Anesthesiology, October 14 edition

This randomized volunteer study evaluated BIS values and responsiveness across sevoflurane, desflurane, and isoflurane regimens, with selected opioid combinations. BIS50 values ranged from 67.5 to 76.2 and BIS95 values from 49.1 to 63.3; BIS alone had an area under the receiver operating characteristic curve of at least 0.95 for predicting responsiveness. Opioids added to sevoflurane had minimal influence, whereas desflurane produced somewhat lower BIS thresholds.

Impact: The study provides experimentally controlled calibration data for a widely used anesthetic monitor and demonstrates that a single BIS target should not be assumed to represent identical clinical states across volatile agents. This supports more nuanced interpretation of processed electroencephalographic monitoring.

Clinical Implications: BIS can provide useful information about responsiveness during volatile anesthesia, but clinicians should interpret thresholds in the context of the specific anesthetic agent and clinical setting. The findings do not justify applying these values directly to patients under surgical stimulation or to older or medically complex populations.

Future Directions: Clinical studies should validate agent-specific BIS thresholds during surgery, in older and critically ill patients, and under combinations of opioids, neuromuscular blockers, and other anesthetic agents. Research should also examine whether individualized BIS interpretation improves outcomes rather than merely predicting responsiveness.

In this randomized controlled trial, bilateral serratus posterior superior intercostal plane block reduced 24-hour opioid consumption by 20.1 mg morphine milligram equivalents compared with an active comparator targeting both the sternum and drain sites. Pain scores improved from 2 hours onward, and Quality of Recovery-15 scores were 10 points higher, exceeding the minimal clinically important difference. These benefits were observed despite substantial post-randomization exclusions.

Impact: This study compares a relatively broad anatomical regional technique with an active multimodal comparator and demonstrates both opioid reduction and a patient-centered recovery benefit. The effect size exceeded a prespecified clinically important threshold, supporting further evaluation within enhanced recovery pathways.

Clinical Implications: SPSIPB may be considered as a component of multimodal analgesia after median sternotomy, particularly when reducing opioid exposure and improving early recovery are priorities. Adoption should be accompanied by ultrasound-guided training and confirmation in larger, multicenter trials.

Future Directions: Multicenter trials should confirm the analgesic and recovery benefits, evaluate block-related complications and diaphragmatic effects, and compare SPSIPB with other contemporary regional techniques within standardized enhanced recovery protocols.

This systematic review included 50 studies and meta-analyzed 43 datasets, finding a pooled mean intraoperative noise level of 70.7 dB(A), substantially above the World Health Organization recommended hospital exposure level of 35 dB(A). Otolaryngology and orthopaedics had the highest pooled exposures, and surgical specialty significantly predicted mean noise level. The study establishes a quantitative basis for targeted environmental and occupational-safety interventions.

Impact: The paper addresses a pervasive but under-measured occupational and patient-safety hazard and synthesizes data across surgical specialties. Its specialty-specific estimates can guide targeted noise-reduction interventions and future studies linking exposure to clinical performance and patient outcomes.

Clinical Implications: Hospitals should consider routine standardized noise measurement, particularly in otolaryngology and orthopaedic operating rooms. Interventions may include equipment and alarm management, communication protocols, staff education, architectural mitigation, and evaluation of effects on vigilance, communication, and patient safety.

Future Directions: Prospective multicenter studies should use standardized continuous monitoring and evaluate whether noise-reduction interventions improve communication, cognitive performance, teamwork, error rates, and patient outcomes. Research should also define clinically meaningful exposure thresholds rather than relying solely on environmental recommendations.