Category: Uncategorized

Disclaimer: This article is intended solely for informational and educational purposes only. It does not constitute medical advice.

Spinal and epidural anesthesia both produce neuraxial blockade by interrupting transmission through spinal nerve roots but are administered in different spaces within the spinal canal, leading to different characteristics, including in the area of motor blockade. Understanding these differences is important because the extent of motor impairment influences surgical conditions, postoperative mobilization, and recovery, and factors into which technique is optimal for a specific procedure. 

Spinal anesthesia typically produces a denser and more predictable motor block than epidural anesthesia. Injection of local anesthetic directly into the cerebrospinal fluid allows rapid exposure of spinal nerve roots to relatively concentrated anesthetic. Depending on the local anesthetic, dose, and level of blockade, spinal anesthesia can produce profound motor paralysis involving the lower extremities. This dense blockade is particularly useful for procedures requiring complete muscle relaxation, including lower abdominal, pelvic, and lower-extremity surgery. The rapid onset and predictable spread of spinal anesthesia also make it possible to achieve an adequate surgical block with relatively small doses of local anesthetic. 

Epidural anesthesia produces less motor blockade than spinal anesthesia, although the degree of blockade depends on the concentration and volume of local anesthetic administered. Lower concentrations may provide predominantly sensory analgesia while preserving substantial motor function, making epidural techniques useful when postoperative analgesia, early mobilization, or preserved function, as in the case of labor analgesia, are priorities. Higher concentrations can produce more extensive motor blockade. Because epidural medication is deposited outside the dura, larger volumes of local anesthetic are typically required to achieve an equivalent sensory level. 

The differential sensitivity of nerve fibers to local anesthetics also contributes to the clinical characteristics of neuraxial blockade. Smaller myelinated fibers involved in pain and temperature transmission are generally blocked at lower concentrations than larger motor fibers. Consequently, dilute epidural solutions can provide effective analgesia while preserving motor function. Increasing the concentration or dose progressively affects motor fibers and results in greater weakness. Because of spinal anesthesia’s higher local anesthetic concentration around the nerve roots, it more commonly produces a dense sensory and motor block. 

Motor blockade can be assessed clinically using standardized scales such as the Bromage score. Following spinal anesthesia, patients may demonstrate complete inability to move the hips, knees, and ankles when a dense block is achieved. Epidural anesthesia using dilute local anesthetic may result in only mild weakness, although substantial motor blockade can occur when higher concentrations are used. Continuous epidural infusions can therefore be titrated to balance analgesia against preservation of motor function. 

The duration of motor blockade also differs between epidural and spinal anesthesia. Spinal anesthesia generally has a defined duration determined largely by the local anesthetic and intrathecal dose. Epidural anesthesia provides greater flexibility because additional boluses or continuous infusions can be administered, allowing the intensity and duration of blockade to be adjusted throughout the procedure and postoperative period. 

In clinical practice, spinal anesthesia is generally preferred when a dense, rapid, and predictable block is desired, whereas epidural anesthesia offers greater ability to titrate the intensity of blockade and preserve motor function. The choice should ultimately be based on the surgical procedure, desired degree of muscle relaxation, anticipated postoperative pain requirements, and patient factors. 

References 

1. Miller RD, Cohen NH, Eriksson LI, et al. Miller’s Anesthesia. 10th ed. Elsevier; 2025. 

2. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. McGraw Hill; 2022. 

3. Bernards CM. Epidural and spinal anesthesia. In: Barash PG, Cullen BF, Stoelting RK, et al, eds. Clinical Anesthesia. 9th ed. Wolters Kluwer; 2023. DOI: 10.2165/00003088-198916050-00002 

4. Bromage PR. Epidural Analgesia. WB Saunders; 1978. DOI: 10.1016/S0095-5108(18)31046-7 

5. Hebl JR. The importance and implications of peripheral nerve blockade and neuraxial anesthesia. Anesthesiol Clin. 2024;42(2):235-252. DOI: 10.1016/j.heliyon.2024.e32441 

Disclaimer: This article is intended solely for informational and educational purposes only. It does not constitute medical advice.

Propofol is one of the most widely used intravenous anesthetic agents due to its favorable pharmacokinetic profile, rapid onset of action, and generally low impact on hemodynamic stability compared to other agents.¹ Although propofol use is broadly considered safe, prolonged or high-dose administration has been associated with the development of propofol infusion syndrome, a rare but potentially life-threatening complication. Initially described in pediatric patients, propofol infusion syndrome is characterized by severe metabolic acidosis and refractory bradycardia progressing to cardiac arrest.² 

The clinical presentation of this condition is often multisystemic, with cardiovascular compromise, metabolic disturbances, and skeletal muscle injury occurring in combination. Because these manifestations are nonspecific and can overlap with the effects of critical illness, early recognition requires a high index of suspicion, particularly in patients receiving prolonged or high-dose propofol infusions. Subsequent reports have identified the syndrome in adults as well, often presenting with a broader range of clinical manifestations, such as rhabdomyolysis, acute kidney injury, cardiac dysfunction, hyperkalemia, and hepatic abnormalities.

Despite increasing recognition of propofol infusion syndrome, its pathophysiology remains incompletely understood, and the absence of a universally accepted diagnostic definition has contributed to ongoing uncertainty regarding its true incidence and clinical spectrum. As reported cases have evolved to include adults receiving propofol within recommended dosing limits, there is a growing need to better characterize the syndrome in contemporary clinical medicine.³  

Cardiac and skeletal muscle injury are hallmark features of the disorder, as evidenced by marked elevations in creatine kinase, troponin I, and myoglobinuria, alongside histological findings of extensive myocyte necrosis. Experimental studies suggest that propofol exerts direct toxic effects on cardiac and skeletal muscle by impairing mitochondrial function. Specifically, propofol inhibits oxidative phosphorylation, disrupts electron transport chain activity (particularly at complexes II and IV), reduces oxygen utilization, impairs calcium channel function, and decreases β-adrenergic receptor responsiveness.⁴ Together, these effects reduce ATP production and myocardial contractility, contributing to the refractory cardiac failure commonly observed in advanced presentations of the condition.^2,5 

Propofol inhibits carnitine palmitoyltransferase I, preventing long-chain fatty acids from entering the mitochondria, while simultaneously disrupting β-oxidation and electron transport, limiting the utilization of medium- and short-chain fatty acids.⁶ The resulting energy deficit is particularly detrimental in critically ill patients with high metabolic demands, leading to bodily dysfunction and tissue necrosis. Accumulation of unused free fatty acids may also promote cardiac arrhythmias.²  

The accumulation of toxic fatty acid intermediates compromises ATP production and exacerbates metabolic acidosis. These metabolic disturbances resemble those observed in inherited mitochondrial disorders, where defects in fatty acid oxidation can lead to rhabdomyolysis, cardiac dysfunction, and hepatic injury during periods of metabolic stress. Consequently, patients with underlying mitochondrial fatty acid oxidation disorders may be particularly susceptible to developing propofol infusion syndrome and should generally avoid prolonged propofol exposure.⁵ 

The risk of propofol infusion syndrome increases with higher propofol doses and prolonged infusion duration, although no definitive dose threshold guarantees safety.³ Current recommendations emphasize minimizing propofol exposure by using the lowest effective infusion rate, incorporating multimodal sedation, and considering alternative sedatives when propofol requirements escalate or metabolic abnormalities develop. Patients with suspected mitochondrial dysfunction, cardiovascular instability requiring high-dose vasopressors, or prolonged low-carbohydrate intake may be at increased risk and warrant additional caution.³ Overall, while propofol infusion syndrome remains a fairly uncommon complication, its high mortality underscores the importance of prompt recognition, careful risk assessment, and preventive strategies to optimize patient safety during prolonged propofol therapy. 

References  

1. Ho KM, Ng JY. The use of propofol for medium and long-term sedation in critically ill adult patients: a meta-analysis. Intensive Care Medicine. 2008;34(11):1969-1979. https://doi.org/10.1007/s00134-008-1186-5  

2. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Medicine. 2003;29(9):1417-1425. https://doi.org/10.1007/s00134-003-1905-x  

3. Hemphill S, McMenamin L, Bellamy MC, Hopkins PM. Propofol infusion syndrome: a structured literature review and analysis of published case reports. British Journal of Anaesthesia. 2019;122(4):448-459. https://doi.org/10.1016/j.bja.2018.12.025  

4. Branca D, Roberti MS, Lorenzin P, Vincenti E, Scutari G. Influence of the anesthetic 2,6-diisopropylphenol on the oxidative phosphorylation of isolated rat liver mitochondria. Biochemical Pharmacology. 1991;42(1):87-90. https://doi.org/10.1016/0006-2952(91)90684-w  

5. Kam PCA, Cardone D. Propofol infusion syndrome. Anaesthesia. 2007;62(7):690-701. https://doi.org/10.1111/j.1365-2044.2007.05055.x  

6. Wolf A, Weir P, Segar P, Stone J, Shield J. Impaired fatty acid oxidation in propofol infusion syndrome. The Lancet. 2001;357(9256):606-607. https://doi.org/10.1016/s0140-6736(00)04064-2   

Evidence-based management of cardiovascular risk in the operating room (OR) is a critical component of protecting patient safety and improving surgical outcomes. Perioperative cardiovascular complications, including myocardial infarction, arrhythmias, heart failure, and stroke, contribute substantially to postoperative morbidity and mortality. As surgical populations age and comorbid disease burden increases, perioperative risk stratification and targeted optimization strategies have become increasingly important. Contemporary management emphasizes guideline-directed evaluation, individualized hemodynamic goals, and prevention of avoidable physiologic stress.

Evidence-based management begins with a preoperative cardiovascular assessment to identify patient-specific and procedure-specific risk factors. Major predictors of perioperative cardiac complications include ischemic heart disease, heart failure, cerebrovascular disease, diabetes mellitus requiring insulin, renal dysfunction, and poor functional status. Risk indices such as the Revised Cardiac Risk Index (RCRI) assist clinicians in estimating perioperative major adverse cardiac events. Current guidelines emphasize that preoperative testing should only be pursued if results are expected to alter management. Routine stress testing in asymptomatic patients undergoing low-risk surgery has not demonstrated improved outcomes and may unnecessarily delay care. 

Functional capacity remains one of the strongest predictors of perioperative cardiac tolerance. Patients capable of performing greater than 4 metabolic equivalents of activity without symptoms generally tolerate noncardiac surgery. Conversely, poor exercise tolerance may indicate limited cardiovascular reserve and increased perioperative risk. Biomarkers such as B-type natriuretic peptide (BNP) and cardiac troponins are also valuable adjuncts for identifying high-risk patients, particularly among elderly individuals and those undergoing major vascular procedures. 

Intraoperative management focuses on maintaining physiologic stability while minimizing myocardial oxygen supply-demand imbalance. Hemodynamic fluctuations, especially prolonged hypotension and tachycardia, are associated with perioperative myocardial injury. Increasing evidence suggests that even brief episodes of mean arterial pressure below critical thresholds may contribute to renal and cardiac complications. Goal-directed fluid therapy and individualized blood pressure management have therefore become important components of cardiovascular risk reduction. 

Beta-blocker therapy is one of the most studied perioperative interventions. Continuation of chronic beta-blockade is strongly recommended because abrupt withdrawal may precipitate ischemia or arrhythmias. However, initiation of high-dose beta-blockers immediately before surgery has been associated with increased stroke and mortality risk despite reducing myocardial infarction incidence. Based on current evidence, beta-blocker therapy may be initiated preoperatively only in certain patients and preferably well in advance of surgery to allow dose titration and stabilization of cardiovascular status prior to entering the OR. 

Management of antiplatelet and anticoagulant therapy requires balancing thrombotic and bleeding risks. Patients with recent coronary stents present particular challenges. Premature discontinuation of dual antiplatelet therapy may lead to catastrophic stent thrombosis, whereas continuation may increase surgical bleeding. Multidisciplinary coordination among anesthesiologists, surgeons, and cardiologists is therefore essential. Elective procedures should ideally be delayed until recommended durations of antiplatelet therapy are completed. 

Postoperative surveillance is a critical component of cardiovascular risk management. Many perioperative myocardial infarctions occur without detectable chest pain due to postoperative analgesia. Postoperative troponin monitoring in high-risk patients may allow earlier detection of myocardial injury and prompt intervention. Enhanced recovery protocols emphasizing early mobilization, multimodal analgesia, and pulmonary optimization may further reduce cardiovascular complications by limiting physiologic stress responses. 

Evidence-based perioperative cardiovascular management continues to evolve toward precision medicine and individualized care pathways. Contemporary practice integrates validated risk assessment tools, guideline-directed medical therapy, vigilant hemodynamic control, and multidisciplinary coordination to reduce perioperative morbidity and mortality. Ongoing research into biomarkers, artificial intelligence risk prediction, and perioperative monitoring technologies may further refine cardiovascular management strategies in the operating room. 

References 

1. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2024 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2024;150(12):e278-e366. https://doi.org/10.1161/CIR.0000000000001285 
2. Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med.2015;373(23):2258-2269. 10.1056/NEJMra1502824 
3. Biccard BM, Rodseth RN. A meta-analysis of the prospective randomised trials of beta-blockade for prevention of perioperative cardiac complications in non-cardiac surgery. Anaesthesia. 2008;63(1):4-16. 10.1111/j.1365-2044.2009.06010.x 
4. Wijeysundera DN, Beattie WS, Austin PC, Hux JE, Laupacis A. Non-invasive cardiac stress testing before elective major non-cardiac surgery: population based cohort study. BMJ. 2010;340:b5526. 10.1136/bmj.b5526 
5. Sessler DI, Meyhoff CS, Zimmerman NM, et al. Period-dependent associations between hypotension during and for four days after noncardiac surgery and a composite of myocardial infarction and death. Anesthesiology.2018;128(2):317-327. 10.1097/ALN.0000000000001985 

Pain is a complex, multidimensional experience that is shaped by biological, psychological, and social factors. This perspective was formally reflected by the International Association for the Study of Pain in a 2020 update to their terminology, in which pain was redefined as both a sensory and emotional experience and key principles, such as the distinction between pain and nociception, were emphasized.¹  These changes reinforced a growing consensus that pain is inherently multifactorial and deeply personal. 

However, it is difficult for research and clinical practice to capture the full complexity of pain. This disconnect has become more pressing with growing inequities in pain management.^2-4 Concurrently, rapid advances in digital health technologies and the increasing use of machine learning and large-scale data systems are transforming how pain is studied. These developments suggest an urgent need to rethink how pain research is conducted and translated into practice.⁵ Innovation in pain measurement approaches is urgently needed in both clinical and research settings. 

Patient-reported outcomes (PROs) have been—and continue to be—the foundation of assessing pain, as they can capture the subjective experience of pain through tools like numeric rating scales, visual analogue scales, and condition-specific questionnaires.⁵ However, traditional PROs are often collected infrequently in clinical or research settings and tend to focus on limited dimensions, such as intensity or location. In addition, self-reports are vulnerable to biases related to memory, context, and social expectations, and they often force patients to simplify complex, non-linear pain experiences into fixed numerical scales. 

To address these limitations, recent innovation includes expansions in how and when pain is reported, with digital tools expanding measurement capabilities across a wider variety of settings. Ecological momentary assessments, enabled by smartphones and digital platforms, allow patients to report pain more frequently in their everyday environments, offering richer and more context-sensitive data.⁶  These methods can better capture how pain changes over time and interacts with factors like mood, sleep, and daily activities, while also reducing the burden of in-person visits.

At the same time, innovations such as digital body maps and pictorial tools aim to make reporting more accessible and expressive, particularly for diverse patient populations. Despite these advancements in the field, persistent challenges include issues of accessibility, reporting fatigue, and the continued influence of psychological and social biases. 

Pain can also be studied with environmental sensors that continuously collect data about the body and surroundings, usually collected through connected “smart” devices. These tools provide detailed and real-time insights into pain by tracking things like heart rate variability, movement, sleep, and daily activities, often without requiring active input from patients.

By combining sensor data with self-reports, researchers can better understand how pain changes over time and affects quality of life through dual approaches of objective and subjective metrics, while also making research and care more accessible through at-home monitoring.⁷ However, these systems still come with significant challenges, including technical complexity, data accuracy issues, and the need to ensure accessibility, comfort, and usability for a wide range of patients. There are also concerns about privacy and bias, among other ethical issues.⁵  

Advancing pain measurement will require integrating subjective and objective approaches to more fully capture the complexity of the total pain experience and support innovation in the field. Combining patient-reported outcomes with emerging digital and sensor-based methods can create a more comprehensive, continuous, and context-aware understanding of pain. Interdisciplinary collaboration and patient-centered design will be essential to ensure that innovations in pain research can effectively translate into more accurate assessments and more equitable and effective care. 

References 

1. International Association for the Study of Pain. Terminology. International Association for the Study of Pain (IASP). Published 2020. https://www.iasp-pain.org/resources/terminology/  

2. Nieto R, Pardo R, Sora B, Feliu-Soler A, Luciano JV. Impact of COVID-19 Lockdown Measures on Spanish People with Chronic Pain: An Online Study Survey. Journal of Clinical Medicine. 2020;9(11):3558. https://doi.org/10.3390/jcm9113558  

3. Puntillo F, Giglio M, Brienza N, et al. Impact of COVID-19 pandemic on chronic pain management: Looking for the best way to deliver care. Best Practice & Research Clinical Anaesthesiology. 2020;34(3):529-537. https://doi.org/10.1016/j.bpa.2020.07.001  

4. Shanthanna H, Strand NH, Provenzano DA, et al. Caring for patients with pain during the COVID ‐19 pandemic: consensus recommendations from an international expert panel. Anaesthesia. 2020;75(7):935-944. https://doi.org/10.1111/anae.15076  

5. Berger SE, Baria AT. Assessing Pain Research: A Narrative Review of Emerging Pain Methods, Their Technosocial Implications, and Opportunities for Multidisciplinary Approaches. Frontiers in Pain Research. 2022;3. https://doi.org/10.3389/fpain.2022.896276  

6. Doherty K, Balaskas A, Doherty G. The Design of Ecological Momentary Assessment Technologies. Interacting with Computers. 2020;32(3). https://doi.org/10.1093/iwcomp/iwaa019  

7. Byrom B, McCarthy M, Schueler P, Muehlhausen W. Brain Monitoring Devices in Neuroscience Clinical Research: The Potential of Remote Monitoring Using Sensors, Wearables, and Mobile Devices. Clinical Pharmacology & Therapeutics. 2018;104(1):59-71. https://doi.org/10.1002/cpt.1077  

Hair transplantation has become an increasingly popular solution for individuals experiencing hair loss. While much attention is given to surgical techniques and final results, anesthesia care is just as important, ensuring that patients remain comfortable, pain-free, and safe throughout the procedure. Understanding how anesthesia works in hair transplant surgery can help reduce anxiety and improve overall patient confidence. 

Hair transplant procedures, such as follicular unit extraction (FUE) and follicular unit transplantation (FUT), are typically performed under local anesthesia ^1,2. This means only the scalp is numbed, allowing the patient to stay awake during the surgery. Local anesthesia is preferred because it minimizes risks and monitoring requirements while still providing effective pain control. 

The anesthesia process usually involves injecting a local anesthetic such as lidocaine into the scalp. It is often combined with epinephrine, which reduces bleeding and helps the anesthetic last longer. To make the injections more comfortable, surgeons may apply a topical numbing cream or use cooling devices beforehand. These processes tend to help reduce the discomfort typically associated with needle injections ^3,4. 

Hair transplant procedures can last several hours, so patient comfort is essential. In addition to local anesthesia, some patients may receive mild sedatives or anti-anxiety medication to help them remain calm and relaxed without losing consciousness. Clinics often provide a comfortable environment where patients can listen to music, watch movies, or take short breaks during the procedure. 

Even though hair transplantation is minimally invasive, proper monitoring is crucial. Medical staff continuously check vital signs such as heart rate and blood pressure to ensure patient safety. A thorough medical evaluation is conducted before the procedure to identify any allergies or health conditions that could affect anesthesia use ^5,6. 

Following the procedure, the effects of anesthesia gradually wear off. Patients may feel mild discomfort or tightness in the scalp, which can be managed with prescribed or over-the-counter pain medications. Following aftercare instructions is important to promote healing and avoid complications. Most patients recover quickly and can resume normal activities within a few days ^2,7. 

Modern advancements have improved anesthesia care in hair transplantation and other dermatological procedures. Techniques such as vibration anesthesia, buffered anesthetic solutions, and needle-free systems have made the process more comfortable. These innovations reduce pain during injections and enhance the overall patient experience ^8–10. 

Anesthesia care is a vital part of hair transplant procedures. It ensures comfort, safety, and a positive experience for patients undergoing treatment. With proper techniques, careful monitoring, and ongoing advancements, anesthesia continues to support successful outcomes and high levels of patient satisfaction. 

References 

1. FUE Hair Transplant: What to Expect, Cost, Pictures, and More. Healthline https://www.healthline.com/health/cosmetic-surgery/everything-to-know-about-a-fue-hair-transplant (2020). 

2. Hair transplant. nhs.uk https://www.nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/hair-transplant/ (2023). 

3. Calonge, W. M. & Louie, D. Anesthesia in Hair Transplantation. in Alopecia (IntechOpen, 2018). DOI:10.5772/intechopen.78352. 

4. Nusbaum, B. P. Techniques to reduce pain associated with hair transplantation: optimizing anesthesia and analgesia. Am J Clin Dermatol 5, 9–15 (2004). DOI: 10.2165/00128071-200405010-00003 

5. Beyaz, S. et al. Evaluation of skin test indications for general anesthetics in real life: a prospective cohort study. Braz J Anesthesiol 72, 350–358 (2021). DOI: 10.1016/j.bjane.2021.07.005 

6. Savic, L., Stannard, N. & Farooque, S. Allergy and anaesthesia: managing the risk. BJA Education 20, 298–304 (2020). DOI: 10.1016/j.bjae.2020.04.005 

7. Goldin, J., Zito, P. M. & Raggio, B. S. Hair Transplantation. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2026). 

8. Comite, S. L., Rahaman, S. & Malkowiak, M. Vibration Anesthesia During Invasive Procedures: A Meta-analysis. J Clin Aesthet Dermatol 17, 29–40 (2024). 

9. Jaju, K. K., Nasim, I., Choudhari, S. & Sandeep A, H. Comparative Evaluation of the Anesthetic Efficacy of Needle-Free Anesthesia and Conventional Anesthesia in Patients With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. Cureus 16, e54661. DOI: 10.7759/cureus.54661 

10. Bhatnagar, A. & Gupta, D. Effectiveness of buffered local anesthetic solutions in pediatric nerve blocks and infiltration anesthesia: a systematic review and meta-analysis. J Dent Anesth Pain Med 26, 19–28 (2026). DOI: 10.17245/jdapm.2026.26.1.19 

Post-operative nausea and vomiting (PONV) is a common problem affecting about 30% of patients. It is a significant cause of patient dissatisfaction and discomfort and has been the subject of extensive outcomes research. Existing pharmaceutical interventions to minimize these outcomes can be associated with clinically relevant side effects, including sedation and potentially life-threatening arrhythmias. Considering these complications, it is worth exploring non-pharmacologic interventions for PONV.

One widely researched alternative to antiemetic drugs for PONV is PC6 stimulation. The PC6 acupuncture point is located on the anterior forearm between the tendons of the palmaris longus and flexor carpi radialis and is targeted in acupuncture therapy to relieve anxiety, stress, and nausea. A Cochrane review synthesizing existing data on PC6 therapy for relieving nausea found moderate evidence to support similar anti-nausea effects compared to commonly used anti-nausea medications like metoclopramide, ondansetron, and cyclizine (Hofman et al., 2015).

However, evidence demonstrating superiority over placebo has been less consistent (Vickers, 1996). This approach is further complicated by the specificity required to target the PC6 point, as it lies in an area of the body often used for IV access or placement of a patient identification bracelet. It is worth considering that the studies included in the Cochrane review were fairly heterogeneous and compared PC6 therapy to several different antiemetics across separate trials, which may limit the overall strength of pooled conclusions (Hofman et al., 2015). In addition, physician adherence to an intervention without a clearly established physiological mechanism may be limited, especially given the aforementioned heterogeneity of data.

Inhaled isopropyl alcohol rescue is another non-pharmacologic strategy for preventing PONV that has received some research interest. In a randomized controlled trial comparing inhaled isopropyl alcohol to saline placebo among emergency department patients, inhaled isopropyl alcohol was associated with a clinically significant decrease in median self-reported nausea levels from 6 out of 10 to 3 out of 10 (Beadle et al., 2016). Furthermore, this effect was achieved within 10 minutes, which suggests potential utility as a rapid adjunctive intervention in acute settings. Isopropyl alcohol is merely one available option within the broader category of aromatherapeutic interventions for treating nausea; other popular alternatives include lavender, citrus, and peppermint.

Nevertheless, the existing research on isopropyl alcohol and other aromatherapy in treating nausea and vomiting is methodologically limited and inconsistent. While the aforementioned study seemed promising, the emergency department setting limits the ability to extrapolate findings directly to PONV (Beadle et al., 2016). Furthermore, studies that document self-reported patient responses can be subjective and vulnerable to bias, particularly in small cohorts. Although other small randomized controlled trials report similar improvements in nausea or vomiting with inhaled isopropyl alcohol over placebo (Anderson & Gross, 2004), the current literature does not consistently support its use as a replacement for established antiemetic therapies.

Overall, reported reductions in nausea vary across studies. Nevertheless, non-pharmacologic therapy may provide a promising adjunct for patients experiencing PONV in the aftermath of surgery, particularly for those who prefer not to add another medication to their postoperative regimen or for patients who do not experience complete relief with standard antiemetics (Lee & Done, 1999). Furthermore, several of the aforementioned studies cited high patient satisfaction with care regardless of achieved clinical effect, highlighting the importance of autonomy in improving patient satisfaction. For these reasons, it is worth considering non-pharmacologic alternatives to antiemetic therapies as complementary options rather than solitary treatments.

References

1. Anderson, L. A., & Gross, J. B. (2004). Aromatherapy with Peppermint, Isopropyl Alcohol, or Placebo is Equally Effective in Relieving Postoperative Nausea. Journal of PeriAnesthesia Nursing, 19(1), 29-35. DOI: 10.1016/j.jopan.2003.11.001
2. Beadle, K. L., et al. (2016). Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial. Annals of Emergency Medicine, 68(1), 1-9. DOI: 10.1016/j.annemergmed.2015.09.031
3. Hofman, D., et al. (2015). P6 acupoint stimulation for preventing postoperative nausea and vomiting. Cochrane Database of Systematic Reviews, (7). DOI: 10.1002/14651858.CD003281.pub4
4. Lee, A., & Done, M. L. (1999). The use of nonpharmacological techniques to prevent postoperative nausea and vomiting: A meta-analysis. Anesthesia & Analgesia, 88(6), 1362-1369. DOI: 10.1016/s0952-8180(99)00035-5
5. Vickers, A. J. (1996). Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. Journal of Royal Society of Medicine. DOI: 10.1046/j.1365-2648.1997.t01-15-00999.x

In hospitals, clinics, and research centers around the world, artificial intelligence (AI) has shifted from a distant concept to a daily presence. With over 1,000 FDA-approved clinical applications and an expanding array of digital health tools, AI has the potential to transform medicine (1, 2). Many healthcare professionals are now incorporating AI into their daily routines, leveraging its capabilities for automating clinical documentation, facilitating drug discovery, and analyzing diagnostic imaging (2-4). Other practitioners remain skeptical, citing concerns about error, lack of oversight, and the potential for bias within AI (5, 6). These differing perspectives on AI across medical professionals raise valuable debates about where AI can have real benefits within healthcare and how to ensure it is implemented safely.

In 2024, approximately 66% of surveyed physicians reported incorporating AI tools into their clinical practices—a striking 78% increase from 2023 (6). This rapid uptake is notable in comparison to previously introduced technologies (6, 7). For physicians, the most common applications of AI include administrative tasks and clinical documentation, as well as patient-facing resource development and translation services (6).

Interestingly, a significant proportion of non-user physicians indicated that they plan to adopt AI tools in the near future, with around 25% intending to do so within the next year (6). This trend is echoed among other medical professionals, including nurses and dentists, who also recognize the potential of AI, despite expressing hopes for additional training and input during the integration process (8, 9).

On an institutional level, similar patterns of AI adoption have emerged, with a tenfold increase in the implementation of domain-specific AI tools since 2023 (7). In fact, compared to around 9% of companies in the broader economy, significantly larger proportions of healthcare systems (27%) and outpatient providers (18%) reported AI adoption in 2025 (7). From the perspective of proponents of AI use within the medical field, increased use can streamline administrative tasks, enhance patient volume predictions, and optimize workflows (7, 10).

These trends reflect not only the ability of medical professionals to overcome hurdles related to AI integration but also their growing confidence in the technology. Recent data indicates that around 68% of physicians now believe that AI can improve patient care (6). Both physicians and nurses generally agree that alleviating administrative burdens represents the most significant opportunity for AI in clinical settings, with some interest in enhancing workflow efficiency as well (6, 8). Although experimental AI tools—ranging from diagnosing diseases to triaging patients—continue to gain momentum in research journals, very few medical professionals report these complex functionalities as motivators for current or future AI use (6, 8, 11).

Despite the potential benefits of AI use, many medical professionals continue to maintain caution, particularly due to concerns regarding accuracy, privacy, and training of AI tools and platforms (12). Although many clinical AI tools demonstrate accuracy, they fail to consistently outperform clinician judgment, especially across diverse patient populations (11, 13). This variability can lead to differing impacts on patient outcomes, which raises concerns about reliance on AI for decision-making (11-13).

For now, even when highly accurate AI models are available in certain fields, medical professionals tend to prefer traditional, clinician-led approaches for diagnostics and treatment (11). Additionally, given the rapid pace of AI adoption, healthcare institutions have often struggled to keep up with data and onboarding practices (14). As a result, many medical professionals cite privacy and training as significant concerns that must be addressed before wider clinical AI application (6, 8, 12).

Overall, many medical professionals maintain a perspective of cautious optimism when it comes to AI integration. In response to the increased use of AI in the clinical setting, around 35% of physicians reported greater excitement than concern, representing a 5% increase since 2023 (6). However, the proportion of physicians with greater concern than excitement has also increased at a similar rate (6). Although evidence demonstrates that AI tools can perform helpful tasks with precision and safety, significant strides towards improved accuracy, privacy, and training must be taken to ensure their successful integration into a broader range of clinical applications (6, 8, 9, 12).

References

1: Murphy, M. 2025. FDA has approved over 1,000 clinical AI applications, with most aimed at radiology. Radiology Business. url: https://radiologybusiness.com/topics/artificial-intelligence/fda-has-approved-over-1000-clinical-ai-applications-most-aimed-radiology

2: Nass, D. 2025. Digital Health Trends 2024: Five Takeaways About Provider-Related Solutions. IQVIA Institute for Human Data Science. url: https://www.iqvia.com/blogs/2025/01/institute-blog-digital-health-trends-2024

3: North, M. 2025. 7 ways AI is transforming healthcare. World Economic Forum. url: https://www.weforum.org/stories/2025/08/ai-transforming-global-health/

4: Ellis, L. 2025. The Benefits of the Latest AI Technologies for Patients and Clinicians. Harvard Medical School Insights. url: https://learn.hms.harvard.edu/insights/all-insights/benefits-latest-ai-technologies-patients-and-clinicians

5: Arvai, N., Katonai, G. & Mesko, B. 2025. Health Care Professionals’ Concerns About Medical AI and Psychological Barriers and Strategies for Successful Implementation: Scoping Review. Journal of Medical Internet Research, vol. 27: e66986. doi: 10.2196/66986

6: American Medical Association. 2025. Physician sentiments around the use of AI in healthcare: motivations, opportunities, risks, and use cases. AMA Augmented Intelligence Research. url: https://www.ama-assn.org/system/files/physician-ai-sentiment-report.pdf

7: Jain, S. 2025. AI Adoption In Healthcare Is Surging: What A New Report Reveals. Forbes. url: https://www.forbes.com/sites/sachinjain/2025/10/21/ai-adoption-in-healthcare-is-surging-what-a-new-report-reveals/

8: Joo, J.Y., Liu, M. & Ho, M.H. 2025. Nurses’ perceptions of artificial intelligence adoption in healthcare: A qualitative systematic review. Nurse Education in Practice, vol. 88: 104542. doi: 10.1016/j.nepr.2025.104542

9: Dentaly.org. 2025. AI Dentistry Survey: Perceptions, Insights, and Possibilities. Dentaly.org. url: https://www.dentaly.org/us/research/ai-in-dentistry/

10: Abdul Baten, RB. 2024. How are US hospitals adopting artificial intelligence? Early evidence from 2022. Health Affairs Scholar, vol. 2: qxae123. doi: 10.1093/haschl/qxae123

11: Busch, F., Hoffmann, L., Xu, L., Zhang, L.J., Hu, B., Garcia-Juarez, I. et al. 2025. Multinational Attitudes Toward AI in Health Care and Diagnostics Among Hospital Patients. JAMA Network Open, vol. 8: e2514452. doi: 10.1001/jamanetworkopen.2025.14452

12: Lawrence, R., Dodsworth, E., Massou, E., Sherlaw-Johnson, C., Ramsay, A.I., Walton, H. et al. 2025. Artificial intelligence for diagnostics in radiology practice: a rapid systematic scoping review. Lancet eClinical Medicine, vol. 83: 103228. doi: 10.1016/j.eclinm.2025.103228

13: Takita, H., Kabata, D., Walston, S.L., Tatekawa, H., Saito, K., Tsujimoto, Y., Miki, Y. & Ueda, D. 2025. A systematic review and meta-analysis of diagnostic performance comparison between generative AI and physicians. Nature NPJ Digital Medicine, vol. 8: 175. doi: 10.1038/s41746-025-01543-z

14: Murdoch, B. 2021. Privacy and artificial intelligence: challenges for protecting health information in a new era. BMC Medical Ethics, vol. 22: 122. doi: 10.1186/s12910-021-00687-3

Sensory innervation of the lower body depends on a highly organized relationship between spinal vertebrae, spinal nerves, and dermatomes. Although the vertebrae and spinal cord segments do not line up perfectly, their functional connections create predictable pathways for sensory signaling. Understanding which vertebral levels correspond to lower body sensory nerves is essential for clinicians performing neuraxial anesthesia, diagnosing nerve injuries, or interpreting sensory deficits.

The nerves emerging from the vertebrae of the lumbar spine (L1–L5) transmit sensory information from the lower body, including the hips, anterior thighs, legs, and portions of the feet. While the spinal cord ends near the L1–L2 vertebral level as the conus medullaris, the lumbar and sacral nerve roots continue downward as the cauda equina before exiting through the intervertebral foramina.

Each lumbar spinal nerve corresponds to a dermatome, a predictable region of skin sensation. L1 sensory fibers serve the area around the inguinal region and upper medial thigh, L2 covers the mid-anterior thigh, L3 provides sensation to the lower anterior thigh and medial knee, L4 contributes to sensation along the medial leg and ankle, and L5 supplies the lateral leg, dorsum of the foot, and great toe. Clinically, these dermatomal patterns help identify nerve compression or injury, such as radiculopathy caused by disc herniation at specific vertebral levels ^1–3.

The sacral spine vertebrae (S1–S5) and their nerves have equally important sensory roles as the lumbar nerves, though they cover a smaller portion of the lower body. Although fused into the sacrum in adulthood, these vertebral levels correspond to distinct nerve roots that serve the posterior and distal aspects of the lower body.

Key sensory distributions include S1, which covers the lateral foot, sole, and posterior calf, S2, providing sensation to the posterior thigh and proximal calf, and S3–S5, which contribute to the perineum and pelvic floor, forming the sensory portion of the pudendal nerve. These sacral dermatomes are especially relevant in obstetric anesthesia and colorectal surgery, where precise sensory blockade determines procedural success ^1,4–7.

Since the spinal cord ends above the actual lumbar vertebrae, the nerve roots descend before exiting, creating a mismatch between vertebral level and spinal segment level. For example, the L5 spinal nerve exits below the L5 vertebra, but its spinal cord segment lies higher, near the T12–L1 vertebral region.

The anatomy of spinal nerves influences several sensory and anesthetic considerations. First, it can impact neuraxial anesthesia, requiring accurate needle placement to achieve the desired sensory block while avoiding cord injury. Second, it can impact the diagnosis of radicular pain, where symptoms indicate the nerve root involved, but imaging must focus on the vertebra where that root exits. Finally, it can also impact surgical planning, particularly in decompression procedures 8–13.

Vertebrae and lower body sensory nerves exist in a finely coordinated anatomical system. By recognizing how lumbar and sacral segments correspond to specific dermatomes, clinicians can more effectively evaluate sensory changes, plan neuraxial procedures, and manage lower-body neurologic conditions. This understanding is essential across biomedical and surgical disciplines.

References

1. Lumbar Spinal Nerves. https://www.spine-health.com/conditions/spine-anatomy/lumbar-spinal-nerves.

2. Spine: Anatomy, Function, Parts, Segments & Disorders. https://my.clevelandclinic.org/health/body/10040-spine-structure-and-function.

3. Central Nervous System Pathways. Physiopedia https://www.physio-pedia.com/Central_Nervous_System_Pathways.

4. The Sacral Plexus – Spinal Nerves – Branches – TeachMeAnatomy. https://teachmeanatomy.info/lower-limb/nerves/sacral-plexus/.

5. Sacral Plexus. Physiopedia https://www.physio-pedia.com/Sacral_Plexus.

6. Miniato, M. A., Black, A. C. & Varacallo, M. A. Anatomy, Back, Lumbosacral Trunk. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).

7. Mullins, B. M. & Kelsall, N. Anatomy of the lumbar and sacral plexuses and lower limb peripheral neuropathies. Surgery (Oxford) 41, 193–199 (2023). DOI: 10.1016/j.mpsur.2023.02.008

8. Metkar, U. S., Lavelle, W. J., Larsen, K., Haddas, R. & Lavelle, W. F. Spinal alignment and surgical correction in the aging spine and osteoporotic patient. N Am Spine Soc J 19, 100531 (2024). DOI: 10.1016/j.xnsj.2024.100531

9. Radiculopathy: Symptoms, Causes & Treatment. Cleveland Clinic https://my.clevelandclinic.org/health/diseases/22564-radiculopathy.

10. Dydyk, A. M., Khan, M. Z. & Singh, P. Radicular Back Pain. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).

11. Berven, S. Advances in Preoperative Planning: When, How and What to Measure. Operative Techniques in Orthopaedics 29, 100713 (2019). DOI: 10.1016/j.oto.2019.100713

12. Olawin, A. M. & Das, J. M. Spinal Anesthesia. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).

13. Overview of neuraxial anesthesia – UpToDate. https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia.

The beach chair position is frequently used during shoulder and upper extremity surgeries. In this position, the patient’s torso is elevated approximately 30 to 70 degrees, and the head is positioned above the heart^.1 Not only does this posture improve access to the site of surgery, but it also aids in drainage from the vein at the surgical site, potentially limiting intraoperative bleeding. However, it introduces a phenomenon known as a hydrostatic gradient, in which blood pressure differs between two points (in this case, between the heart and the brain). Cerebral perfusion—the flow of oxygenated blood to brain tissue—can thus be reduced in the beach chair position. To prevent complications, active monitoring is necessary.

Cerebral perfusion pressure (CPP) is defined as the mean arterial pressure at brain level minus intracranial or central venous pressure.² Normally, the brain maintains constant blood flow despite changes in blood pressure. However, when patients undergo anesthesia and are placed in the beach chair position, the combined effects of head elevation, vasodilation, and anesthetic-induced cardiovascular depression can lower CPP, potentially resulting in inadequate cerebral perfusion and ensuing symptoms like dizziness and vision changes, as well as more severe consequences like stroke or permanent brain damage.

There have been reports of adverse neurologic outcomes linked to the beach chair position, though these incidents are rare. A 2005 case series described four instances of catastrophic ischemic injuries, including stroke and spinal cord infarction, following shoulder surgery performed in the beach chair position under general anesthesia.³ Other studies have shown that increased body mass index has a statistically significant association with oxygen desaturation in the brain.⁴ Such desaturations are usually temporary, but their cumulative effects may contribute to postoperative complications. Notably, a patient can have multiple such events in the course of a single operation.

To monitor cerebral perfusion in the beach chair position, some experts suggest monitoring cerebral oxygen saturation using near-infrared spectroscopy (NIRS) and mean arterial pressures.⁵ Others report using phenylephrine in addition to monitoring to maintain a certain blood pressure level.⁶ One challenge in this area is that practices for managing cerebral perfusion in this context can vary widely. For instance, more than 500 anesthesiologists and surgeons from the United Kingdom were surveyed, and together they reported using a wide range of chair angles and cerebrovascular monitoring practices and whether they rely on local guidelines.⁷

Cognitive outcomes in the days following surgery are at stake. A 2023 study from researchers in Germany examined postoperative cognitive dysfunction (POCD) in older adults undergoing orthopedic surgery in the beach chair versus supine (lying on one’s back) positions. POCD at one week occurred in 21% of patients in the beach chair group compared to 10% in the supine group.⁸

However, some research, including a recent study of 863 patients who underwent arthroscopic shoulder surgery,⁹ shows that the beach chair position does not affect cognitive function, as compared to pre-surgery levels. Nonetheless, further research is needed to better understand the interaction between the beach chair position, cerebral perfusion, and possible complications.

References

1. Mannava, S. et al. Basic Shoulder Arthroscopy: Beach Chair Patient Positioning. Arthroscopy Techniques 5, e731–e735 (2016), DOI: 10.1016/j.eats.2016.02.038

2. Mount, C. A. & Das, J. M. Cerebral Perfusion Pressure. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).

3. Pohl, A. & Cullen, D. J. Cerebral ischemia during shoulder surgery in the upright position: a case series. J Clin Anesth 17, 463–469 (2005), DOI: 10.1016/j.jclinane.2004.09.012

4. Salazar, D. et al. Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects. J Shoulder Elbow Surg 22, 1228–1235 (2013), DOI: 10.1016/j.jse.2012.12.036

5. Ko, S.-H. et al. Cerebral oxygenation monitoring of patients during arthroscopic shoulder surgery in the sitting position. Korean J Anesthesiol 63, 297–301 (2012), DOI: 10.4097/kjae.2012.63.4.297

6. Mori, Y. et al. Cerebral oxygenation in the beach chair position before and during general anesthesia in patients with and without cardiovascular risk factors. J Clin Anesth 27, 457–462 (2015), DOI: 10.1016/j.jclinane.2015.06.007

7. Ensor, D. et al. Should the beach chair position have national guidelines to reduce the risk of cerebrovascular complications? Results from a National Survey of Surgeons and Anaesthetists. Shoulder Elbow 17, 459–465 (2024), DOI: 10.1177/17585732241269147

8. Groene, P. et al. Postoperative cognitive dysfunction after beach chair positioning compared to supine position in orthopaedic surgery in the elderly. Arch Orthop Trauma Surg 144, 575–581 (2024), DOI: 10.1007/s00402-023-05109-0

9. Takayama, K., Ichimura, A. & Ito, H. Arthroscopic shoulder surgery in the beach chair position under single interscalene block does not affect patients’ cognitive function. JSES International https://doi.org/10.1016/j.jseint.2025.09.007 (2025) DOI:10.1016/j.jseint.2025.09.007.

The lateral position is necessary for certain thoracic, renal, hip, and neurosurgical procedures. While this positioning allows surgeons optimal access to the operative site in these cases, it presents unique challenges for anesthesiologists. Providing safe and effective anesthesia during surgery in the lateral position requires careful attention to airway management, ventilation, hemodynamic stability, and protection of the patient’s pressure points.

When a patient is placed in the lateral position, significant physiological changes occur compared to the more common supine position. Gravity affects ventilation and perfusion, leading to ventilation-perfusion mismatch. The dependent lung (the one closest to the operating table) typically receives greater blood flow due to gravity, but it may not ventilate as efficiently because of compression from abdominal contents or surgical positioning. Conversely, the nondependent lung may ventilate better but receives less perfusion. This imbalance can reduce oxygenation, making vigilant monitoring and ventilatory adjustments essential during anesthesia ^1,2.

Securing the airway is a critical concern before turning the patient laterally. Intubation is almost always performed in the supine position, as airway access becomes more challenging once the patient is positioned on their side. After repositioning, the anesthesiologist must reassess tube placement and ensure that ventilation is not compromised. In procedures such as thoracotomy, one-lung ventilation may be required, often using a double-lumen endotracheal tube or bronchial blocker. Managing one-lung ventilation requires precise control of oxygenation and carbon dioxide levels, with careful use of positive end-expiratory pressure (PEEP) and selective oxygen supplementation as needed ^3–5.

Using the lateral position for surgery can also impact circulation, another important area managed by anesthesia teams. Venous return may be reduced due to shifts in body weight, leading to changes in cardiac output and blood pressure. In addition, surgical retraction and positioning devices may exert pressure on large vessels. Continuous hemodynamic monitoring, which may involve invasive arterial lines or central venous catheters in high-risk cases, helps guide fluid and vasopressor management. Anesthesiologists must anticipate variations and be prepared to intervene promptly ^6,7.

Patient safety during surgery in the lateral position extends beyond anesthesia delivery. Improper positioning can result in nerve injuries, pressure sores, or musculoskeletal strain. In collaboration with the surgical team, the anesthesiologist ensures that the head and neck are aligned, the dependent arm is supported, and padding is placed under pressure points such as the knees, elbows, and iliac crest. Special attention is required for the brachial plexus and peroneal nerve, which are at higher risk of compression injuries in this position. Eye protection is also critical to prevent corneal abrasions or pressure-related damage ^8–10.

Intraoperative monitoring in the lateral position is comprehensive. Standard monitoring is supplemented with advanced tools depending on the complexity of the procedure. Continuous pulse oximetry and capnography are indispensable, while arterial blood gas analysis may be required to assess oxygenation during one-lung ventilation. Frequent reassessment of positioning, airway security, and hemodynamics is essential throughout the surgery ^11,12.

Anesthesia for surgery in the lateral position requires a thorough understanding of the physiological changes that occur and the potential complications that may arise. By anticipating challenges in ventilation, hemodynamics, and patient positioning, anesthesiologists can provide safe and effective care.

References

1.         O’Connor, D. & Radcliffe, J. Patient positioning in anaesthesia. Anaesthesia & Intensive Care Medicine 25, 743–748 (2024). DOI: 10.1016/j.mpaic.2024.08.003

2.         Openanesthesia. Patient Positioning: Physiologic Effects. OpenAnesthesia https://www.openanesthesia.org/keywords/patient-positioning-physiologic-effects/.

3.         Cui, P. et al. Tracheal intubation in the lateral position in emergency medicine: a narrative review and clinical protocol. World J Emerg Med 16, 103–112 (2025). DOI: 10.5847/wjem.j.1920-8642.2025.034

4.         Morimoto, T. et al. Anesthetic management in the lateral position in a patient with Parkinson’s disease who developed severe long-seated forward flexion with the face buried between the knees: a case report. JA Clinical Reports 11, 9 (2025). DOI: 10.1186/s40981-025-00773-0

5.         Meena, S. K., Pathak, S., Singh, A. & Jain, N. Lateral Positioning and Airway Management in Penetrating Abdominal Trauma: A Case Report. Cureus 17, e78466 (2025). DOI: 10.7759/cureus.78466

6.         Obasuyi, B. I., Fyneface-Ogan, S. & Mato, C. N. A comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section. Int J Obstet Anesth 22, 124–128 (2013). DOI: 10.1016/j.ijoa.2012.12.005

7.         Yokoyama, M., Ueda, W. & Hirakawa, M. Haemodynamic effects of the lateral decubitus position and the kidney rest lateral decubitus position during anaesthesia. Br J Anaesth 84, 753–757 (2000). DOI: 10.1093/oxfordjournals.bja.a013588

8.            Proper Patient Positioning Guidelines: Lateral Position. AliMed https://www.alimed.com/blogs/patient-positioning/proper-patient-positioning-guidelines-lateral-position (2023).

9.            Ippolito, M. et al. The prevention of pressure injuries in the positioning and mobilization of patients in the ICU: a good clinical practice document by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). J Anesth Analg Crit Care 2, 7 (2022). DOI: 10.1186/s44158-022-00035-w

10.       Optimal Patient Positioning in the OR: which Fixation Systems Prevent Pressure Points and Nerve Damage? – Inspital | Innovation for Hospital. https://inspital.com/optimal-patient-positioning-in-the-or-which-fixation-systems-prevent-pressure-points-and-nerve-damage/ (2025).

11.       Klein, A. A. et al. Recommendations for standards of monitoring during anaesthesia and recovery 2021. Anaesthesia 76, 1212–1223 (2021). OI: 10.1111/anae.15501

12.       Checketts, M. R. et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 71, 85–93 (2016). DOI: 10.1111/anae.13316