Nellys Jhoana Bustamante Mejia Rueda

Adaptive anesthesia has emerged as a paradigm shift in modern perioperative medicine, integrating neurophysiologic monitoring and individualized anesthetic control to optimize patient outcomes. This review analyzes current evidence on the role of electroencephalographic monitoring, depth-of-anesthesia indices, and closed-loop systems in guiding anesthetic management. A structured analysis of high-impact studies published from 2020 onward was conducted, focusing on neurophysiological mechanisms, perioperative outcomes, and technological advancements. The findings demonstrate that EEG-based monitoring improves the accuracy of anesthetic depth assessment and allows for more precise titration of anesthetic agents. Excessive anesthetic depth was consistently associated with higher rates of postoperative delirium, cognitive dysfunction, and hemodynamic instability, while adaptive strategies contributed to improved intraoperative stability and recovery profiles. Closed-loop systems showed potential in reducing variability and enhancing anesthetic precision, although their implementation remains limited. From an international perspective, the adoption of adaptive anesthesia is increasing, including in Latin American contexts such as Mexico, Colombia, and Ecuador, despite existing disparities in resources and training. Overall, adaptive anesthesia represents a transition toward precision-based, patient-centered perioperative care. Further research is required to standardize protocols, validate emerging technologies, and ensure broader clinical applicability.

Clinical complexity in internal medicine has increasingly shifted from isolated organ-based disease models toward integrative, systems-based approaches. This review analyzes the interaction between gastrointestinal and urological systems as a representative model of multisystem disease. A narrative synthesis of high-impact literature was conducted, focusing on shared pathophysiological mechanisms, including systemic inflammation, metabolic dysregulation, microbiota alterations, neuroautonomic dysfunction, and organ crosstalk. The findings demonstrate that gastrointestinal and urological disorders frequently coexist and are interconnected through dynamic biological networks rather than independent processes. Multimorbidity emerges as a central framework in which conditions influence each other’s progression and clinical expression. The gut–kidney–bladder axis, along with the role of the microbiome and metabolic syndrome, provides key insights into these interactions. Furthermore, integrated care approaches show a clear advantage over fragmented management, improving clinical outcomes through coordinated and mechanism-based strategies. These results support the need for a paradigm shift in internal medicine toward systems-based thinking, particularly in clinical and educational settings. The integration of gastrointestinal and urological perspectives offers a more comprehensive understanding of disease and contributes to more effective, patient-centered care.