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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

Among intravenous agents used in general anesthesia, propofol has long been the standard drug of choice due to its rapid onset, short duration, and favorable recovery profile. Its mechanism enhances inhibitory GABAergic transmission, producing reliable sedation and anesthesia. However, propofol is not without drawbacks, as adverse reactions ranging from minor events like injection-site pain to serious complications like propofol infusion syndrome can limit propofol usage.¹ To address these challenges, researchers have pursued alternatives with improved safety and tolerability profiles. In 2017,² ciprofol was first introduced as a next-generation intravenous anesthesia agent that shows potential to replace propofol in clinical practice.

Ciprofol builds on the traditional 2,6-disubstituted phenol structure shared by classic intravenous anesthetics such as propofol but features the addition of a cyclopropyl group that modifies the agent’s chemical and pharmacological properties. This substitution reduces lipophilicity and breaks the symmetry of the parent molecule, which creates a chiral center and produces stereoselective activity at the GABA_A receptor. These structural changes enhance receptor binding affinity and production. This results in a higher receptor affinity for ciprofol over propofol, as confirmed by radioligand-binding assays.³ Additionally, the R-enantiomer of ciprofol demonstrates greater stereoselectivity for the GABA_A receptor than propofol’s S-enantiomer. Together, these results indicate ciprofol has stronger target selectivity and higher action intensity.

Mechanistically, ciprofol functions as both a positive allosteric modulator and direct agonist of the GABA_A receptor. Electrophysiological studies, such as competitive binding assays and whole-cell patch-clamp experiments, confirm that ciprofol facilitates chloride influx by binding to butylbicyclophosphorothionate and t-butylbicycloorthobenzoate targets (two extremely potent GABA receptor antagonists) in the chloride channels of GABA_A receptors through receptor-associated pathways.⁴ The influx of chloride can cause hyperpolarization of nerve cell membranes by increasing the intracellular chloride concentration and further activating GABAergic neurons to achieve central nerve inhibition, producing sedative and anesthetic effects.

In a 2022 preclinical study, both ciprofol and propofol were administered to rats via intravenous injection to assess hypnotic potency and safety. Loss of righting reflex was used as a behavioral marker of anesthesia, with the effective dose (ED₅₀) values calculated based on the proportion of animals losing reflex at different doses. To evaluate safety, the lethal dose (LD₅₀) value was determined by monitoring mortality after escalating doses, and the therapeutic index was then derived from the LD₅₀/ED₅₀ ratio. They found ciprofol has approximately 4–5 times higher hypnotic potencythan propofol and exhibits ahigher therapeutic index, indicative of a wider safety margin.⁵

A prospective, double-blind, single-center RCT enrolled 120 female patients undergoing general anesthesia for gynecological surgery. There were no significant differences between patients who received propofol or ciprofol in terms of induction success rate, duration of successful induction, time to induction (as measured by the loss of eyelash reflex), and tracheal intubation. However, the overall incidence of adverse events was significantly lower in the ciprofol group than in the propofol group (20% vs. 48%, respectively).⁶

Current evidence suggests ciprofol offers certain pharmacological and clinical advantages over propofol. Its structural modifications enhance stereoselectivity and receptor affinity, translating to stronger potency at lower dosage levels. Preclinical studies in murine models demonstrated a higher therapeutic index, supporting a wider safety margin over propofol. Early clinical trials further confirmed the agent’s comparable anesthetic efficacy while reducing the incidence of adverse events. These findings indicate that ciprofol has potential as a next-generation intravenous anesthesia agent to become widely used in the operative setting.

References

1. Mashour G. A., Sanders R. D., and Lee U., Propofol Anesthesia: A Leap Into the Void? Anesthesiology. (2022) 136 (3), 405-407, https://doi.org/10.1097/ALN.000000000000411035120194
2. Zhang C., Li F., Yu Y., et al. Design, Synthesis, and Evaluation of a Series of Novel Benzocyclobutene Derivatives as General Anesthetics. Journal of Medicinal Chemistry. 2017;60(9):3618-3625. https://doi.org/10.1021/acs.jmedchem.7b00253
3. Qin L., Ren L., Wan S., et al. Design, Synthesis, and Evaluation of Novel 2,6-Disubstituted Phenol Derivatives as General Anesthetics. Journal of Medicinal Chemistry. 2017;60(9):3606-3617. https://doi.org/10.1021/acs.jmedchem.7b00254
4. Lu M, Liu J, Wu X, Zhang Z. Ciprofol: A Novel Alternative to Propofol in Clinical Intravenous Anesthesia? BioMed Research International. 2023;2023:1-12. https://doi.org/10.1155/2023/7443226
5. Liao J., Li M., Huang C., et al. Pharmacodynamics and Pharmacokinetics of HSK3486, a Novel 2,6-Disubstituted Phenol Derivative as a General Anesthetic. Frontiers in Pharmacology. 2022;13. https://doi.org/10.3389/fphar.2022.830791
6. Chen B., Yin X., Jiang L., Liu J., Shi Y., Yuan B., The Efficacy and Safety of Ciprofol Use for the Induction of General Anesthesia in Patients Undergoing Gynecological Surgery: A Prospective Randomized Controlled Study. BMC Anesthesiology. 2022;22(1). https://doi.org/10.1186/s12871-022-01782-7

Anesthesia providers may face radiation exposure in their daily work, particularly during procedures that employ imaging technologies such as fluoroscopy. While most attention tends to focus on radiologists and interventional cardiologists, anesthesiologists and nurse anesthetists often stand close to radiation sources, sometimes without full awareness of the risk.

Anesthesia providers experience radiation exposure from both operating rooms and non-operative settings like interventional radiology or catheterization labs. The main source of exposure is scattered radiation from the patient and not the primary beam—increasing physical distance from the patient is critical to reducing exposure. Dosimeter monitoring has revealed that residents’ maximum deep dose equivalent over a three-month period was around 0.50 mSv, and eye exposure was about 0.52 mSv, both well below recommended occupational limits ¹.

In interventional cardiology settings, exposure levels remain low. Analyses of the annual mean effective dose from 2019 to 2023 found values ranging from approximately 0.92 mSv in 2020 down to about 0.65 mSv in 2023. These levels are significantly below the 20 mSv annual occupational limit, though some individual readings did exceed the 1 mSv public exposure threshold ².

Additional research carried out across three Mid-Atlantic hospitals assessed anesthesia providers’ compliance with radiation safety measures in operating rooms. Data from initial observations demonstrated that almost 83% of providers followed appropriate safety precautions such as wearing lead aprons, thyroid shields, or standing more than one meter from radiation sources. Following a brief educational intervention, compliance increased to nearly 96%. This suggests that education and awareness significantly influence safety behaviors ³. In addition, clinical research continues to reinforce the “time, distance, and shielding” principle as foundational for radiation protection, urging heightened awareness among anesthesia providers ⁴.

Anesthesia providers have a certain degree of control over two key factors in their levels of radiation exposure: distance and shielding. While time spent near radiation sources is often dictated by patient care, adhering to proper distance (ideally more than one meter) and utilizing protective equipment (lead aprons, thyroid collars, eye protection) can substantially reduce risk.

Routine use of dosimeters is also advised, though observational data indicate that usage remains low among providers. Working closely with procedural teams, such as by ensuring imaging is paused until protective gear is donned, can further minimize unnecessary exposure.

In general, education initiatives have already demonstrated an impact in boosting compliance, and broader adoption of safety protocols and consistent monitoring will continue to safeguard anesthesia professionals in radiation-prone environments ^5–7.

Radiation exposure among anesthesia providers is generally low, often well within regulatory limits. However, the cumulative effect of repeated exposure, particularly during frequent imaging-guided procedures, warrants continued vigilance. Scattered radiation remains the principal risk, but adherence to basic safety principles (like limiting time near the source, maximizing distance, and employing shielding) can effectively minimize potential harm.

References

1. Wang, R. R., Kumar, A. H., Tanaka, P. & Macario, A. Occupational Radiation Exposure of Anesthesia Providers: A Summary of Key Learning Points and Resident-Led Radiation Safety Projects. Semin Cardiothorac Vasc Anesth 21, 165–171 (2017). DOI: 10.1177/1089253217692110

2. Shbeer, A. Assessment of the Occupational Radiation Exposure of Anesthesia Staff in Interventional Cardiology. Risk Manag Healthc Policy 17, 1093–1100 (2024). DOI: 10.2147/RMHP.S460054

3. Spinella, J. et al. Radiation Safety Practices Among Anesthesia Providers: A Multi-Site Observational Pilot Study. Journal of Radiology Nursing 43, 230–234 (2024). DOI: 10.1016/j.jradnu.2024.08.003

4. Kim, J. H. Three principles for radiation safety: time, distance, and shielding. Korean J Pain 31, 145–146 (2018). DOI: 10.3344/kjp.2018.31.3.145

5.  Kim, T. H., Hong, S. W., Woo, N. S., Kim, H. K. & Kim, J. H. The radiation safety education and the pain physicians’ efforts to reduce radiation exposure. Korean J Pain 30, 104–115 (2017). DOI: 10.3344/kjp.2017.30.2.104

6. Ali, M. A., Salim, B., Siddiqui, K. M. & Khan, M. F. Attitudes and knowledge of anesthesiology trainees to radiation exposure in a Tertiary care hospital. Saudi J Anaesth 14, 459–463 (2020). DOI: 10.4103/sja.SJA_659_19

7. Lalabekyan, B., Rennie, A. & Luoma, V. Principles of radiation safety for anaesthetists. BJA Education 25, 181–190 (2025). DOI: 10.1016/j.bjae.2025.01.005

Regional anesthesia, including spinal and epidural techniques, is widely used in surgical, orthopedic, and obstetric practice due to its benefits in pain control, muscle relaxation, and avoidance of general anesthesia. A critical step in the administration and monitoring of regional anesthesia is the accurate physical assessment of the block level. This ensures that the anesthesia has achieved the desired sensory and motor coverage, confirms the safety and effectiveness of the procedure, and helps detect complications such as an excessively high block or incomplete anesthesia.

Sensory block assessment is the primary physical assessment method used to determine the level of regional anesthesia. Several techniques are commonly used, each targeting specific nerve fibers responsible for sensation. One of the most frequently employed methods is temperature sensation testing. This involves applying a cold stimulus—such as an alcohol swab, ice cube, or ether-soaked gauze—to the skin and asking the patient to report changes in cold perception. The loss of cold sensation indicates blockade of small-diameter sensory fibers and offers a sensitive indication of anesthetic spread.

Another well-established method is the pinprick test, which involves gently pricking the skin with a blunt needle or safety pin. Patients are asked to differentiate between sharp and dull sensations across various dermatomal levels. This test targets the A-delta fibers that transmit pain and provides a reliable estimate of the block’s upper level. However, it is subjective and requires patient cooperation, which can sometimes limit its reliability. Light touch assessment is also used and involves stroking the skin with cotton wool or a gauze pad. It evaluates the larger A-beta fibers, which are usually the last to be blocked and the first to recover. Light touch testing is often used alongside other methods to confirm the full extent of the block.

Motor block assessment complements sensory testing, especially in procedures requiring muscle relaxation or when assessing a patient’s readiness for mobilization postoperatively. The most common tool for motor block evaluation is the Bromage scale. This scale ranges from full movement (grade 0) to complete inability to move the lower limbs (grade 3). Assessment is conducted by asking the patient to flex the knee, lift the leg, or wiggle the toes. Motor block assessment is especially important in labor analgesia and lower extremity surgeries to ensure adequate nerve involvement without unnecessarily compromising patient mobility.

In addition to these physical assessment methods for regional anesthesia, some clinicians assess autonomic blockade, which typically extends several dermatomes above the sensory block level. Though not routinely measured, it can provide important information about the depth of the block. Signs of sympathetic blockade include hypotension, bradycardia, and increased skin temperature in the affected dermatomes. Some studies have explored using infrared thermometers or thermographic imaging to assess changes in skin temperature as an indirect measure of sympathetic block. While promising, these methods are not yet standard practice due to cost, complexity, and variability in interpretation.

Accurate block assessment requires a combination of methods and an understanding of their limitations. Variability in patient response, communication barriers, and preexisting conditions such as neuropathy can affect the reliability of physical assessments. Furthermore, interobserver differences can lead to inconsistent evaluations unless clear protocols are followed. Despite these challenges, combining sensory, motor, and—when necessary—autonomic evaluations provides a more comprehensive and reliable picture of the anesthetic block.

References

1. Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985;64(7):715-730. PMID: 3893222.
2. Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001;94(5):888-906. doi: 10.1097/00000542-200105000-00030.
3. Klide AM. Anatomy of the spinal cord and how the spinal cord is affected by local anesthetics and other drugs. Vet Clin North Am Small Anim Pract. 1992 Mar;22(2):413-6. doi: 10.1016/s0195-5616(92)50654-4.
4. Kitahata LM. Modes and sites of “analgesic” action of anesthetics on the spinal cord. Int Anesthesiol Clin. 1975 Spring;13(1):149-70. doi: 10.1097/00004311-197513010-00007.
5. Heavner JE. Jamming spinal sensory input: effects of anesthetic and analgesic drugs in the spinal cord dorsal horn. Pain. 1975 Sep;1(3):239-255. doi: 10.1016/0304-3959(75)90041-X.

A genicular nerve block is a minimally invasive procedure used to diagnose or treat chronic knee pain, particularly in cases where other treatments such as medications or physical therapy have not provided adequate relief. This technique targets the genicular nerves—small sensory nerves that transmit pain signals from the knee joint to the brain. By blocking these nerves, the procedure can reduce or eliminate pain, allowing for improved mobility and quality of life ¹.

The genicular nerve block is most commonly used for patients suffering from chronic osteoarthritis of the knee, especially those who are not candidates for knee replacement surgery. It is also used for individuals experiencing persistent post-surgical knee pain or pain following knee trauma. In some cases, the block is used as a diagnostic tool to determine whether a patient is likely to respond well to a longer-term treatment such as genicular nerve ablation ^2,3.

During the procedure, a healthcare provider injects a local anesthetic, often combined with a steroid, near the genicular nerves around the knee. Using fluoroscopy or ultrasound, the provider ensures that the needle is accurately placed; the injected anesthetic temporarily blocks the transmission of pain signals from the knee to the brain.

Genicular nerve blocks are typically performed by pain management specialists, anesthesiologists, or other physicians with specialized training. These providers have expertise in musculoskeletal and nervous system anatomy and the use of image-guided procedures for injections near nerves to ensure precision and safety. The procedure is typically carried out on an outpatient basis and takes less than half an hour. Most patients report only mild discomfort during the injections and can return home shortly afterward. Driving is usually not recommended immediately after the procedure, so arranging for transportation is advised ^1,4–6.

Many individuals experience significant pain relief within hours of the procedure. The duration of relief varies depending on the individual, but it typically lasts several days to a few weeks for diagnostic blocks. If the patient experiences meaningful relief, this can indicate that a more permanent treatment, such as radiofrequency ablation of the genicular nerves, may be effective. In such cases, the nerves are targeted with heat energy to disrupt pain signals more permanently ^4,7,8.

The genicular nerve block is considered safe, but like all medical procedures, it carries some risks. These include temporary soreness at the injection site, bleeding, infection, or allergic reaction to the medications used. Rarely, the procedure may not provide any pain relief, or the relief may be short-lived. Proper patient selection and imaging guidance significantly reduce the risk of complications ^1,9.

The genicular nerve block is an effective, low-risk option for diagnosing and managing chronic knee pain, especially for those seeking alternatives to surgery. When successful, it can lead to longer-term solutions and help restore a patient’s mobility, comfort, and quality of life.

References

1. Genicular Nerve Block. Cleveland Clinic https://my.clevelandclinic.org/health/treatments/24823-genicular-nerve-block.
2. OSC, O. Diagnostic Genicular Nerve Blocks for Knee Pain. Orthopaedic and Spine Center of Newport News https://www.osc-ortho.com/blog/diagnostic-genicular-nerve-blocks-for-knee-pain/ (2021).
3. Genicular Nerve Block | Pain Specialists of America. https://www.psadocs.com/services/genicular-nerve-block/.
4. Hasoon, J., Orhurhu, V. J. & Yazdi, C. Genicular Nerve Blocks for the Management of Chronic Knee Pain Related to Osteoarthritis – A Case Series. Orthop Rev (Pavia) 16, 126046. DOI: 10.52965/001c.126046
5. NYSORA. Genicular Nerve Blocks. NYSORA https://www.nysora.com/techniques/lower-extremity/nysora-com-genicular-nerve-blocks/ (2021).
6. Genicular Nerve Blocks – AOA Orthopedic Specialists. https://www.arlingtonortho.com/conditions/knee/genicular-nerve-blocks/ (2018).
7. Li, W., Xu, F., Chen, F., Cao, L. & Bao, X. Effect of Genicular Nerve Block (GNB) on Pain in Lesions of the Knee Joint: A Meta-Analysis of Randomized Controlled Trials. JPR 18, 511–522 (2025). DOI: 10.2147/JPR.S503937
8. Konya*, Z. Y., Akin Takmaz, S., Basar, H., Baltaci, B. & Babaoglu, G. Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain. Turk J Med Sci 50, 86–95 (2020). DOI: 10.3906/sag-1906-91
9. Ferguson MD, K. & Kalia MD, H., MPH, FIPP, FACPM. Complications of Genicular Nerve Blocks and Ablations. in Complications of Pain-Relieving Procedures 387–391 (John Wiley & Sons, Ltd, 2022). DOI: 10.1002/9781119757306.ch45.

Surgery start time can be influenced by a wide range of factors, from logistical challenges to clinical considerations. These variables can affect surgical efficiency, patient outcomes, and the overall functioning of healthcare systems. Understanding these factors is crucial for optimizing surgical schedules and ensuring timely, safe procedures.

One key factor influencing surgery start time is the patient’s preoperative preparation. Surgeons, anesthesiologists, and nurses must ensure that the patient is ready for surgery, which includes obtaining medical history, conducting laboratory tests, and confirming the patient is fasting, if necessary. Preoperative imaging and screenings are also vital, and delays in completing these tasks can push back start times. Last-minute changes in the patient’s condition, such as fluctuations in blood pressure or an allergic reaction to anesthesia, may also cause delays as the team aims to stabilize the patient ¹.

The coordination of the perioperative team is another significant factor. A typical team includes the surgeon, anesthesiologist, surgical nurses, and other specialists, all of whom must be present and prepared for the surgery. If any member of the team is delayed or unavailable, the surgery may be postponed. Delays can occur due to emergencies in other operating rooms, scheduling conflicts, or another procedure overrunning its scheduled time. Additionally, specialized surgeons or anesthesiologists may not always be available, especially for complex surgeries ^2–4.

The availability of operating rooms plays a critical role in surgery start times. Surgical facilities often have limited ORs, and scheduling conflicts can arise; surgeons may need to adjust start times to accommodate the availability of the OR. Delays may also occur if previous surgeries run over their allotted time or if the operating room requires extra cleaning or setup between procedures. In facilities with high patient volumes or specialized procedures, managing OR availability can be a complex challenge ^5,6.

In addition, anesthesia preparation and equipment setup are also crucial factors affecting surgery start time. The anesthesia team must ensure all medications and equipment are ready and functioning properly, including calibrating anesthesia machines and confirming drug dosages. Similarly, the surgical team must ensure that all required instruments and devices are sterile and ready for use. Delays in equipment availability or malfunctioning devices can significantly impact the start time, as can the need for additional preparation or sterilization of specific instruments ^7,8.

Patient-related factors also play an important role. These can include anxiety, mobility issues, or difficulties with anesthesia induction. For example, patients with anxiety may require additional time to be sedated or reassured before surgery. Those with complex medical histories may need more time for preparation or monitoring, which can cause delays. Ensuring that the patient is adequately prepared and comfortable is essential to a successful surgical outcome ^7,9.

Surgery start time is shaped by multiple factors, from preoperative preparation and team coordination to operating room availability and patient-specific needs. By understanding and managing these variables, healthcare providers can optimize surgical scheduling, leading to timely surgeries, better patient care, and more efficient healthcare delivery.

References

1. Meneveau, M. O. et al. Patient and Personnel Factors Affect Operating Room Start Times. Surgery 167, 390–395 (2020). DOI: 10.1016/j.surg.2019.08.011

2. Firde, M., Ayine, B., Mekete, G., Sisay, A. & Yetneberk, T. Root causes of first-case start time delays for elective surgical procedures: a prospective multicenter observational cohort study in Ethiopia. Patient Saf Surg 18, 23 (2024). DOI: 10.1186/s13037-024-00405-z

3. Cassera, M. A., Zheng, B., Martinec, D. V., Dunst, C. M. & Swanström, L. L. Surgical time independently affected by surgical team size. The American Journal of Surgery 198, 216–222 (2009). DOI: 10.1016/j.amjsurg.2008.10.016

4. Meyers, A. et al. Quantifying the impact of surgical teams on each stage of the operating room process. Front. Digit. Health 6, (2024). DOI: 10.3389/fdgth.2024.1455477

5. Hara, K. et al. Development of an estimation formula for preparation time of anesthesia induction and surgery accounting for clinical department factors in optimal surgery schedule management. Sci Rep 14, 25185 (2024). DOI: 10.1038/s41598-024-75631-7

6. Gupta, B., Agrawal, P., D’souza, N. & Soni, K. D. Start time delays in operating room: Different perspectives. Saudi J Anaesth 5, 286–288 (2011). DOI: 10.4103/1658-354X.84103

7. Al Amin, M., Baldacci, R. & Kayvanfar, V. A comprehensive review on operating room scheduling and optimization. Oper Res Int J 25, 3 (2024). DOI: 10.1007/s12351-024-00884-z

8. Sasano, N. et al. Time progression from the patient’s operating room entrance to incision: factors affecting anesthetic setup and surgical preparation times. J Anesth 23, 230–234 (2009). DOI: 10.1007/s00540-008-0713-4

9. Okeke, C. J. et al. Delay of Surgery Start Time: Experience in a Nigerian Teaching Hospital. Nigerian Journal of Surgery 26, 110 (2020). DOI: 10.4103/njs.NJS_61_19