Anesthesiology and Perioperative Science最新文献

{"title":"Relationships in anesthesia work areas between contamination measured as colony-forming units, Staphylococcus aureus detection, and S. aureus transmission","authors":"Arnav Bhushan,&nbsp;Franklin Dexter,&nbsp;Carmen Brindeiro,&nbsp;Randy W. Loftus,&nbsp;Unyime Ituk","doi":"10.1007/s44254-026-00169-y","DOIUrl":"10.1007/s44254-026-00169-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Earlier, patients developed surgical site infection for 2.0% of cases without <i>Staphylococcus aureus</i> transmission through anesthesia work areas, 11% with <i>S. aureus</i> transmitted susceptible to prophylactic antibiotic, and 18% with transmission of antibiotic-resistant isolates. A randomized trial and an effectiveness study both found that anesthesiologists who used basic preventive measures (e.g., alcohol releasing intravenous caps) and received feedback on colony-forming units per surface area sampled (CFU) had reduced <i>S. aureus transmission</i> and postoperative healthcare-associated infections. We used prospectively collected data to evaluate whether CFU would be a reliable criterion for hospitals to assess anesthesiologists’ contributions to postoperative infections.</p><h3>Methods</h3><p>During the summer of 2025, reservoirs (e.g., anesthetist’s hands at case start/end) were sampled during 81 cesarean delivery cases performed in the same operating room. There were ≤ 15 reservoirs sampled per case.</p><h3>Results</h3><p>52/1016 reservoir samples had <i>S. aureus</i> detected, more often with greater CFU (<i>P</i> = 0.0063). The 159/1016 samples with &lt; 100 CFU had no <i>S. aureus</i>. Total CFU of all reservoirs for each case to total <i>S. aureus</i> isolates was 2.50 × 10⁹ per <i>S. aureus</i> (standard error 0.53 × 10⁹, <i>N</i> = 81 cases). CFU and <i>S. aureus</i> transmission were uncorrelated (all 15 reservoirs’ unadjusted <i>P</i> ≥ 0.12, Holm-Bonferroni <i>P</i> &gt; 0.99).</p><h3>Conclusions</h3><p>With substantive contamination (≥ 100 CFU), so few isolates are <i>S. aureus</i> that surrogate measures of insufficient disinfection (e.g., ATP bioluminescence) are inaccurate markers both of <i>S. aureus</i> isolation and transmission. The lack of association between contamination and transmission shows that feedback on CFU provides information on the effectiveness of disinfection, not on <i>S. aureus</i> transmission.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00169-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147642580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Neurophysiological differences between dexmedetomidine sedation and natural sleep across the rodent lifespan: implications for aging and perioperative brain health","authors":"Morgan J. Siegmann,&nbsp;Daniel P. Zachs,&nbsp;Jonathan D. Kenny,&nbsp;Arianna R. S. Lark,&nbsp;Fayaz A. Mir,&nbsp;Eric D. Melonakos,&nbsp;Mohsen Hozan,&nbsp;Sarah Toledano,&nbsp;Rebecca R. Goldblum,&nbsp;Yang Liu,&nbsp;Michael A. Nolan,&nbsp;Gabriella Cohen,&nbsp;Jinyoung Choi,&nbsp;Christian G. White,&nbsp;Eliza A. Crowley,&nbsp;Abigail Hardy Carpenter,&nbsp;Bryton A. Toro,&nbsp;Channing E. Syme,&nbsp;Emery N. Brown,&nbsp;Christa J. Nehs","doi":"10.1007/s44254-026-00168-z","DOIUrl":"10.1007/s44254-026-00168-z","url":null,"abstract":"","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00168-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147606545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"A systematic review and meta-analysis on ketamine use and postoperative delirium in older patients undergoing spine or orthopedic surgery\"","authors":"Zainab Mahnoor,&nbsp;Habib Ullah,&nbsp;Hifza Khalid","doi":"10.1007/s44254-026-00167-0","DOIUrl":"10.1007/s44254-026-00167-0","url":null,"abstract":"","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00167-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147561520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of perioperative remote ischemic conditioning on postoperative delirium and cognitive outcomes: a systematic review and meta-analysis of randomized controlled trials","authors":"Kaden Lam,&nbsp;Bogna Anna Drozdowska,&nbsp;Ryan Rosentreter,&nbsp;Alyssa Coloso,&nbsp;Aravind Ganesh","doi":"10.1007/s44254-026-00164-3","DOIUrl":"10.1007/s44254-026-00164-3","url":null,"abstract":"<div><h3>Purpose</h3><p>Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications in surgical patients, which contribute to longer hospital stays, poorer functional outcomes and reduced quality of life. As a potential intervention to address this significant burden, remote ischemic conditioning (RIC)—a low cost, non-invasive therapy involving inducing brief cycles of ischemia and reperfusion—has gained interest. The aim of this systematic review and meta-analysis was to synthesise current evidence on the effects of perioperative RIC on neurocognitive outcomes.</p><h3>Methods</h3><p>This systematic review was conducted in accordance with PRISMA guidelines and was registered with PROSPERO (CRD420251041823). A literature search was performed using MEDLINE, Embase, and Web of science from inception to March 16, 2025. Eligible studies included randomized controlled trials (RCTs) assessing the use of perioperative RIC in human adults (≥ 18 years of age) undergoing surgery. Outcomes of interest included incidence of POD and POCD, and performance on global and domain-specific cognitive measures (e.g., Mini Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA], and Trail Making Test [TMT]). Study screening, data extraction, and risk of bias assessment using the Cochrane risk of bias tool (ROB-2) were performed by independent reviewers. The DerSimonian-Laird model was used to analyze outcomes, while study heterogeneity was evaluated using Cochran’s Q.</p><h3>Results</h3><p>Out of 4,664 records screened, 16 publications from 15 RCTs (2,912 patients) were included. POD incidence at &lt; 30 days (odds ratio [OR]: 0.77, 95% confidence interval [CI] 0.50 to 1.20, <i>n</i> = 6), POCD incidence at &lt; 30 days (OR: 0.79, 95% CI 0.53 to 1.20, <i>n</i> = 5) and POCD incidence at ≥ 30 days groups (OR: 1.06, 95% CI 0.62 to 1.80, <i>n</i> = 3) were not significantly different between groups. Conversely, patients who received RIC had better MoCA (standardized mean difference [SMD] = 0.48, 95% CI 0.19 to 0.76, <i>n</i> = 2), Stroop test part 1 (SMD = 0.38, 95% CI 0.13 to 0.64, <i>n</i> = 2) and part 2 (SMD = 0.26, 95% CI 0.05 to 0.48, <i>n</i> = 2) scores at &lt; 30 days, and better MMSE (SMD = 1.16, 95% CI 0.81 to 1.50, <i>n</i> = 2) scores at ≥ 30 days. RIC did not significantly improve TMT A and B completion time, Digit Symbol Substitution Test scores, Stroop part 3, Verbal Fluency Test semantic/phonemic, digit span forward/backward, and immediate/delayed verbal memory at any time point.</p><h3>Conclusion</h3><p>We found no support for a preventative effect of perioperative RIC on the incidence of short- and long-term post-operative neurocognitive disorders. Whereas there was no clear benefit of RIC for domain-specific cognitive performance, results indicated the intervention may improve global cognitive function, although there were only a limited number of trials in this regard.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00164-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147559717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chinese expert consensus on thoracolumbar interfascial plane block (2025 edition)","authors":"Hui Zhang,&nbsp;Tao Xu,&nbsp;Xiaoping Wang,&nbsp;The Chinese Expert Consensus Writing Group on Thoracolumbar Interfascial Plane Block","doi":"10.1007/s44254-026-00165-2","DOIUrl":"10.1007/s44254-026-00165-2","url":null,"abstract":"<div><p>The thoracolumbar interfascial plane (TLIP) block is a relatively new fascial plane block technique. It involves the injection of local anesthetic into the interfascial plane between the multifidus and longissimus muscles or between the longissimus and iliocostalis muscles in the lumbar region. This approach achieves analgesia by blocking the dorsal rami of the thoracolumbar spinal nerves and their branches that traverse these fascial layers. The TLIP block has been effectively applied in perioperative pain management for spinal surgery and in the treatment of chronic pain conditions. This expert consensus systematically reviews the anatomical basis, blocking techniques, distribution of blockade, choice of local anesthetics, potential complications, and clinical applications of TLIP block, providing evidence-based guidance for its safe and effective clinical use. </p><p><b>Practice guideline registration</b> Practice Guideline Registration for Transparency (PREPARE-2025CN203).</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00165-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147560051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sphenopalatine ganglion neurostimulation for the treatment of cluster headache and migraine: a narrative review","authors":"Hanpu Ji,&nbsp;Yongfang Zhang,&nbsp;Yushu Zhou,&nbsp;Ziyi Zeng,&nbsp;Donglin Xiong,&nbsp;Changyu Jiang,&nbsp;Yuhui Luo","doi":"10.1007/s44254-026-00166-1","DOIUrl":"10.1007/s44254-026-00166-1","url":null,"abstract":"<div><p>Sphenopalatine ganglion (SPG) neurostimulation has emerged as a promising therapy for patients with refractory cluster headache and selected cases of migraine. This narrative review provides a comprehensive synthesis of the current evidence on SPG neurostimulation as a novel therapeutic strategy for headache management. As a key parasympathetic ganglion involved in the trigeminal autonomic reflex, the SPG constitutes a logical and clinically relevant target for neuromodulation in the treatment of severe headache disorders. Clinical evidence supports the efficacy of SPG neurostimulation in aborting acute cluster headache attacks and reducing attack frequency in chronic cases, while limited data suggest potential acute pain relief in migraine. Long-term follow-up indicates sustained efficacy in cluster headache, including improved quality of life and reduced medication use. Adverse effects are mostly mild and transient. Serious complications are rare, but include procedure- or device-related events such as infection or venous injury reported in some studies. Future research should prioritize optimizing electrode placement, stimulation parameters, and long-term outcome evaluation, and further clarify the underlying mechanisms to improve clinical efficacy and safety.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00166-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147441180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural and functional characterization of nucleus accumbens as a potential biomarker of the transition from acute to chronic pain after thoracoscopic surgery","authors":"Yangzi Zhu,&nbsp;Yan Zhang,&nbsp;Shengjie Bai,&nbsp;Meiyan Zhou,&nbsp;Miao Zhang,&nbsp;Xuefeng Pan,&nbsp;Yibing Shi,&nbsp;Liwei Wang,&nbsp;Jun-Li Cao","doi":"10.1007/s44254-026-00163-4","DOIUrl":"10.1007/s44254-026-00163-4","url":null,"abstract":"<div><h3>Purpose</h3><p>Chronic postsurgical pain (CPSP) poses substantial therapeutic and preventive challenges as a common postoperative complication. Identifying predictive biomarkers could enable early intervention in high-risk patients. Preclinical evidence indicates that the nucleus accumbens (NAc) plays a key role in pain chronification, yet human neuroimaging data for CPSP are scarce. This prospective cohort study characterized longitudinal structural and functional alterations in NAc subregions as potential biomarkers for CPSP development after thoracoscopic surgery.</p><h3>Methods</h3><p>Forty patients underwent multimodal magnetic resonance imaging (MRI), including resting-state fMRI, diffusion tensor imaging, T1-weighted imaging) and clinical assessments at acute (≤ 1 week) and chronic (12 weeks) postoperative phases. Based on the diagnostic criteria for CPSP, thirteen patients developed CPSP at 12 weeks.</p><h3>Results</h3><p>CPSP group patients displayed elevated pain catastrophizing scores despite comparable acute pain intensity, indicating maladaptive affective processing. Compared to non-CPSP controls, CPSP patients exhibited significantly reduced slow-5 band fractional amplitude of low-frequency fluctuation (fALFF) in bilateral NAc shell and core subregions during both phases. Decreased functional connectivity between shell and core emerged specifically at 12 weeks. Reduced gray matter density (GMD) and inferomedial atrophy were observed in bilateral NAc of CPSP patients at both timepoints. Early postoperative bilateral NAc GMD and NAc shell fALFF correlated with subsequent pain intensity and predicted CPSP development with high discriminative accuracy, particularly when combined.</p><h3>Conclusions</h3><p>These findings establish NAc structural and functional alterations as promising neuroimaging biomarkers for CPSP susceptibility, revealing a unified neurobiological mechanism underlying affective dysregulation and pain chronification.</p><h3>Trial registration</h3><p>Registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=131606) with No. ChiCTR2100049631, on August 7, 2021.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00163-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147339247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of remimazolam versus midazolam for outpatient dental sedation: a multicenter, randomized, controlled, non-inferiority trial","authors":"Bing Liu,&nbsp;Peijuan Wang,&nbsp;Wei Zhu,&nbsp;Cong Yu,&nbsp;Liyong Jia,&nbsp;Xiaotong Shi,&nbsp;Zhi Wang,&nbsp;Ting Xu,&nbsp;Qian Li,&nbsp;Xudong Yang,&nbsp;Juzhao Zhao,&nbsp;Zhoupeng Zheng,&nbsp;Yong Li,&nbsp;Na Xing,&nbsp;Tiejun Zhang,&nbsp;Nan Zhao,&nbsp;Weifang Shan,&nbsp;Qiumiao Chen,&nbsp;Lina Zhang,&nbsp;Yanyu Liu,&nbsp;Yuyan Sun,&nbsp;Zijian Guo,&nbsp;Qiuyuan Hong,&nbsp;Sulin Tang,&nbsp;Xiaofei Qi,&nbsp;Yanna Li,&nbsp;Li Wang,&nbsp;Zhaohua Ji,&nbsp;Rui Lu,&nbsp;Hui Zhang","doi":"10.1007/s44254-025-00160-z","DOIUrl":"10.1007/s44254-025-00160-z","url":null,"abstract":"<div><h3>Purpose</h3><p>Intravenous sedation is commonly used in routine dental procedures, however, existing agents are associated with limitations in recovery profiles and postoperative complications. Remimazolam has emerged as a promising alternative to address these clinical challenges. This study aimed to establish the non-inferiority of titrated remimazolam compared to midazolam concerning both efficacy and safety endpoints in dental extraction procedures.</p><h3>Methods</h3><p>This randomized, single-blind, parallel-controlled, non-inferiority study was conducted across 13 centers in China from September 2021 to July 2023. A total of 612 eligible patients scheduled for dental extraction were randomized to receive either remimazolam (group R, initial dose of 0.1 mg/kg with 2 mg top-ups; n = 307) or midazolam (group M, initial dose of 0.05 mg/kg with 1 mg top-ups; n = 305). The primary endpoint was the sedation success rate, with a predefined non-inferiority margin of 6%. Secondary outcomes included recovery time, discharge readiness, adverse events, and 24-h postoperative complications.</p><h3>Results</h3><p>Remimazolam demonstrated non-inferior efficacy, achieving success rates of 99.0% compared to 96.1% for midazolam (adjusted risk difference, 95% confidence interval, 2.81 [−1.29 to 6.91]; adjusted <i>P</i> = 0.179). Patients in group R recovered faster and were discharged earlier than patients in group M (5 [3, 6] vs. 7 [4, 10] min, <i>P</i> &lt; 0.001; and 46 [38, 53] vs. 52 [44, 60] min, <i>P</i> &lt; 0.001). Additionally, patients in group R exhibited a significantly lower incidence of 24-h postoperative adverse reactions (4.6% vs. 12.1%; adjusted <i>P</i> = 0.030).</p><h3>Conclusions</h3><p>Titrated remimazolam demonstrates non-inferior sedation success when compared to midazolam while offering a superior recovery profile and improved postoperative safety. These findings indicate that remimazolam may serve as a more advantageous sedative option for outpatient dental procedures, especially in environments requiring rapid patient turnover.</p><h3>Trial registration</h3><p>The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100050822, URL: https://www.chictr.org.cn/showproj.html?proj=133251, Principal investigator: Hui Zhang, date of registration: September 4, 2021).</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00160-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147338470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From sedation to regeneration: the emerging role of Dexmedetomidine in biomaterial-assisted spinal cord repair","authors":"Yi Li,&nbsp;Yi Zhong,&nbsp;Huisheng Zhong,&nbsp;Nayin Zhong,&nbsp;Guanghua Wu,&nbsp;Maolin Zhong,&nbsp;Qinwen Zhong","doi":"10.1007/s44254-025-00152-z","DOIUrl":"10.1007/s44254-025-00152-z","url":null,"abstract":"<div><p>Spinal cord injury (SCI) remains a major clinical challenge with limited regenerative capacity. Dexmedetomidine (DEX), a selective alpha2-adrenergic agonist widely used in anesthesia, has demonstrated neuroprotective effects that extend beyond sedation and analgesia. In parallel, biomaterials offer structural scaffolds and controlled-release platforms capable of modulating the hostile post-injury microenvironment. This narrative review summarizes studies published over the past two decades that were retrieved from PubMed, Web of Science, and other databases using combinations of keywords related to “dexmedetomidine,” “biomaterials,” and “spinal cord injury.” Preclinical and clinical evidence relevant to DEX pharmacology, biomaterial-based delivery, and their potential integration in SCI repair was critically analyzed. Current findings indicate that DEX exerts multifaceted neuroprotection by regulating inflammation, apoptosis, oxidative stress, and endoplasmic reticulum stress, while biomaterials such as hydrogels, nanocarriers, and scaffolds can enhance its local and sustained delivery, thereby improving bioavailability and therapeutic efficacy. Preliminary preclinical evidence suggests that combining DEX with biomaterials augments scaffold bioactivity and mitigates the limitations of systemic administration, although direct clinical validation remains scarce. These emerging strategies highlight a multidisciplinary direction for integrating pharmacology, biomaterials, and clinical translation. Overall, the synergy between DEX and biomaterial-assisted delivery represents a promising conceptual framework for advancing SCI management from symptomatic care toward functional neuroregeneration.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00152-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147336742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating BIS and cerebral oximetry in anesthesia: a narrative review on advanced monitoring for cardiac surgery","authors":"Muqaddas Zahra Sherazi,&nbsp;Suhaini Kadiman,&nbsp;Suneta Sulaiman","doi":"10.1007/s44254-025-00146-x","DOIUrl":"10.1007/s44254-025-00146-x","url":null,"abstract":"<div><p>Monitoring anesthetic depth and cerebral oxygenation is particularly important in cardiac anesthesia, where patients are at increased risk of neurological complications and hemodynamic instability. Conventional monitoring approaches based primarily on vital signs and clinical assessment may lack sensitivity for detecting subtle cerebral hypoxia or inadequate anesthetic depth during complex procedures. This narrative review employed a structured literature search of PubMed, Scopus, and Web of Science to identify relevant clinical studies, reviews, and case reports evaluating the use of Bispectral Index (BIS) monitoring and near-infrared spectroscopy (NIRS)–based cerebral oximetry in cardiac anesthesia. The review focuses on the complementary physiological information provided by BIS, which estimates anesthetic depth from electroencephalographic activity, and cerebral oximetry, which enables continuous assessment of regional cerebral oxygenation. Evidence from randomized trials and observational studies suggests that BIS-guided anesthesia is associated with a reduced incidence of intraoperative awareness, shorter extubation times, and decreased intensive care unit length of stay, while defined cerebral oximetry thresholds are consistently linked to postoperative cognitive dysfunction and adverse neurological outcomes. When used together, BIS and NIRS may facilitate earlier recognition of inadequate sedation, cerebral hypoperfusion, and global physiological compromise during cardiopulmonary bypass, with case reports highlighting critical scenarios such as “triple low” states and refractory cerebral desaturation. The review also proposes a conceptual framework and an interim standard operating procedure to guide integrated use of these modalities in clinical practice. Important limitations are discussed, including interindividual pharmacologic variability, sensor-related artifacts, and patient-specific heterogeneity, which contribute to variability in signal interpretation. Emerging directions such as adaptive algorithms, multimodal neuromonitoring platforms, and wireless technologies integrated into Enhanced Recovery After Surgery pathways are also considered. Overall, although BIS and cerebral oximetry each provide incomplete information when applied in isolation, their combined use offers a potentially synergistic neuromonitoring strategy in cardiac anesthesia. The current evidence base, however, remains heterogeneous, underscoring the need for large-scale, methodologically robust studies to clarify outcome benefits and inform standardized implementation.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00146-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147336741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}