Background/Objectives: Monitored anesthesia care is increasingly used for transfemoral transcatheter aortic valve implantation (tf-TAVI), but the optimal sedative regimen remains uncertain. We compared remimazolam with dexmedetomidine during tf-TAVI. Methods: In this single-center randomized trial, 34 patients were assigned 1:1 to remimazolam or dexmedetomidine. Primary outcomes were the number of intraoperative hypotensive episodes, defined as mean arterial pressure <65 mmHg requiring vasopressor treatment, and cumulative phenylephrine and norepinephrine doses. Secondary outcomes included hemodynamic and physiological variables, regional cerebral oxygen saturation (rSO₂), arterial blood gases, recovery time, surgeon requests for deeper sedation, and procedural outcomes. Longitudinal variables were analyzed using generalized estimating equations with Holm adjustment for time-specific comparisons. Results: No significant between-group differences were detected in intraoperative hypotensive episodes or cumulative phenylephrine and norepinephrine doses, and no significant group-by-time interactions were observed for blood pressure. Both left and right rSO₂ showed significant group-by-time interactions, with higher remimazolam values at selected time points after Holm adjustment. Arterial carbon dioxide tension was higher and arterial pH lower with remimazolam immediately before rapid ventricular pacing and at procedure completion. Recovery was faster with remimazolam (mean ± standard deviation, 13.5 ± 7.2 vs. 32.4 ± 12.5 min; p < 0.001), and surgeon requests for deeper sedation were less frequent (11.8% vs. 76.5%; p < 0.001). Conclusions: Remimazolam was associated with faster recovery and fewer surgeon requests for deeper sedation; however, the trial was not designed or powered to establish equivalence for hypotensive episodes, vasopressor requirements or hemodynamic outcomes.

I-gel has been used in various clinical situations. The study investigated alterations in respiratory parameters following a stepwise lung recruitment maneuver (LRM) using the i-gel. The research involved 60 patients classified as American Society of Anesthesiologists class I-II, aged 30 to 75 years, undergoing elective urologic surgery. Various respiratory parameters, including lung compliance, airway resistance, leak volume, airway pressure, and oxygen reserve index, were recorded at different time points: before LRM, immediately after LRM, and at 5, 15, and 30 minutes after LRM, as well as at the end of the surgery. The primary outcome was to assess an improvement in lung compliance. Dynamic lung compliance (mean ± SD) was significantly increased from 49.2 ± 1.8 to 70.15 ± 3.2 mL/cmH ₂ O ( P  < .05) after LRM. Static lung compliance (mean ± SD) was increased considerably from 52.4 ± 1.7 to 65.0 ± 2.5 mL/cmH ₂ O ( P  < .05) after the LRM. Both parameters maintained a statistically significant increased status for a certain period compared to baseline despite a decreased degree of increment. Airway resistance (mean ± SD) was significantly reduced after the LRM from 12.05 ± 0.56 to 10.41 ± 0.64 L/cmH ₂ O/s ( P  < .05). Stepwise LRM using i-gel may improve lung compliance and airway resistance. Repeated procedures could lead to prolonged improvements in respiratory parameters.

Adductor canal block (ACB) is widely used for perioperative analgesia in knee surgery because it provides effective pain control while preserving quadriceps muscle strength. With the increasing use of ultrasound-guided regional anesthesia, interest has expanded beyond conventional morphologic imaging toward quantitative assessment of peripheral nerve function and biomechanics. Shear wave elastography (SWE) is an emerging ultrasound-based technique that enables real-time quantification of tissue stiffness and has recently gained attention in peripheral nerve evaluation. Previous SWE studies have primarily focused on chronic neuropathic conditions, including entrapment neuropathy and diabetic neuropathy, in which increased nerve stiffness is commonly observed. However, emerging observations suggest that peripheral nerve stiffness may dynamically decrease following regional anesthesia procedures such as ACB. This finding raises the possibility that nerve stiffness reflects not only chronic structural pathology but also transient physiologic and biomechanical modulation. Potential mechanisms underlying reduced stiffness after ACB include perineural hydrodissection, decreased fascial compression, sympathetic blockade-induced vasodilation, altered intraneural pressure, and changes in surrounding muscle tension. Because the saphenous nerve within the adductor canal is superficial and consistently visualized under ultrasound guidance, ACB represents an attractive model for investigating dynamic changes in peripheral nerve biomechanics. This narrative review summarizes current evidence regarding SWE assessment of peripheral nerves and discusses the potential implications of dynamic stiffness changes after regional anesthesia. We review the biomechanical principles of SWE, factors affecting nerve stiffness, current evidence in neuropathic and perioperative settings, technical limitations, and future clinical applications. Understanding the dynamic behavior of peripheral nerve stiffness may expand the role of SWE from a diagnostic tool for neuropathy to a quantitative biomarker for regional anesthesia and perioperative nerve physiology.

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly encountered in pain practice, but reported pain improvement may reflect direct antinociception, weight loss, metabolic change, or disease-specific effects. This structured narrative review examined these possibilities and relevant safety issues. Methods: PubMed/MEDLINE, Embase, and Web of Science Core Collection were searched through 15 May 2026. Peer-reviewed human studies, key mechanistic preclinical studies, systematic reviews and meta-analyses, and professional guidance relevant to pain outcomes or procedural safety were considered. Metabolic-only and non-peer-reviewed reports were excluded, and human pain-primary evidence was prioritized. Results: Preclinical data support plausible mechanisms involving spinal microglia, interleukin-10, beta-endorphin, neuroinflammation, and sensory-neuron signaling, but direct analgesic efficacy at systemic clinical doses has not been demonstrated. In STEP 9 (n = 407), mean WOMAC pain scores at 68 weeks changed from baseline by −41.7 points with semaglutide 2.4 mg and −27.5 points with a placebo; body weight changed by −13.7% and −3.2%, respectively. Liraglutide produced additional weight loss without superior knee-pain reduction. Diabetic peripheral neuropathy evidence was mainly structural or neurophysiologic; idiopathic intracranial hypertension and ROSE-010-treated irritable bowel syndrome showed disease-specific signals, whereas fibromyalgia- and opioid-related findings remained observational or hypothesis-generating. Gastrointestinal dysmotility, reduced intake, and lean-mass loss may offset functional benefits. Conclusions: GLP-1RAs are not established analgesics. Current human signals are best interpreted as indirect metabolic–functional or disease-specific effects. Future trials should use validated pain-primary outcomes, control for weight loss, and monitor treatment-related harms.

Shoulder surgery often requires effective regional analgesia, but interscalene brachial plexus block, the current reference technique, is frequently associated with hemidiaphragmatic paresis and upper-extremity motor blockade. These limitations have driven interest in diaphragm-sparing approaches that preserve respiratory and functional recovery. The sub-omohyoid fascial plane block (SOFPB) is an emerging ultrasound-guided interfascial concept that targets the fascial compartment deep to the omohyoid muscle near the superior trunk–suprascapular nerve complex. In this narrative review, SOFPB is considered as an operational umbrella term for closely related sub-omohyoid approaches rather than as a fully standardized single technique. This review summarizes the anatomical rationale, sonoanatomy, proposed mechanisms, technical considerations, and available clinical evidence for SOFPB and related sub-omohyoid approaches in shoulder surgery. Current evidence suggests that sub-omohyoid approaches may provide clinically meaningful analgesia through suprascapular nerve involvement, partial superior trunk coverage, and variable interfascial spread while potentially reducing phrenic nerve exposure compared with conventional interscalene block. However, direct evidence remains limited and heterogeneous, with inconsistent nomenclature, variable injectate volumes, and insufficient standardized assessment of diaphragmatic function, motor preservation, and patient-centered outcomes. Cadaveric dye studies provide anatomical plausibility but should be interpreted as indirect and hypothesis-generating evidence rather than proof of clinical efficacy or respiratory safety. Therefore, SOFPB should currently be regarded as a promising but unvalidated addition to the spectrum of diaphragm-sparing shoulder blocks rather than a replacement for established techniques. Future anatomical imaging studies, dose-finding trials, and head-to-head randomized comparisons are needed to define its optimal role in contemporary shoulder regional anesthesia.