Comments to: Efficacy of intraoperative thoracoscopic intercostal nerve blocks in nonintubated and intubated video-assisted thoracic surgery: A randomized study

I read the article by Chan et al. with great interest.1 They have nicely connected an EEG-based real time density spectral arrays (DSAs) monitoring to a target-control intravenous infusion (TCI) pump. This paper clearly demonstrates the unique value of combining nerve block
analgesia to general anesthesia in non-intubation thoracoscopic surgery. In addition to the unique advantage of advanced technologies, I would like to provide my perspectives from the pharmacokinetic, electrophysiological, sociobehavioral, and precision medicine points of view to further elucidate the clinical benefits not thoroughly discussed within their manuscript.
First, the pharmacokinetic advantage: the choice of ultrashort remifentanil also plays a key success factor. Remifentanil is such a rapid onset potent analgesic agent that can suppress surgical stress almost immediately after injection. More importantly, its analgesic effect as well as respiratory depression also wane immediately after stopping infusion. This unique onset-offset property ensures the tight control of effect-site concentration (Ce) in a real time
fashion. Without this superb drug in action, the demandsupply equilibrium across the surgical stimuli and anesthetic level could hardly achieve.