The best proven approach to predicting response to surgical stimulation under general anesthesia is use of pharmacokinetic–pharmacodynamic (PK/PD) models for opioids and hypnotics. An alternative approach is based on the individual assessment of a physiologic reflex evoked by a standardized noxious test. In this issue of Anesthesiology, Guglielminotti et al. demonstrate that the pupillary dilatation reflex amplitude is as accurate as use of PK/PD models for predicting movement in response to surgical stimulation. In an accompanying Editorial View, Larson and Gupta tell us how pupillometry may bring us a step closer to tailoring anesthesia in real-time to meet the needs of each individual patient.

  • Guglielminotti et al.: Prediction of Movement to Surgical Stimulation by the Pupillary Dilatation Reflex Amplitude Evoked by a Standardized Noxious Test, p. 985

  • Larson and Gupta: Pupillary Reflex Dilation to Predict Movement: A Step Forward Toward Real-time Individualized Intravenous Anesthetics, p. 961