Several methodological constraints merit acknowledgment. The cohort size was relatively modest, and enrollment was restricted to ASA physical status I and II patients, limiting extrapolation to higher

The gap

Consensus across the literature

Supporting evidence — 3 representative gaps

• Postoperative diastolic perfusion pressure as a predictor of delirium after cardiac surgery (2026) · doi

  This study has several strengths. It includes a large sample size, enhancing statistical power and reliability. Multiple analytical approaches, including multivariable regression and restricted cubic spline analysis, were applied to ensure robustness. In addition, DPP is a simple and clinically accessible parameter, increasing the translational value of our findings. single-center study, which may Several limitations should be acknowledged. First, this was a retrospective limit generalizability and introduce potential selection bias. Second, although multiple confounders were adjusted for, residual confounding cannot be excluded. Third, although anesthesia management was relatively standardized, detailed data on anesthetic depth and drug dosing were not available, which may influence both hemodynamic stability and delirium risk. In addition, ASA physical status classification was not available in the database and therefore could not be included in the analysis, which may have introduced residual confounding. Fourth, DPP was used as a surrogate for organ perfusion, and direct measurements of cerebral perfusion were not available. Fifth, DPP was assessed only during the early postoperative period. Finally, due to the observational design, causal relationships cannot be established.

  Keywords: available several multiple addition residual confounding cannot perfusion strengths includes large sample size enhancing statistical
• Effect Of BIS-Guided Propofol Infusion Compared To Conventional Weight- Based Infusion On Hemodynamic Stability And Recovery Profile In General (2026) · doi

  Limitations: Despite demonstrating significant clinical benefits of BIS-guided propofol infusion, the present study has should be acknowledged. First, this was a single-centre study, which may limit the generalizability of the findings to other institutions with different patient populations, surgical practices, or anaesthetic protocols. Multicentre trials would provide broader external validity. Second, the study excluded high-risk patients (ASA III and IV). Therefore, the results cannot be extrapolated to patients with significant cardiovascular, respiratory, or systemic comorbidities. Since haemodynamic stability is particularly critical in such populations, future studies including high- risk cohorts are warranted. Third, blinding of the anaesthesiologist was not feasible due to the nature of BIS monitoring. This may introduce performance bias, as the treating anaesthesiologist was aware of group allocation. However, objective outcome measures such as propofol consumption, MAP variability, and Modified Aldrete Scores reduce the likelihood of substantial long-term postoperative subjective bias. Fourth, outcomes such as hospital stay duration, patient satisfaction recovery, and cost-effectiveness scores, cognitive analysis were not evaluated. Inclusion of these parameters would provide a more comprehensive understanding of the clinical and economic impact of BIS monitoring. Fifth, the sample size, though adequate to detect significant differences in primary outcomes, may not be powered sufficiently to evaluate rare adverse events such as intraoperative awareness. Finally, the study focused primarily on propofol-based anaesthesia. The findings may not be directly applicable to volatile anaesthetic techniques without further comparative research. propofol CONCLUSION BIS-guided infusion provides: - Superior haemodynamic stability - Reduced propofol requirement - Faster early recovery - Lower incidence of PONV Routine BIS-guided titration may enhance precision anaesthesia delivery in elective surgical patients undergoing TIVA. recruitment; intraoperative Author Contributions: study design; Author 1: Conceptualization of formulation of research hypothesis; supervision of patient anaesthesia management; data interpretation; drafting and critical revision of the manuscript; final approval of the version to be published. Author 2: Data collection and patient enrolment; intraoperative monitoring documentation; statistical analysis; preparation of tables and results section; literature review and referencing; contribution to manuscript drafting. Author 3: Methodology design support; ethical approval coordination; data verification and validation; critical review of discussion and interpretation; editing for scientific accuracy; overall administrative oversight. All authors contributed substantially to the study conception, design, data acquisition, analysis, and manuscript preparation. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the IJDDT, Volume16 Issue 9s, January 2026 work. REFERENCES 1. Smith I, White PF, Nathanson M, Gouldson R. Propofol: an update on its clinical use. Anaesthesia. 2020;75(Suppl 1):S10–S18. 2. Miller RD, et al. Miller’s Anaesthesia. 9th ed. Philadelphia: Elsevier; 2021:823–856. 3. Asehnoune K, et al. Conventional vs target control infusion: impact on drug consumption. Br J Anaesth. 2021;127(5):789–798. 4. Punjasawadwong Y, et al. BIS monitoring reduces anaesthetic exposure. 5. Cochrane Database Syst Rev. 2020;3:CD008012. 6. Myles PS, and al. awareness prevention. et BIS Lancet. 2022;399(10330):145–154. 7. Cao Y, et al. BIS-guided TIVA in ambulatory anesthesia. J Clin Monit Comput. 2023;37(4):875– 883. 9. 8. Arnaoutakis GJ, et al. BIS vs clinical signs for propofol infusion. Anaesth Crit Care Pain Med. 2021;40(6):100900. Joshi GP, et al. Propofol consumption with BIS guidance. Anesth Analg. 2022;134(3):550–558. 10. Khurana G, et al. Depth monitoring in general surgery patients. Indian J Anaesth. 2023;67(10):789–795. 11. Kim HJ, et al. Clinical outcomes with BIS targeting in surgeries. Clin Exp Otorhinolaryngol. ENT 2024;17(2):125–131. 12. Lee JH, et al. Haemodynamic variability in orthopaedic anaesthesia. J Orthop Surg Res. 2023;18(1):556. 13. Chung F, et al. Modified Aldrete Scoring for PACU Care.

  Keywords: propofol anaesthesia clinical monitoring guided infusion patient patients author manuscript significant anaesthetic haemodynamic critical consumption
• Comparative Efficacy of Esmolol, Labetalol, and Lignocaine in Attenuating Hemodynamic Responses to Laryngoscopy and Intubation: A Randomized Double-Blind Study (2026) · doi

  Several methodological constraints merit acknowledgment. The cohort size was relatively modest, and enrollment was restricted to ASA physical status I and II patients, limiting extrapolation to higher-risk clinical populations. As a single-center investigation, site-specific practices may have influenced outcomes in ways not generalizable to other institutional settings. Fixed drug dosing precluded exploration of dose- response relationships, and hemodynamic surveillance was confined to the 10 minutes immediately following intubation, leaving longer-term cardiovascular effects uncharacterized. The exclusive use of non- invasive blood pressure monitoring may have introduced measurement imprecision when compared with direct intra-arterial recordings. Additionally, a formal sample size power calculation was not performed prior to study initiation, which may limit precision in estimating treatment effects. Potential operator- related variability may also have influenced peri-intubation hemodynamic responses despite standardized intubation techniques. Furthermore, adverse events were infrequent, limiting detailed comparative safety analysis between groups.

  Keywords: intubation size limiting influenced hemodynamic effects several methodological constraints merit acknowledgment cohort relatively modest enrollment