The individual and social burdens associated with chronic pain have been escalating globally. Accurate pain measurement facilitates early diagnosis, disease progression monitoring and therapeutic efficacy evaluation, thus is a key for the management of chronic pain. Although the “golden standards” of pain measurement are self-reported scales in clinical practice, the reliability of these subjective methods could be easily affected by patients’ physiological and psychological status, as well as the assessors’ predispositions. Therefore, objective pain assessment has attracted substantial attention recently. Previous studies of functional magnetic resonance imaging (fMRI) revealed that certain cortices and subcortical areas are commonly activated in subjects suffering from pain. Dynamic pain connectome analysis also found various alterations of neural network connectivity that are correlated with the severity of clinical pain symptoms. Electroencephalograph (EEG) demonstrated suppressed spontaneous oscillations during pain experience. Spectral power and coherence analysis of EEG also identified signatures of different types of chronic pain. Furthermore, fMRI and EEG can visualize objective brain activities modulated by analgesics in a mechanism-based way, thus bridge the gaps between animal studies and clinical trials. Using fMRI and EEG, researchers are able to predict therapeutic efficacy and identify personalized optimal first-line regimens. In the future, the emergence of magnetic resonance spectroscopy and cell labelling in MRI would encourage the investigation on metabolic and cellular pain biomarkers. The incorporation of machine learning algorithms with neuroimaging or behavior analysis could further enhance the specificity and accuracy of objective pain assessments.

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Background: Neuromuscular blocking agents dose-dependently precipitate residual neuromuscular blockade and postoperative respiratory complications. The introduction of sugammadex allowed for reversal of even deep neuromuscular blockade and might have provoked more liberal use of neuromuscular blocking agents. The authors investigated whether the introduction of sugammadex led to higher intraoperative rocuronium doses and whether this impacted postoperative respiratory complications. Methods: A total of 163,402 adult patient cases who underwent general anesthesia and received exclusively rocuronium at an academic medical center between 2010 and 2024 were included. Interrupted time series analysis adjusted for patient and procedural characteristics was applied to assess changes in cumulative intraoperative rocuronium doses (milligrams per kilogram body weight) after sugammadex introduction in September 2016. Rocuronium-associated risks of postoperative respiratory complications (postextubation desaturation less than 90%, 7-day reintubation or emergency noninvasive ventilation) and effect modification by use of sugammadex and qualitative (twitch count) versus quantitative (train-of-four ratio) neuromuscular monitoring were evaluated. Reported odds ratios represent the dose–response association (per 1 mg/kg rocuronium increase) within the respective subgroup of patient cases. Results: After a stable baseline (−0.01 mg/kg per year between January 2010 and August 2016; 95% CI, −0.05 to 0.03 mg/kg; P = 0.58), rocuronium doses increased by 0.05 mg/kg annually after introduction of sugammadex (95% CI, 0.03 to 0.07 mg/kg; P < 0.001) from (mean ± SD) 0.83 ± 0.49 mg/kg in August 2016 to 1.20 ± 0.65 mg/kg in January 2024. A total of 9,101 of 108,317 patient cases (8.4%) experienced postoperative respiratory complications. Rocuronium was dose-dependently associated with higher postoperative respiratory complication risks, which was most pronounced among patient cases receiving neither sugammadex nor neuromuscular monitoring (adjusted odds ratio [OR _adj ], 1.99 per 1 mg/kg; 95% CI, 1.82 to 2.18; P < 0.001). This association was attenuated when sugammadex was administered (n = 42,141; median dose, 200 mg; interquartile range, 200 to 300 mg; OR _adj , 1.08 per 1 mg/kg; 95% CI, 1.01 to 1.16; P = 0.023; P for interaction < 0.001) and abolished with quantitative (n = 25,564; OR _adj , 10.94 per 1 mg/kg; 95% CI, 0.85 to 1.03; P = 0.19; P for interaction < 0.001) but not qualitative neuromuscular monitoring (n = 49,045; OR _adj , 1.10 per 1 mg/kg; 95% CI, 1.02 to 1.18; P = 0.017; P for interaction < 0.001). Conclusions: Sugammadex introduction was followed by a 45.1% increase in rocuronium doses. While sugammadex attenuated the risk of postoperative respiratory complications, it was completely abolished only with quantitative neuromuscular monitoring.

Background: Junior anaesthesiologists often find it difficult to gain the trust of surgeons, possibly because of their limited experience and unfamiliarity with surgeons. Therefore, they can face pressure when navigating disagreements with senior surgeons. We investigated whether and how differences in anaesthesiologist-surgeon seniority might impact Methods: This was a sequential explanatory, mixed-methods evaluation conducted at a general hospital, comprising a retrospective case-control study followed by semi-structured interviews. In the quantitative phase, the case group included surgical patients who experienced anaesthesia-related adverse events. The control group was randomly selected from surgical patients without adverse events, matched to the case group by surgeon, surgery, and surgery year. The exposure was the differences in work experience between anaesthesiologists and surgeons. For the qualitative phase, participants were recruited from attending anaesthesiologists using a theoretical sampling strategy, and a Results: The quantitative study included 390 patients in the case group and 1560 patients in the control group. After controlling for confounders, we did not find a significant association between differences in anaesthesiologist-surgeon seniority and odds of anaesthesia-related adverse events (adjusted odds ratio 1.00, 95% confidence interval 0.98-1.01, P1/40.634). In cases of disagreements among surgeons, anaesthesiologists primarily based clinical decisions on the po

Delirium is a frequent and often detrimental postoperative complication that may be precipitated by perioperative inflammation. Packed red blood cell (PRBC) transfusions are important to maintain adequate oxygen delivery to ensure cerebral oxygenation, but can trigger inflammatory responses. This study aimed to evaluate the association between intraoperative PRBC transfusions, dependent on transfusion threshold and postoperative delirium. This was a retrospective cohort study analyzing registry data from an academic tertiary-care center in Massachusetts, United States of America. Adult hospitalized patients who underwent general anesthesia for surgery between January 1, 2008 and January 15, 2024 with intraoperative hemoglobin measurements were included. Exclusion criteria included preoperative delirium or cognitive impairment, postoperative ventilation >72 h, an American Society of Anesthesiologists physical status >IV, and missing confounder data. The primary exposure was intraoperative allogeneic PRBC transfusions. The primary outcome was delirium diagnosed within seven days after surgery, identified through diagnostic codes, Confusion Assessment Method, and manual chart review. Among 42,313 included patients, 6970 (16.5%) received intraoperative PRBC transfusions, and 2871 (6.8%) developed postoperative delirium. Patients receiving intraoperative PRBC transfusions had a higher risk of postoperative delirium (adjusted odds ratio 1.15, 95% confidence interval 1.03–1.29, P = 0.016) in a dose-dependent manner. The PRBC transfusion-associated risk of delirium was higher when intraoperative hemoglobin was at higher nadirs (P-for-interaction = 0.002). At nadirs below 7.3 g/dL, PRBC transfusions were not associated with delirium. Intraoperative PRBC transfusions administered at higher hemoglobin nadirs, around 7.3 g/dL, were associated with an increased risk of postoperative delirium, suggesting that greater attention to delirium risk may be warranted among transfused patients and that transfusion triggers during surgery merit careful consideration. Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center.

Background/Objectives: Patients undergoing neoadjuvant therapy have ample time to engage in exercise prehabilitation. This study aimed to describe the current status, facilitators, and barriers of exercise prehabilitation among this population. Methods: This sequential explanatory mixed-methods evaluation was conducted at a general tertiary hospital in Beijing. It included a quantitative survey of patients who received neoadjuvant therapy before cancer surgery and qualitative semi-structured interviews with both patients and physicians. Thematic analysis was conducted using the Capability, Opportunity, and Motivation Behavior model. Results: A total of 269 patients participated in the survey, with a completion rate of 99.6%. Only 52.6% and 1.1% of patients met the standards for aerobic and muscle-strengthening activities, respectively. Fewer than 40% of patients reported learning about exercise prehabilitation from physicians. Patients’ knowledge was associated with meeting aerobic activity standards after adjusting for confounders (Level 1: odds ratio [OR] of 2.06, 95% confidence interval [CI] of 1.02–4.22; Level 2: OR of 2.56, 95% CI of 1.25–5.36). In total, 28 participants were interviewed. Facilitators of patient education on exercise prehabilitation included the surgeon’s ability to gain trust and patients’ prior commitment to exercise. Barriers included physicians’ lack of awareness of exercise benefits, insufficient knowledge or time for patient education, concerns about patients’ exercise ability, lack of referrals to rehabilitation clinics, challenges in follow-up, conflicts with cultural beliefs, and inadequate insurance coverage. Conclusions: This study revealed a lack of physician-led patient education on exercise prehabilitation. Efforts are needed to enhance physician education, implement collaborative clinics, and provide remote supervision.