinical practice. Full article

The teaching of medical history, once central to medical education, has been progressively displaced by science- and competency-focused curricula. In anesthesiology, despite the presence of historical scholarship and institutional resources, the history of this specialty is rarely used as a formal educational tool. This narrative review explores how historical narratives can support the development of professionalism and professional identity in anesthesia training. An exploratory search of the literature revealed no prior studies explicitly linking anesthesia history to professional identity formation, underscoring a gap in current scholarship. Drawing on the foundational literature in medical education and selected historical examples, including figures such as Crawford Long, Henry Beecher, and Virginia Apgar, this review illustrates how reflective engagement with historical episodes can deepen ethical awareness, foster identity formation, and contextualize the evolving role of the anesthesiologist. It proposes a theoretical framework and strategies for integrating historical content into anesthesia curricula and argues that historical reflection can complement existing methods for teaching professionalism. The history of anesthesia, when purposefully employed, offers a powerful means to humanize training, support critical reflection, and better prepare trainees for the ethical and professional challenges of contemporary practice. Full article

Opioid use disorder remains a leading national cause of mortality. Physician opioid prescribing contributes to this crisis. In urogynecology, most of these prescriptions are aimed at addressing postoperative pain. This expert review examines the factors that contribute to postoperative pain and opioid use in urogynecologic patients. We discuss patient characteristics, physician interventions and alternative therapies that may influence postoperative pain and opioid use. By identifying patients at higher risk for postoperative pain and opioid use and utilizing evidence-based strategies to mitigate postoperative pain, physicians caring for urogynecology patients can both reduce postoperative opioid use while still providing adequate patient pain control. Full article

Background: Topical anaesthesia of the nasal mucosa is essential for comfortable and effective nasal instrumentation. However, current methods often result in uneven anaesthesia, which can cause discomfort. This study evaluates the clinical performance of a newly developed soft mist nasal atomiser (NAA: Nasal Atomiser Adapter) for nasal topical anaesthesia. Methods: Twenty healthy adult volunteers received 1 mL of 4% lidocaine via the NAA in two doses of 0.5 mL each, administered into one nostril. Five minutes after administration, a size 7 nasopharyngeal airway was inserted into the anaesthetised nostril to assess tolerance. Comfort and anaesthetic effectiveness were rated by both participants and the attending anaesthesiologist using numeric rating scales (1–10). Results: The median total spraying time was 177.5 s (range, 152–192 s), which included the 120 s waiting period between the two 0.5 mL doses. Insertion of the nasopharyngeal airway took a median of 8.0 s (range 2–25 s). Participants rated the comfort of nasal lidocaine administration at a median of 9/10, and anaesthesia levels were rated as good to very good by both participants and clinicians. In 85% of cases, no reaction was observed during insertion of the nasopharyngeal airway; minimal reactions occurred in the remaining 15%. No adverse events were reported. Conclusions: The NAA provided effective, reliable, and safe anaesthesia of the nasal cavity, with a high level of comfort for the subject. It enabled fast and comfortable nasal instrumentation. These findings support the NAA as a promising alternative to conventional nasal anaesthetic techniques. Full article

Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most prevalent clinically significant complication in adult patients undergoing open heart surgery, closely linked to increased mortality and morbidity. Among intensive care unit (ICU) patients, CSA-AKI is the second most common type of acute kidney injury, surpassed only by sepsis-induced AKI. The Doppler-based Renal Resistive Index (RRI) measurement is a rapid and non-invasive diagnostic tool with potential for the early detection of acute kidney injury in intensive care unit patients and could also be useful as an early predictor of acute kidney injury (AKI) in the context of cardiac surgery, particularly when used in conjunction with novel biomarkers. Full article

Nociceptin/orphanin FQ (N/OFQ) is a neuropeptide that activates the nociceptin opioid peptide (NOP) receptor, a G protein-coupled receptor structurally similar to classical opioid receptors but with distinct pharmacological properties. Unlike μ-opioid receptor (MOR) agonists, NOP receptor agonists provide analgesia with a reduced risk of respiratory depression, tolerance, and dependence. This review synthesizes current evidence from molecular studies, animal models, and clinical trials to evaluate the therapeutic potential of the N/OFQ–NOP system in pain management and anesthesia. A literature review was conducted through a PubMed search of English language articles published between 2015 and 2025 using keywords such as “nociceptin,” “NOP receptor,” “bifunctional NOP/MOR agonists,” and “analgesia.” Primary research articles, clinical trials, and relevant reviews were selected based on their relevance to NOP pharmacology and therapeutic application. Additional references were included through citation tracking of seminal papers. Comparisons with classical opioid systems were made to highlight key pharmacological differences, and therapeutic developments involving NOP-selective and bifunctional NOP/MOR agonists were examined. In preclinical models of chronic inflammatory and neuropathic pain, NOP receptor ago-nists reduced hyperalgesia by 30–70%, while producing minimal effects in acute pain as-says. In healthy human volunteers, bifunctional NOP/MOR agonists such as cebrano-padol provided significant pain relief, achieving ≥30% reduction in pain intensity in up to 70% of subjects, with lower incidence of respiratory depression compared with morphine. Sunobinop, another NOP/MOR agent, demonstrated reduced next-day residual effects and a favorable cognitive safety profile. Clinical data also suggest that co-activation of NOP and MOR may attenuate opioid-induced hyperalgesia and tolerance. However, challenges remain, including variability in receptor signaling and limited human trial data. The N/OFQ–NOP receptor system represents a promising and potentially safer target for analgesia and perioperative care. Future efforts should focus on developing optimized NOP ligands, incorporating personalized approaches based on receptor variability, and advancing clinical trials to integrate these agents into multimodal pain management and enhanced recovery protocols. Full article

This case report describes the acute and multidisciplinary management anesthesiologists performed for an intra-operative bronchobiliary fistula during a routine endoscopic retrograde cholangiopancreatography for a patient with intrahepatic cholangiocarcinoma. During the procedure, an unexpected rapid airway deterioration was encountered due to bile infiltration of the right bronchus and anesthesia circuit, necessitating (1) emergent extubation and reintubation with bronchoscopy, (2) extubation and reintubation with double-lumen endotracheal tube with right-bronchial blocker, and (3) transportation of the patient from endoscopy to interventional radiology for biliary drain placement. Overall, this case highlights a rare but serious consideration for patients with intrahepatic cholangiocarcinoma who may present with a bronchobiliary fistula and the steps taken to prevent total airway compromise and ensure rapid patient stabilization through coordination with advanced gastroenterology, interventional pulmonology, and interventional radiology. Full article

Introduction: Propofol is a widely used sedative drug in electrophysiological studies (EPS). However, literature has shown that this drug may interfere with the cardiac conduction system (CCS). Our objective is to evaluate whether propofol interferes with CCS and the inducibility of arrhythmias during EPS. Method: A systematic review and a meta-analysis were performed. The databases were PubMed, Embase, Web of Science, and Scopus. Rayyan software was used to select the studies. Three Mesh terms were used: Propofol, Cardiac arrhythmias, Electrophysiologic Study, and Cardiac. Cohort studies and randomized clinical trials were included. Results: Only one of the six studies showed four cases where it was impossible to induce arrhythmia. We found no significant difference between propofol and the control group in the analyzed variables: cycle length, atrial-His, His-ventricular, corrected sinus node recovery time, atrial effective refractory factor, and ventricular effective refractory period, with low heterogeneity (I² = 0% to a maximum of I² = 8%). A significant difference in favor of the control group was found in the analysis of the atrioventricular node effective refractory period (MD:18.67 {95% CI 4.86 to 32.47} p = 0.008, I² = 44%). Discussion: The meta-analyzed data in this study showed that propofol possibly does not interfere with CCS, making it a safe drug for this type of procedure. Conclusions: However, extra care should be exercised with pediatric patients when the arrhythmia’s mechanism is automatic. More robust studies are still needed in this class. Full article

Background: PP-007 (SANGUINATE^®, PEGylated carboxyhemoglobin, bovine) is under development to treat conditions of ischemia/hypoxia. Hemorrhagic/hypovolemic shock (H/HVS) becomes a life-threatening comorbidity due in part to hypotension and hypoxia. Blood transfusions are indicated, but supply and compatibility issues may limit subject access or when blood is not an option due to religious restriction or concern for clinical complications. PP-007 is universally compatible with an effective hydrodynamic radius and colloidal osmotic pressure facilitating perfusion without promoting extravasation. Methods: A review of previous clinical trials was performed and revealed an Open-Label Phase 1 safety study of acute severe anemia (hemoglobin ≤ 5 g/dL) in adult (≥18 y) patients unable to receive red blood cell transfusion (NCT02754999). Primary outcomes included safety events with secondary efficacy measures of organ function and survival at 1, 14, and 28 days. Additionally, a retrospective review of published, peer-reviewed case reports was performed, evaluating the administration of Sanguinate for Expanded Access in those patient populations where blood was not an option over the past 12 years. Results: A total of 103 subjects were enrolled in the Phase I safety study with significant co-morbidities that most commonly included hypertension (n = 43), acute and chronic kidney disease (n = 38), diabetes mellitus (n = 29), gastrointestinal bleeds (n = 18), and sickle cell disease (n = 13). Enrollment characteristics included decreased hemoglobin and severe anemia (mean baseline hemoglobin of 4.2 g/dL). Treatments included an average of three infusions [range 1–17]. Secondary efficacy measures were mean Hb levels, respiratory support, and vasopressor requirements, all demonstrating clinically relevant improvements. Fourteen additional cases were identified in the literature. Though one patient died due to pre-treatment conditions, all patients but one were discharged home in stable condition. Conclusion: Collectively, these observations are encouraging and provide support for the continued evaluation of PP-007 in advanced clinical trials in severe anemia including H/HVS. The review of published case reports underscored the potential of Sanguinate to reduce early mortality. Adverse effects included transient hypertension, lethargy, dizziness, and troponin elevation. These findings highlight the need for continued research and funding of blood alternatives to improve outcomes when standard blood transfusions are unavailable or contraindicated. Full article

Background/Objectives: Prone positioning is a key strategy to improve oxygenation in ARDS patients, particularly used during the COVID-19 pandemic. However, its impact on visual function remains poorly investigated. This study assesses the effect of prone positioning on self-perceived visual acuity and functional vision in ARDS patients after ICU discharge. Methods: A single-center observational study was conducted at Santo Stefano Hospital (Prato, Italy) from March 2020 to April 2023. We included adult COVID-19 ARDS patients, ventilated invasively, and subjected to at least one prone positioning cycle. Patients with pre-existing visual disorders were excluded. Visual function was evaluated through the CATQUEST-9SF questionnaire administered via telephone follow-up. Rasch analysis was applied to generate a linear visual function scale. Logistic regression was used to identify predictors of reduced visual function. Results: Out of 300 ICU admissions, 182 met the inclusion criteria, and 39 completed the follow-up. Older age (OR 1.148, p < 0.05), female sex (OR 0.066, p < 0.05), and increased number of prone cycles (OR 3.576, p < 0.05) were significantly associated with reduced visual function. The model’s predictive performance was excellent (AUC = 0.8997). Conclusions: Prone positioning improves respiratory outcomes but may have unintended visual consequences. Monitoring visual function should be integrated into ICU follow-up programs to mitigate long-term visual impairment. Full article

Background/Objectives: The management of patients with severe systemic comorbidities undergoing radiologic interventional procedures presents a significant challenge for anesthesiologists. Selecting an appropriate combination of anesthetic drugs is crucial to ensure a safe, painless procedure, facilitate rapid recovery, and minimalize complications. Here, we present a case of a 68-year-old female patient of ASA V status with a history of diabetes, coronary artery disease, and severe chronic obstructive pulmonary disease due to lung emphysema and dependence on a home oxygenator, requiring sedation for CT-guided percutaneous drainage of the aortic graft infection. Methods: After on-site emergent patient preparation and several position adjustments, sedation was initiated and maintained using continuous infusions of remimazolam and esketamine. Results: Throughout the procedure, the patient remained sedated, comfortable, and free of unwanted movements. The patient was hemodynamically stable and maintained oxygen saturation between 92 and 96%. Conclusions: In our opinion, the combination of remimazolam and esketamine demonstrated an effective and safe profile for procedural sedation. This approach holds the potential to influence standard operating protocols, particularly for patients with severe and multiple comorbidities requiring personalized anesthetic management. Full article

Objectives: Comparative analyses of anesthetic agents on mutants with altered anesthetic sensitivity remain limited in the current literature. This study examines the sensitivity of various Drosophila melanogaster wild-type strains and mutants to the volatile anesthetics chloroform and isoflurane. We utilized recently identified mutants in ion channel-encoding genes and others historically selected for anesthetic resistance, such as AGAR (autosomal general anesthesia resistant) and har (halothane-resistant). Method: Based on the principles of the conventional inebriometer assay used to isolate these mutants, we developed a new, simpler method to measure the anesthetic response in these flies. Results: Interestingly, we discovered that wild-type flies exhibit varying levels of anesthetic resistance. Contrary to previous reports, AGAR and har mutants showed little resistance to anesthesia using our method. Several ion channel mutants displayed increased resistance or sensitivity. Across all strains, isoflurane was more potent than chloroform. To ensure objectivity, all experiments were conducted double-blind. These findings highlight the variability in anesthetic sensitivity among both wild-type and mutant flies and underscore the importance of assay design in assessing resistance. Full article