Damaris Anahi Sampedro Martínez

Anesthesia is a complex physiological intervention capable of producing significant neurophysiological and systemic alterations that influence perioperative and postoperative patient outcomes. Contemporary evidence suggests that anesthetic agents affect cortical connectivity, thalamocortical communication, neurotransmitter regulation, cardiovascular stability, respiratory physiology, inflammatory pathways, and metabolic homeostasis. The objective of this review was to analyze the neurophysiological and systemic effects of anesthesia and evaluate their implications for perioperative recovery, postoperative complications, and patient-centered outcomes. A narrative review methodology supported by the Scientific Method framework was employed. Scientific literature indexed in internationally recognized databases including PubMed, Scopus, ScienceDirect, and specialized anesthesiology journals was analyzed. The review focused on studies published between 2015 and 2025 involving neurophysiological mechanisms of anesthesia, postoperative neurocognitive disorders, hemodynamic instability, systemic physiological alterations, perioperative brain health, and individualized anesthetic management strategies. The analyzed evidence demonstrated that anesthesia produces coordinated alterations involving neural networks, organ perfusion, inflammatory activation, respiratory dynamics, and metabolic regulation. Excessive anesthetic depth was associated with increased postoperative delirium and cognitive dysfunction, particularly among elderly and vulnerable patients. Intraoperative hypotension demonstrated a strong relationship with postoperative organ dysfunction and perioperative morbidity. Furthermore, individualized strategies such as electroencephalography-guided anesthesia, regional anesthesia, multimodal analgesia, and precision-based hemodynamic management were associated with improved recovery profiles and better postoperative outcomes.

Multimorbidity and clinical complexity have become increasingly important challenges in contemporary internal medicine due to demographic aging, epidemiological transition, and the growing prevalence of chronic non-communicable diseases. The coexistence of multiple chronic conditions frequently leads to polypharmacy, frailty, cognitive impairment, functional decline, increased healthcare utilization, and difficulties in therapeutic decision-making. The present review aimed to analyze the relationship between multimorbidity and clinical complexity within modern internal medicine, emphasizing the impact of chronic disease accumulation, patient-centered care, healthcare fragmentation, and public health determinants, particularly in Latin American contexts such as Mexico, Colombia, and Ecuador. A narrative review methodology based on the Scientific Method was employed using scientific literature indexed in PubMed, Scopus, Google Scholar, BMJ Journals, and related academic databases. The analyzed evidence demonstrated that multimorbidity significantly increases healthcare utilization, medication-related risks, hospitalization, and therapeutic complexity, particularly among geriatric populations. The findings additionally highlighted the importance of interdisciplinary management, shared decision-making, comprehensive geriatric assessment, and individualized therapeutic planning focused on functionality and quality of life rather than isolated disease-centered targets. The review concludes that modern internal medicine requires integrative and humanistic healthcare models capable of balancing scientific evidence with patient priorities, social determinants, and long-term healthcare sustainability.