Search Results (17)

Introduction: Balancing hypnosis and antinociception during general anesthesia remains challenging, as traditional clinical and hemodynamic signs incompletely reflect cortical and nociceptive processing. Electroencephalogram (EEG)-derived indices such as qCON (hypnosis) and qNOX (nociception probability) (Quantium Medical, Barcelona, Spain), as well as their predecessors IoC1 (Index of consciousness) and IoC2 (Angel-6000 A multi-parameter Anesthesia Monitor, Shenzen Weihao Kang Medical Technology Co., Ltd., Shenzen, Guangdong, China), have been developed to provide a dual assessment of anesthetic state. Their clinical role, technical limitations, and impact on drug titration, however, remain incompletely defined. Methods: A structured narrative review was conducted based on studies investigating IoC/qCON and qNOX in the context of anesthetic depth or nociception monitoring. Studies were grouped into three thematic domains: (1) validation against clinical or EEG standards, (2) use in guiding anesthetic or opioid administration, and (3) technical characteristics, including signal delay and pharmacodynamic modeling implications. Results: Sixteen studies met inclusion criteria. Eight validation studies demonstrated that IoC/qCON correlates strongly with clinical sedation scales and established EEG-derived indices such as BIS and entropy. Five interventional studies evaluating drug titration found limited impact of qCON-guided hypnosis control on anesthetic consumption but more consistent effects of qNOX/IoC2 guidance on opioid dosing and intraoperative stability. Three technical investigations showed that qCON exhibits processing delays on the order of tens of seconds that can be accounted for by incorporating monitor lag into pharmacodynamic analyses. Conclusions: qCON and qNOX provide complementary EEG-based indices of hypnosis and cortical nociceptive responsiveness. Evidence supports their validity as indicators of anesthetic brain state but highlights technical limitations, such as processing delay and susceptibility to physiologic factors. Their optimal clinical use lies in multimodal monitoring strategies that integrate EEG besides classic clinical and monitoring parameters. Full article

Introduction: Severe traumatic brain injury (sTBI) frequently coexists with polytrauma and often necessitates damage control neurosurgery (DCNS), where rapid decompression and temporary stabilization take precedence over definitive reconstruction. Within this context, anesthetic management must balance cerebral protection with ongoing resuscitation, yet high-quality DCNS-specific evidence remains limited. Materials and Methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2015–2025) was conducted using MeSH terms and keywords related to neurotrauma, anesthesia, intracranial pressure, and perioperative management. Studies were included if they examined anesthetic or hemodynamic strategies in severe TBI or DCNS and reported relevant clinical or physiologic outcomes. Results: Nineteen articles addressing perioperative strategies for optimizing DCNS outcomes were analyzed. Discussion: Preoperative care emphasizes hemodynamic stabilization and permissive hypertension, damage control resuscitation including massive transfusion protocols, optimization of cerebral perfusion pressure (CPP) and neuromonitoring, and the use of hyperosmolar therapy. Transexamic acid can be used in sTBI safely but with unclear improvement in outcomes. Intraoperatively, propofol-based total intravenous anesthesia is generally preferred over volatile agents due to favorable effects on intracranial pressure (ICP), cerebral blood flow (CBF), autoregulation, and emergence. While historically contraindicated, ketamine and etomidate are now increasingly used as hemodynamically protective induction agents. Analgesic and sedative strategies prioritize dexmedetomidine and carefully titrated opioids to minimize respiratory depression and reduce postoperative complications. CPP and ICP-directed management relies on individualized blood pressure targets, vasopressor selection, lung-protective ventilation, and strict temperature control. Conclusions: Emerging evidence has suggested the benefit of DCNS for patient survival. Overall, perioperative care is guided largely by physiology and extrapolation, highlighting the need for standardized protocols. Full article

Background: Remimazolam tosilate is a novel, ultra-short-acting benzodiazepine. To address the unmet clinical need for safe and controllable general anesthetic options in children and adolescents, both top-down (i.e., population pharmacokinetics—PopPK) and bottom-up (i.e., physiologically based PK—PBPK) modeling approaches were combined to leverage their respective strengths for dose selection in children and adolescents aged 3–18 years. Methods: Pooled PK data from adult studies were used to develop and verify the adult PopPK and PBPK models. The PopPK model included allometric scaling to describe body weight effects, while the PBPK modeling incorporated the age-dependent physiological and metabolic ontogeny. Potential covariates and intrinsic factors influencing remimazolam exposure were assessed. Both models were then applied to simulate PK and derive exposure metrics in 3–18-year-old children and adolescents. The predictions from both approaches were used to support pediatric dose selection using an adult-matching exposure approach. Results: The PopPK and PBPK model simulations yielded consistent exposure predictions and converged on the same recommended dosing regimens for the pediatric population, providing mutual confirmation of model reliability. Both models indicated that the proposed regimens of remimazolam would achieve systemic exposures in children and adolescents (3–18 years) comparable to those in adults receiving an induction dose of 0.3 mg/kg followed by maintenance infusions of 1.0 or 3.0 mg/kg/h. Two pediatric dosing regimens were recommended: 1. Lower dose group: induction 0.2 mg/kg, initial maintenance 1.0 mg/kg/h, titratable as needed, with a maximum rate of 3.0 mg/kg/h (up to 4.0 mg/kg/h for individuals ≤ 30 kg). 2. Higher dose group: induction 0.3 mg/kg, initial maintenance 2.0 mg/kg/h, titratable as needed, with a maximum rate of 3.0 mg/kg/h (up to 4.0 mg/kg/h for individuals ≤ 30 kg). The model-informed dosing regimens have received regulatory approval from the Center for Drug Evaluation (CDE) in China and are currently being evaluated in an ongoing clinical trial. Conclusions: The integrated PopPK–PBPK approach supports evidence-based dosing recommendations of remimazolam for general anesthesia in children and adolescents aged 3–18 years and provides a reference for dose selection in future clinical studies. Full article

Background: Tidal volume (VT) during mechanical ventilation in dogs varies considerably between individuals, but the contributions of airway dead space (VDaw) and alveolar tidal volume (VTalv) to this variability remain unclear. Methods: In this prospective, observational, exploratory study, 95 anesthetized dogs receiving volume-controlled ventilation with VT initially set at 15 mL kg⁻¹ of predicted ideal body weight (IBW) were analyzed. When necessary, TV was titrated within a predetermined quasi-static driving pressure range (i.e., >6 and <10 cmH₂O) to maintain normocapnia. Volumetric capnography was used to measure expired tidal volume (VTe), VDaw, and VTalv. The relative contributions of VDaw and VTalv to VTe variability were assessed across body sizes and breeds, including brachycephalic dogs. In addition, the effects of ideal body weight (IBW) on the variability of VTe, VDaw, and VTalv were evaluated. Results: VTalv accounted for a greater proportion of the observed VTe variability than VDaw, indicating that interindividual differences in VTalv were the primary determinant of VT variability. Brachycephalic dogs exhibited smaller VDaw but similar VTalv compared with non-brachycephalic dogs. Ideal body weight was correlated with proportionally higher VDaw and lower VTalv. Recumbency was not correlated with the observed variability in VT components. Conclusions: VTalv was the main determinant of VT variability among anesthetized dogs, and the brachycephalic breeds studied exhibited smaller VDaw but similar VTalv compared with non-brachycephalic breeds. These findings highlight the importance of considering VTalv and breed-specific airway anatomy when individualizing ventilatory settings. Full article

Background/Objectives: Emergency surgical patients are at increased risk of acute postoperative delirium. Processed EEG monitoring, such as entropy indices and burst suppression ratio (BSR), may optimize anesthetic dosing, yet their role in non-elective surgery remains underexplored. This retrospective cohort study aimed to examine whether entropy monitoring and intraoperative burst suppression are associated with the incidence of early postoperative delirium during the first 72 h after emergency surgery. Methods: Adult patients undergoing emergency surgery between March 2022 and March 2024 were classified into two groups based on anesthesia records: the entropy-monitored group (EG) and the standard care group without processed EEG (SG). Demographic, intraoperative, and cognitive data (NEECHAM scores during the first 72 h) were extracted from institutional perioperative records. The primary outcome was postoperative delirium (NEECHAM ≤ 24), with secondary analyses examining anesthetic exposure, burst suppression, and intraoperative hemodynamics. Results: Entropy-monitored patients received lower sevoflurane and fentanyl doses and exhibited improved hemodynamic stability, including fewer hypotensive episodes and lower norepinephrine requirements. Early postoperative cognitive dysfunction (NEECHAM ≤ 24) was more frequent among patients with intraoperative burst suppression, with BSR > 15% or suppression duration > 6 min strongly associated with cognitive decline within the first 72 h. Conclusions: In this retrospective cohort, entropy-guided anesthesia was associated with more precise anesthetic titration and more stable hemodynamic parameters. Burst suppression characteristics may serve as indicators of neurocognitive vulnerability rather than solely reflecting direct effects of anesthetic dosing. These results support the use of processed EEG monitoring in emergency surgery, though prospective studies are needed to confirm these findings. Full article

Background: Left lateral tilt is traditionally recommended during cesarean delivery to reduce aortocaval compression and maintain maternal hemodynamic stability; however, with the widespread adoption of prophylactic vasopressor strategies recommended by current guidelines, the incremental benefit of routine tilt remains uncertain. Methods: We conducted a prospective, nonrandomized observational comparative study at the University Hospital Bratislava including 99 women undergoing elective cesarean delivery under spinal anesthesia. Participants were managed either with a standard ~15° left lateral tilt (n = 41) or in a flat supine position without tilt (n = 58), according to the day of surgery and routine anesthesiologist practice; all other anesthetic and surgical procedures were identical. A prophylactic norepinephrine infusion was initiated at 0.05 µg/kg/min and titrated to maintain systolic arterial pressure at 90–100% of baseline. The primary outcome was the average norepinephrine infusion rate (µg/kg/min) from induction of spinal anesthesia to neonatal delivery. Secondary outcomes included total norepinephrine dose to delivery, dose normalized per kilogram, and neonatal outcomes (Apgar scores and umbilical arterial blood gas parameters). Results: The median norepinephrine infusion rate was 0.03 µg/kg/min in both groups (tilt: IQR 0.01–0.04 vs. no-tilt: IQR 0.02–0.04; p = 0.325). Total norepinephrine dose to delivery (20 [15–35] µg; p = 0.89) and dose per kilogram (0.25 [0.15–0.33] µg/kg vs. 0.34 [0.17–0.44] µg/kg; p = 0.10) were also comparable. Neonatal outcomes, including Apgar scores and umbilical arterial blood gas parameters, did not differ significantly between groups. In a multivariable regression sensitivity analysis adjusting for maternal and procedural covariates, table tilt was not independently associated with norepinephrine requirements. Conclusions: In parturients undergoing cesarean delivery under spinal anesthesia with prophylactic norepinephrine infusion, a 15° left lateral tilt did not reduce vasopressor requirements or improve neonatal outcomes. Routine maternal tilt therefore appears unnecessary for hemodynamic optimization in this setting, and patient positioning can be individualized without compromising maternal or neonatal safety. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) remains a frequent and clinically relevant complication following open lumbar discectomy (OLD) under general anesthesia. The present study represents a secondary, post hoc analysis of a randomized controlled trial originally designed to investigate the effects of infiltration anesthesia (IA) on postoperative pain perception and opioid consumption. The objective of this analysis was to explore the incidence of PONV in patients undergoing OLD under adequacy of anesthesia (AoA)-guided general anesthesia, with or without IA. Methods: This secondary analysis included 94 patients undergoing OLD under AoA-guided general anesthesia with fentanyl titration based on the surgical pleth index (SPI). Patients were randomized to receive IA with 0.2% ropivacaine (RF) or bupivacaine (BF) plus 50 µg fentanyl, or no IA (control). PONV was assessed as early (in the post-anesthesia care unit), late (in the neurosurgical ward), and overall (within 48 h postoperatively). Opioid consumption and Apfel risk scores were also analyzed. All analyses related to PONV were exploratory. Results: PONV occurred in 12.8% of patients, with no significant differences between study groups. Postoperative morphine consumption was significantly lower in the RF group than in the control group (2.7 ± 5.3 mg vs. 7.1 ± 5.9 mg; p < 0.05). Higher pre-induction SPI values were observed in patients who experienced early PONV (73.1 ± 9.7 vs. 59.5 ± 17.2; p < 0.05); however, this exploratory finding requires confirmation in larger studies. Conclusions: In this secondary, post hoc analysis, no significant differences in PONV incidence were observed between anesthetic groups in patients undergoing OLD under AoA-guided general anesthesia. The observed association between pre-induction SPI values and early PONV should be interpreted cautiously and requires confirmation in adequately powered prospective studies. Full article

Background/Objectives: Severe aortic stenosis (AS) poses major anesthetic challenges because cardiac output is highly dependent on preload and heart rate, and abrupt afterload reduction or tachycardia may precipitate ischemia and cardiovascular collapse. Coexisting myelodysplastic syndrome (MDS) with severe thrombocytopenia further increases the perioperative bleeding risk, which we considered particularly important in the anesthetic planning for this patient. We report a case of laparoscopic anterior resection in a patient with severe AS and thrombocytopenia, highlighting a transfusion strategy adjusted according to the patient’s response and remimazolam-based anesthesia. To the best of our knowledge, there have been no previous reports describing remimazolam-based total intravenous anesthesia achieving stable hemodynamics without vasopressor support in a patient with severe AS and MDS–related thrombocytopenia. Method: A 78-year-old man with previously diagnosed MDS and chronic pancytopenia, whose baseline platelet counts (PLTs) ranged from 20,000 to 40,000/μL, was found to have severe AS (aortic valve area, 0.73 cm²; mean pressure gradient, 42 mmHg) during preoperative evaluation for laparoscopic anterior resection. After platelet transfusions titrated to his response, the patient’s PLT increased to 93,000/μL before surgery. Anesthesia was induced and maintained with remimazolam and remifentanil, which were chosen to prevent afterload reduction associated with propofol. Results: Hemodynamics, including arterial pressure, cardiac index, systemic vascular resistance index, and cerebral oxygen saturation, remained stable without vasopressor support. Transient systolic hypertension during surgical stimulation was controlled using remifentanil titration and esmolol. Recovery and the postoperative course were uneventful, and the patient was discharged in a stable condition. Conclusions: Remimazolam-based total intravenous anesthesia can provide hemodynamic stability without vasopressors in high-risk patients with severe AS, and a transfusion strategy adjusted step by step according to the patient’s response can be effective for optimizing PLTs while minimizing the transfusion-related risks of MDS-associated thrombocytopenia. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) are common after general anesthesia (GA) and, in patients undergoing vitreoretinal surgery, may be triggered by the oculocardiac reflex (OCR) leading to the oculoemetic reflex (OER). Inadequate dosing of intravenous rescue opioid analgesics may further provoke OCR. Adequacy of Anesthesia (AoA) monitoring enables optimized titration of intravenous rescue opioid analgesics, while preemptive intravenous or peribulbar analgesia may reduce opioid use. This study evaluated the impact of preemptive paracetamol or peribulbar block (PBB) combined with AoA-guided GA on the incidence of PONV, OCR, and OER in patients undergoing vitreoretinal surgery. Methods: A total of 185 patients were randomized to four groups: GA with AoA-guided intraoperative rescue opioid analgesia plus a single intravenous dose of paracetamol 1 g, or PBB using 1% ropivacaine, 0.5% bupivacaine, or a 1:1 mixture of 0.5% bupivacaine/2% lidocaine. Data from 175 patients were analyzed. Results: AoA-guided GA yielded an OCR incidence of 11.4% and PONV incidence of 4%. PBB, regardless of anesthetic solution, did not significantly reduce intraoperative rescue opioid analgesia requirements or the incidence of PONV, OCR, or OER compared with intravenous paracetamol. Notably, no PONV occurred in patients with three Apfel risk factors (predicted risk ≈ 61%) who received PBB. Conclusions: No overall advantage of PBB over intravenous paracetamol was observed. It may, however, benefit patients at high PONV risk. Full article

Artificial intelligence (AI) enhances anesthesiology by introducing adaptive systems that improve clinical precision, safety, and responsiveness. This review examines the integration of AI in anesthetic practice, with a focus on closed-loop systems that exemplify autonomous control. These platforms integrate continuous physiologic inputs, such as BIS, EEG, heart rate, and blood pressure, to titrate anesthetic agents in real time, providing more consistent and responsive management than manual methods. Predictive algorithms reduce intraoperative hypotension by up to 40%, and systems such as McSleepy demonstrate greater accuracy in maintaining anesthetic depth and shortening recovery times. In critical care, AI supports sedation management, reduces clinician cognitive load, and standardizes care delivery during high-acuity procedures. The review also addresses the ethical, legal, and logistical challenges to widespread adoption of AI. Key concerns include algorithmic bias, explainability, and accountability for machine-generated decisions and disparities in access due to infrastructure demands. Regulatory frameworks, such as HIPAA and GDPR, are discussed in the context of securing patient data and ensuring its ethical deployment. Additionally, AI may play a transformative role in global health through remote anesthesia delivery and telemonitoring, helping address anesthesiologist shortages in resource-limited settings. Ultimately, AI-guided closed-loop systems do not replace clinicians; instead, they extend their capacity to deliver safe, responsive, and personalized anesthesia. These technologies signal a shift toward robotic anesthesia, where machine autonomy complements human oversight. Continued interdisciplinary development and rigorous clinical validation will determine how AI integrates into both operating rooms and intensive care units. Full article

Neuromuscular blocking agents (NMBAs) are essential in intraocular surgeries to improve surgical conditions and ensure optimal ventilation. However, residual blockade can pose significant risks, particularly in pinnipeds due to their unique diving physiology. This case report describes the use of sugammadex for reversing rocuronium and AMG for monitoring neuromuscular block (NMB) in a California sea lion undergoing lensectomy. The objective is to evaluate the feasibility and safety of sugammadex for reversal of rocuronium-induced neuromuscular blockade and acceleromyography (AMG) for monitoring neuromuscular function in pinnipeds, with the goal of improving anesthetic management and recovery. Rocuronium (0.3 mg/kg IV) was used to achieve complete NMB, and an additional 0.1 mg/kg IV was administered to prolong the block. Sugammadex (1 mg/kg IV) reversed the NMB, with recovery within 90 s. Neuromuscular function was monitored using AMG, with the ulnar nerve of the foreflipper as the stimulation site. AMG allowed for an objective assessment of neuromuscular function, ensuring accurate titration of the NMBA and reversal agent. This is the first report documenting the use of sugammadex for the reversal of rocuronium and AMG for neuromuscular monitoring in a sea lion. This successful application highlights the potential of these techniques to improve anesthesia protocols, patient safety, and welfare in marine mammal medicine. Full article

Neuromuscular blocking agents such as atracurium and rocuronium are commonly used during anesthetic procedures in laboratory pigs. However, species-specific dosing guidelines remain limited, leading to reliance on data extrapolated from other species. This prospective, blinded study aimed to determine the equipotent dose for atracurium (A) and rocuronium (R) in laboratory pigs receiving propofol and to compare their cost-effectiveness. Twelve healthy animals were randomly distributed according to the drug administered (n = 6 per group). For both drugs, the infusion rate was adjusted following an up-and-down titration to maintain a train-of-four count between 3 and 4. Group differences were analyzed using the Wilcoxon signed-rank test. The bolus induction dose (mg/kg) was comparable between atracurium (2.3 [1.8–2.6]) and rocuronium (2 [2]), while atracurium was associated with higher costs (CHF/kg: A, 1.122 [0.878–1.366] versus R, 0.208 [0.208–0.208]; p = 0.002725). The maintenance infusion rate (mg/kg/h) was approximately 40% lower for atracurium (2.7 [2.5–2.8]) than for rocuronium (4.5 [4.4–4.5]; p = 0.004922), yet the maintenance cost (CFH/kg/h) remained higher for atracurium (A: 1.30 [1.22–1.37] versus R: 0.47 [0.45–0.47]; p = 0.0043). This study reports higher doses for anesthetized pigs compared to other species and demonstrates that rocuronium offers superior cost-effectiveness compared to atracurium under these experimental conditions. Full article

Background/Objectives: Precisely selected patients require vitreoretinal surgeries (VRS) performed under general anesthesia (GA) when intravenous rescue opioid analgesics (IROA) are administered intraoperatively, despite a risk of adverse events, to achieve hemodynamic stability and proper antinociception and avoid the possibility of intolerable postoperative pain perception (IPPP). Adequacy of anesthesia guidance (AoA) optimizes the titration of IROA. Preventive analgesia (PA) techniques and intravenous or preoperative peribulbar block (PBB) using different local anesthetics (LAs) are performed prior to GA to optimize IROA. The aim was to analyze the utility of PBBs compared with intravenous paracetamol added to AoA-guided GA on the incidence of IPPP and hemodynamic stability in patients undergoing VRS. Methods: A total of 185 patients undergoing vitreoretinal surgery (VRS) were randomly assigned to one of several anesthesia protocols: general anesthesia (GA) with analgesia optimized through AoA-guided intraoperative remifentanil opioid analgesia (IROA) combined with a preemptive single dose of 1 g of paracetamol (P group), or PBB using one of the following options: 7 mL of an equal mixture of 2% lidocaine and 0.5% bupivacaine (BL group), 7 mL of 0.5% bupivacaine (BPV group), or 7 mL of 0.75% ropivacaine (RPV group). According to the PA used, the primary outcome measure was postoperative pain perception assessed using the numeric pain rating scale (NPRS), whereas the secondary outcome measures were as follows: demand for IROA and values of hemodynamic parameters reflecting quality or analgesia and hemodynamic stability. Results: A total of 175 patients were finally analyzed. No studied PA technique proved superior in terms of rate of incidence of IPPP, when IROA under AoA was administered (p = 0.22). PBB using ropivacaine resulted in an intraoperative reduction in the number of patients requiring IROA (p = 0.002; p < 0.05) with no influence on the dose of IROA (p = 0.97), compared to paracetamol, and little influence on hemodynamic stability of no clinical relevance in patients undergoing VRS under AoA-guided GA. Conclusions: PA using paracetamol or PBBs, regardless of LAs used, in patients undergoing VRS proved no advantage in terms of rate of incidence of IPPP and hemodynamic stability when AoA guidance for IROA administration during GA was utilized. Therefore, PA using them seems no longer justified due to the potential, although rare, side effects. Full article

The application of intraoperative neural monitoring (IONM) has been widely accepted to improve surgical outcomes after thyroid surgery. The malfunction of an IONM system might interfere with surgical procedures. Thus, the development of anesthesia modalities aimed at ensuring functional neuromonitoring is essential. Two key issues should be taken into consideration for anesthetic management. Firstly, most patients undergo recurrent laryngeal nerve monitoring via surface electrodes embedded in an endotracheal tube. Thus, advanced video-assisted devices might optimize surface electrode positioning for improved neuromonitoring signaling accuracy. Secondly, neuromuscular blocking agents are routinely used during thyroid surgery. The ideal neuromuscular block should be deep enough for surgical relaxation at excision and recovered enough for an adequate signal f nerve stimulation. Proper neuromuscular block management could be achieved by titration doses of muscle relaxants and reversal agents. Full article

Obesity increases the risk of prolonged emergence from general anesthesia due to the delayed release of anesthetic agents from body fat. This trial aimed to evaluate the effects of sevoflurane and desflurane along with anesthetic depth monitoring on emergence time from anesthesia in obese patients. Adults with a body mass index ≥ 30 kg·m⁻² undergoing laparoscopic sleeve gastrectomy at a medical center were randomized into four groups: sevoflurane or desflurane anesthesia with or without M-Entropy guidance on anesthetic depth in a ratio of 1:1:1:1. In the M-Entropy guidance groups, the dosage of sevoflurane and desflurane was adjusted to achieve response and state entropy values between 40 and 60 during surgery. In the non-M-Entropy guidance groups, the dosage of anesthetics was titrated according to clinical signs. Primary outcome was time to spontaneous eye opening. A total of 80 participants were randomized. Compared to sevoflurane, desflurane anesthesia significantly reduced the time to spontaneous eye opening [mean difference (MD): −129 s; 95% confidence interval (CI): −211, −46], obeying commands (−160; −243, −77), tracheal extubation (−172; −266, −78), and leaving operating room (−148; −243, −54). M-Entropy guidance further reduced time to eye opening (MD: −142 s; 99.2% CI: −276, −8), tracheal extubation (−199; −379, −19), and leaving operating room (−190; −358, −23) in the desflurane but not the sevoflurane group. M-Entropy guidance significantly reduced the risk of agitation during emergence, i.e., risk difference: −0.275 (95% CI: −0.464, −0.086); and number needed to treat: 4. Compared to sevoflurane, using desflurane to maintain general anesthesia accelerated the return of consciousness in obese patients. M-Entropy guidance further hastened awakening in patients using desflurane and prevented emergence agitation. Full article