Towards a better understanding of anesthesia emergence mechanisms: Research and clinical implications

Table 1 Suggestions for additional research on emergence from anesthesia

Type of study	Topic(s)
Multicenter RCTs	Effects of drugs on AE time, features, and postoperative complications including mental status changes
Multicenter RCTs	Effects of antinociceptive interventions (e.g., neuraxial anesthesia) on accelerating emergence and improving patient outcomes
Animal research (molecular/behavioral research)	Effects of AE modulation on molecular targets of neuroinflammation
Animal research (behavioral research)	Effects of AE modulation on early postoperative behavioral changes
Animal research (molecular/imaging/behavioral research)	Anesthetics mechanisms; Linkage between brain areas involved in cognitive functioning and AE features
Animal research/in humans	Neurophysiological changes under general anesthesia (e.g., by combining EEG approaches with electrodiagnostic methods, including EMG and EPs, or with brain activity measures such as fNIRS, and neuroimaging modalities like fMRI)
In vitro/In vivo (e.g., mutant analysis in Drosophila)	Anesthetic mechanisms (e.g., genes encoding for second-messengers, memory formation substrates, ion channels, synaptic proteins)

RCT: Randomized controlled trial; AE: Anesthesia emergence; EMG: Electromyography; EPs: Evoked potentials; fNIRS: Functional near-infrared; fMRI: Functional magnetic resonance imaging.