Optimal Anesthesia by RENNY

Abstract A 34-year-old woman with a history of maxillary carcinoma treated by proton therapy underwent partial maxillectomy under general anesthesia. Continuous quantitative EEG monitoring—using bispectral index (BIS), spectral edge frequency (SEF), and density spectral array (DSA)—revealed BIS 33 and SEF 12 Hz, with theta–delta dominance and no burst suppression. This chapter demonstrates how ane...

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1. Introduction Perioperative arrhythmias are among the most frequently encountered cardiac events during anesthesia and surgery, with an incidence ranging from 40% to 70% depending on the patient population and surgical complexity. These rhythm disturbances range from transient, clinically silent episodes to sustained, life-threatening ventricular arrhythmias. From an anesthesiologist’s perspecti...

Abstract Oxidative stress represents a central mechanism in perioperative organ injury. During ischemia–reperfusion, reactive oxygen species (ROS) such as superoxide, hydrogen peroxide, and hydroxyl radicals damage endothelium, mitochondria, and cellular proteins. Modern anesthetic pharmacology, however, provides anesthesiologists with redox-modulating agents that can mitigate this injury. This up...

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. Case Summary — The Monitor Triad Patient: 62-year-old male Procedure: Colostomy closure Reversal: Neostigmine 2.5 mg + Glycopyrrolate 0.4 mg IV Status: Following commands with slow cognition and elevated BP Monitors: Covidien BIS–DSA: BIS 76, SEF 18 Hz, emerging red–yellow transition Dräger A350 Ventilator: EtCO₂ 34 mmHg, RR 25/min, spontaneous pattern Philips IntelliVue: HR 88 bpm, BP 168/113 (...

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Abstract Bispectral Index (BIS) monitoring is widely employed to assess anesthetic depth, yet its reliability diminishes when cortical synchrony is influenced by non-GABAergic drugs such as dexmedetomidine and magnesium, or by regional anesthesia techniques that suppress afferent input. We report the case of a 45-year-old female (BMI 29) undergoing laparoscopic donor nephrectomy under sevoflurane...

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1. Introduction The intraoperative combination of neuroendocrine tumor (NET)–induced hypertensive crisis and massive hemorrhage represents one of anesthesia’s greatest physiologic challenges. Traditional monitors describe hemodynamics, but EEG-derived monitoring (BIS and DSA) allows anesthesiologists to “see” the brain’s response to circulatory and anesthetic forces in real time . This case illust...

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Abstract Pain perception under anesthesia challenges the classical understanding of consciousness in medicine. While anesthetics aim to eliminate awareness and pain, emerging neuroscientific evidence reveals persistent nociceptive processing even in states of apparent unconsciousness. This chapter explores the molecular, neurophysiological, and ethical dimensions of pain under anesthesia. It bridg...

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Abstract At key steps in thyroid and parathyroid surgery the NIM endotracheal tube converts the airway into a neurophysiology monitor. Understanding amplitude, latency and waveform morphology allows the anesthesiologist to distinguish true recurrent laryngeal nerve (RLN) injury from technical or pharmacologic artefact and to act in real time to protect voice. This article uses two intraoperative N...

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Abstract The Renin–Angiotensin–Aldosterone System (RAAS) governs blood pressure, intravascular volume, and electrolyte balance — processes central to anesthetic physiology. Perioperative modulation of RAAS by disease and drugs underlies common anesthesia problems: induction hypotension, vasoplegia, volume derangements, and dyskalemias. This revised article integrates molecular detail with immediat...

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Abstract During long-duration oncologic surgeries, the anesthetic brain does not remain static — it drifts through evolving oscillatory states that reflect changes in drug kinetics, physiology, and cortical network dynamics. While the Bispectral Index (BIS) provides a numerical surrogate of depth, the Density Spectral Array (DSA) reveals the cortical topography of anesthesia in color and frequency...

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