This Month in Anesthesiology

Abstract

21 Feasibility of a Multicomponent Protocol to Promote Dreaming during Surgical AnesthesiaImage: A. Johnson, Vivo Visuals Studio.Implementation of a treatment bundle consisting of verbal priming, propofol infusion, electroencephalography-guided titration, 10 min or longer of minimization of stimulation, and immediate dream interviews resulted in a high incidence of reported dreaming. Apart from the no-stimulation emergence period component, the implementation was feasible in a clinical situation. Successful implementation of the no-stimulation emergence period dramatically increased the rate of dream recall. Dream recall was correlated with better sleep quality but was unrelated to recovery time and analgesic or antiemetic use in the postanesthesia care unit in a subset of the patients. See the accompanying Editorial on page 1. 72 Efficacy and Safety of Remimazolam Tosylate versus Propofol for Sedation of Postoperative Mechanically Ventilated Patients in Intensive Care Units: A Multicenter, Randomized, Single-blind, Noninferiority, Phase 3 TrialImage: Adobe Stock.This phase 3, single-blind, noninferiority, randomized trial in 29 centers in China enrolled patients undergoing a variety of major surgical procedures who were expected to require postoperative mechanical ventilation for 6 h or more to either propofol or remimazolam infusion titrated to maintain a Richmond Agitation–Sedation Scale score of –2 to +1 during a maximum treatment duration of 24 h. Remimazolam was found to be noninferior to propofol with regard to the primary outcome, sedation success (defined as maintaining target sedation range for 70% or more of drug administration time without rescue sedation) 98.1% versus 96.2%, respectively. 98 Effect of Paroxetine or Escitalopram Coadministered with Oxycodone versus Oxycodone Alone on Ventilation during Hypercapnia: A Randomized Clinical TrialImage: Adobe Stock.Paroxetine and escitalopram, two commonly prescribed selective serotonin reuptake inhibitors (SSRIs), reduce hypercapnic ventilatory response after 21 days of administration, both alone and when coadministered with oxycodone. These findings suggest that SSRIs may exert a class effect on hypercapnic ventilation that persists with chronic use. 135 Prevalence and Risk Factors of Deep Spinal Infection after Single-shot Epidural Injections: A Nationwide Cohort Study of 3.8 Million Pain OutpatientsImage: J. P. Rathmell.Multiple risk factors for deep spinal infection (DSI) highlight the need for careful patient selection and risk stratification—especially in older, comorbid, immunosuppressed patients, and with lumbosacral procedures. Selective nerve root block was associated with a lower risk of DSI. 184 Developing a Framework for Career Fulfillment in Academic Anesthesiology: Findings from a Single-institution Focus Group StudyImage: J. P. Rathmell.This qualitative study provides a novel, faculty-driven conceptual framework—centered on the “purposeful yes”—to help academic anesthesiology faculty intentionally shape their careers for greater fulfillment and retention. By integrating guiding questions that reflect evolving priorities, work–life integration, and strategies for overcoming impostor phenomenon, this study offers actionable steps for long-term satisfaction and tailored career development seldom addressed in previous literature. See the accompanying Editorial on page 4. 147 Cryotherapy and Duration of Inflammatory Pain in MiceImage: Simulated cryoablation image created with ChatGPT 5.2.Two models of acute inflammatory pain in mice (local paw inflammation with complete Freund’s adjuvant and intramuscular acidic saline injection) were used to test the impact of 30- to 60-min water-based hind paw cooling on nociceptive sensitivity, assessed by three behavioral measures for more than 30 days. Cryotherapy, applied using variable timing protocols on the first 3 days after injections, was observed to prolong the duration of pain behavior by approximately two-fold, from approximately 15 days to more than 30 days. Alternate therapies, including heat, menthol, and contrast therapy (alternating heat and cold) did not affect pain resolution. Early injection of exogenous neutrophils into the affected hind paw reversed pain chronification caused by cryotherapy. 195 Defining Perioperative Right Heart Failure in Cardiac Surgery: A Multiparametric Approach to Diagnosis and ManagementImage: From original article.Right heart failure (RHF) is a serious perioperative complication with substantial morbidity and mortality. This Clinical Focus Review introduces a physiologically based framework for perioperative RHF in cardiac surgery, including an updated multiparametric definition, key hemodynamic and echocardiographic findings, comprehensive management and treatment strategies, and future research directions. 215 Beyond Unconsciousness: Optimizing Antinociception during General AnesthesiaImage: From original article.This review examines the evolving concept of intraoperative nociception, its underlying physiologic and neurobiological mechanisms and consequences, and the clinical strategies employed to assess and optimize antinociception regimens. By critically examining basic science and clinical trials, the authors aim to establish a framework for defining appropriate antinociception delivery during general anesthesia, thereby aiming for optimal patient recovery by minimizing early postoperative pain, the development of chronic pain, and other potential long-term complications related to intraoperative nociceptive processing during surgery.