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Dexmedetomidine is a selective α2-adrenergic agonist that produces a sedation state resembling non–rapid eye movement sleep. Early EEG studies demonstrated characteristic oscillatory patterns suggesting engagement of endogenous sleep circuits rather than conventional GABAergic anesthesia.

These neurophysiologic properties have generated interest in dexmedetomidine as a strategy to improve perioperative brain health. Recent meta-analyses and large clinical trials, including the MINDDS study, have examined its potential impact on postoperative delirium.

Emerging neuroimaging approaches are beginning to provide new insight into how dexmedetomidine alters brain physiology. Ultra-high-field 7T fMRI can detect large-scale cerebrospinal fluid (CSF) pulsations linked to glymphatic transport. This talk will integrate electrophysiology, clinical evidence, and advanced imaging to explore how dexmedetomidine affects brain state, delirium risk, and CSF dynamics.

What do patients experience during anesthesia, and does it matter? Can we deliberately facilitate dreaming during anesthesia, and if so, can these experiences be therapeutic? This talk will present three lines of research examining how anesthesia dreaming can be intentionally facilitated, what these experiences are like, and whether they may hold therapeutic value. Across these studies, a consistent picture emerges: it is possible to intentionally induce a brain state conducive to dreaming during anesthesia; the experience is predominantly positive and associated with high subjective sleep quality; and anesthesia dreaming may carry therapeutic benefits both within and beyond the operating room. These findings suggest that what patients experience during anesthesia deserves our attention, and that how we manage emergence may shape those experiences in clinically meaningful ways.

Understanding how consciousness emerges, transforms, and recovers requires moving beyond static state classifications toward the study of dynamic brain configurations. This talk presents research from Dr. Duclos’ lab combining high-density EEG with experimental and computational approaches to probe and modulate brain-state dynamics across sleep and anesthesia. Her work first characterizes how functional brain networks reorganize across and within sleep stages, shifting from more segregated configurations in NREM to increasingly integrated and complex dynamics across the night and into wakefulness. Complementary findings from lucid dreaming further demonstrate spectral and network changes associated with the transient reinstatement of higher-order processing. The talk then presents a novel extension of closed-loop auditory stimulation to anesthesia, proposing the targeted modulation of slow-wave (delta) activity by delivering stimuli phase-locked to endogenous oscillations, with the goal of shaping brain-state stability.

Finally, anesthesia is framed as a controlled perturbational model to probe latent brain dynamics, revealing signatures predictive of recovery of consciousness in unresponsive patients. Together, this work positions brain-state dynamics as a mechanistic substrate of consciousness and a potential target for intervention, with implications for sleep physiology, anesthetic care, and disorders of consciousness.

The concept of sleep is often erroneously portrayed under general anesthesia. Anesthesia providers will often describe to patients and their caregivers that the depressed consciousness that we achieve under general anesthesia is congruent with the concept of sleep; however, clinical science paints a different picture. Awareness is inextricably a poignant concern among adults that undergo anesthesia, but the idea of cognition, memory formation and recall is rarely addressed in the pediatric population. The aim of this presentation is to provide the best contextual knowledge and evidence of the infant brain under general anesthesia to elucidate best anesthesia practice and informed consent.

Take advantage of dedicated networking breaks to connect with colleagues, exchange ideas, and explore new collaborations.

Cognitive behavioral therapy for insomnia (CBTi) is the first-line treatment for insomnia, yet substantial inter-individual variability in treatment response remains. Understanding the mechanisms underlying CBTi and identifying predictors of response are critical to improving treatment outcomes and advancing personalized care.

In this presentation, I will report findings from randomized controlled trials examining the effects of CBTi across multiple physiological and neural domains. Using a multimodal approach, these studies assess changes in heart rate variability, immunological outcomes, and brain function. Neuroimaging data include both resting-state functional connectivity and task-based functional MRI, providing insight into neural processes associated with treatment.

In addition to treatment-related changes, I will present work investigating sleep microarchitecture as a predictor of CBTi response, with a particular focus on sleep spindles. These analyses aim to identify neurophysiological markers associated with differential treatment outcomes.

Together, this work contributes to a more comprehensive understanding of the mechanisms and variability of response to CBTi, with implications for the development of more targeted and effective interventions for insomnia

As the surgical demographic shifts toward an increasingly aged population, the traditional organ-specific approach to risk assessment is proving insufficient. Geriatric syndromes –multifactorial conditions such as frailty and cognitive impairment – have emerged as superior predictors of postoperative morbidity compared to chronological age or isolated comorbidities. Among the most pervasive yet under-addressed drivers of these syndromes is the dysregulation of sleep-wake cycles, which serves as both a precursor to and a consequence of physiological vulnerability.

This presentation defines the core components of geriatric syndromes, focusing on the phenotypic and deficit-accumulation models of frailty and the spectrum of perioperative neurocognitive disorders (PND). We will detail evidence-based strategies for frailty assessment in the high-pressure perioperative environment, including the Clinical Frailty Scale (CFS), while highlighting the catastrophic consequences of frailty, such as increased 30-day mortality, prolonged institutionalization, and the “delirium-to-dementia” trajectory.

A central pillar of this talk explores the complex, bidirectional relationship between sleep architecture and geriatric vulnerability. We examine how chronic sleep fragmentation and circadian misalignment accelerate the accumulation of frailty through systemic inflammation (inflamm-aging) and impaired glymphatic clearance of neurotoxic metabolites. Conversely, we discuss how the “frail state” inherently destabilizes sleep through altered melatonin metabolism and reduced physiological resilience to surgical stress.

Finally, we propose a multi-modal framework for intervention. This includes “sleep-hygiene prehabilitation,” the strategic use of melatonin agonists, and the implementation of nurse-led delirium prevention bundles (e.g., HELP protocol). By re-prioritizing sleep as a modifiable vital sign, perioperative clinicians can bridge the gap between surgical survival and functional thriving.

The perioperative evaluation of patients with sleep apnea must be meticulously studied. We primarily use type 1 and type 3 polysomnography for sleep assessment, and type 2 may also be used. Patients should undergo a comprehensive evaluation, including physical examinations, systemic examinations, and the patient’s expectations regarding surgery. Careful consideration should be given to which medications will be used during the operative period, including anesthetic infiltration and medications that may alter respiratory drive. Postoperative monitoring with oximetry and maintenance of care and periodic assessments of vital signs is of paramount importance, as are the medications used to reduce symptoms in elderly patients and certain medications, particularly opioids.

Drug induced Sleep Endoscopy is used to evaluate the airway in patients with obstructive sleep apnea. CPAP is the gold standard of treatment, but is not well tolerated in all pediatric or adult patients. Oral mandibular advancement devices, surgery, and nerve stimulator devices are all possible alternative treatments that can be evaluated during the study. To achieve conditions as close as possible during non-REM sleep, Dexmedetomidine is the drug of choice for DISE studies. It has minimal effect on brain wave amplitude and frequency, does not cause respiratory depression, and has hypnagogic effects. Other possible agents used are opiates, propofol, ketamine, and versed, but all have greater effects on brain wave activity, sedation, or respiratory suppression. The anesthesia needs to support spontaneous respiration similar to sleep, with same levels of airway collapse as the patient’s normal sleep. The plane of sedation cannot be too deep that it approaches full general anesthesia. Some centers use EEG monitoring including BIS or Sedline monitors during the procedure to assess proper levels of sedation. Depending upon the location and amount of airway collapse, the patient can be evaluated for surgical intervention, including hypoglossal nerve stimulators.

The main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19 600 anaesthetics (95% CI 1:16 700–23 450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030–9700), and without it was ~1:135 900 (1:78 600–299 000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. The incidence of accidental awareness during caesarean section was ~1:670 (1:380–1300). Two thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental; rapid sequence induction; obesity; difficult airway management; neuromuscular blockade; and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, most due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness
included: female sex; age (younger adults, but not children); obesity; anaesthetist seniority (junior trainees); previous awareness; out-of-hours operating; emergencies; type of surgery (obstetric, cardiac, thoracic); and use of neuromuscular blockade. The following factors were not risk factors for accidental awareness: ASA physical status; race; and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from 5th National Audit Project – the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

GLP-1 agonists, increasingly used for managing diabetes, obesity, and other conditions such as non-alcoholic fatty liver disease, present unique challenges for anesthesia providers. Patients on GLP-1RA appear to have a higher risk of delayed gastric emptying and returned gastric content despite adequate fasting. The standard fasting guidelines often fail to account for the altered physiology they induce. This may increase the risk of aspiration of gastric content during sedation and general anesthesia. Although there are several published recommendations, they have significant limitations because the data to provide evidence-based clinical guidelines is sparse and of low quality. This is a complex clinical puzzle anesthesiologists are still trying to solve. Provide practical, actionable approaches to perioperative care for patients taking GLP-1 receptor agonists. The aim is to make available guidance clearer, more practical, and applicable to clinicians. There is uncertainty or controversy surrounding the anesthetic implications of GLP-1 receptor agonist.

Overall, there is consensus that preoperative withholding of GLP-1RAs is inadvisable, irrespective of the indication for their use. Furthermore, it seems appropriate to consume liquid diet for at least 24 h in patients at high risk of gastroparesis. There should be low threshold to perform gastric ultrasound and rapid sequence induction of general anesthesia, if appropriate. The available recommendations should be adapted to individual patients and facilities with the primary aim of maintaining patient safety. Finally, peri-procedure management of patients receiving GLP-1RAs should be based on shared decision-making of the anesthesiologist, the proceduralist/surgeon, and the patient. This lecture will help you understand the current (and somewhat confusing) recommendations about GLP-1RA in the perioperative setting, explain the underlying uncertainties, and give you practical strategies for anesthetic management.

Take advantage of dedicated networking breaks to connect with colleagues, exchange ideas, and explore new collaborations.

Sleep-disordered breathing has a high prevalence in the pediatric population. Often times these children present for surgery undiagnosed. In the perioperative setting, screening tools and risk assessments are invaluable in creating individualized care plans to avoid untoward outcomes. These vulnerable patients are best served with a multispecialty approach to help reduce perioperative complications.

Over the past few decades, EEG monitoring has become increasingly common in anesthesia practice, with BIS and SedLine among the most widely used tools in the United States. Yet in pediatric anesthesia, EEG remains underused, often because many of us were never formally taught how to interpret it and are not sure what extra value it adds beyond our usual monitors. This short talk will review some benefits and challenges of pediatric EEG monitoring and show how it can be easier to learn, and more useful, than many of us expect.

Obesity Hypoventilation Syndrome (OHS) is an underrecognized disorder characterized by the combination of obesity, sleep-disordered breathing, and chronic daytime hypercapnia. Patients with OHS are at particularly high risk for perioperative respiratory complications, including difficult ventilation, opioid-induced ventilatory impairment, and postoperative respiratory failure. Despite these risks, OHS often remains undiagnosed prior to surgery, limiting opportunities for risk mitigation and perioperative optimization.

This presentation reviews practical approaches to the screening and perioperative management of OHS, based on the recently published work “Screening and Perioperative Management of Obesity Hypoventilation Syndrome.” The talk will highlight strategies for identifying patients at risk in the preoperative setting, including clinical features, laboratory markers such as serum bicarbonate, and the role of sleep testing. Evidence-based perioperative management principles will be discussed, including preoperative evaluation, intraoperative considerations, postoperative monitoring, and the use of positive airway pressure therapy.

The goal of this session is to provide anesthesiologists and perioperative clinicians with a clear framework for recognizing OHS and implementing practical management strategies that reduce perioperative respiratory complications and improve patient safety.

Portable sleep monitors capable of estimating sleep patterns are increasingly embedded in daily life, creating new opportunities to promote sleep health while raising important clinical and public health questions. Drawing on population studies and clinical research in Canada, this presentation will examine how consumer sleep technologies are reshaping sleep awareness, health behaviors, and interactions with healthcare providers. Surveys of Canadian adults indicate that roughly one in five individuals has used a wearable device to monitor sleep, with many reporting perceived benefits such as increased awareness of sleep habits and motivation to improve sleep routines, while others experience heightened concern or anxiety about sleep metrics.

This talk will highlight emerging evidence on the real-world use of sleep wearables, including demographic patterns of adoption, associations with sleep and mental health symptoms, and how wearable data influence healthcare-seeking behaviors. It will also address key limitations of current technologies—such as variable accuracy in sleep staging, proprietary algorithms, and the potential for “orthosomnia,” or excessive preoccupation with achieving idealized sleep metrics. Examples will be given of clinical applications in insomnia and sleep apnea care. Finally, the session will discuss the ongoing efforts to map guidelines and practical strategies for healthcare providers to engage with patients who use wearable sleep trackers.