Daily Anesthesiology Research Analysis
Three studies advance perioperative neuroscience and airway care: dose-adjusted intraoperative EEG alpha power predicts postoperative delirium independent of CSF Alzheimer biomarkers; a double-blind RCT shows tapered-cuff endotracheal tubes reduce postoperative sore throat; and a nested case-control study links perioperative chemokines (CCL11, CCL5) to delayed neurocognitive recovery in older adults.
Summary
Three studies advance perioperative neuroscience and airway care: dose-adjusted intraoperative EEG alpha power predicts postoperative delirium independent of CSF Alzheimer biomarkers; a double-blind RCT shows tapered-cuff endotracheal tubes reduce postoperative sore throat; and a nested case-control study links perioperative chemokines (CCL11, CCL5) to delayed neurocognitive recovery in older adults.
Research Themes
- Perioperative neurocognition and EEG monitoring
- Airway device design and postoperative patient-reported outcomes
- Inflammation biomarkers for perioperative cognitive disorders
Selected Articles
1. Associations between anaesthetic dose-adjusted intraoperative EEG alpha power, processing speed, and postoperative delirium: analysis of data from three prospective studies.
In 82 older adults, lower anaesthetic-dose-adjusted intraoperative alpha power independently predicted higher odds of postoperative delirium and correlated with slower preoperative processing speed, but not CSF Alzheimer biomarkers. This supports dose-adjusted alpha power as a perioperative neurophysiologic marker linked to delirium vulnerability.
Impact: Provides an actionable EEG-derived biomarker (dose-adjusted alpha power) that may refine delirium risk stratification beyond dementia pathology. Bridges intraoperative monitoring with cognitive outcomes.
Clinical Implications: Incorporating dose-adjusted alpha power into intraoperative EEG monitoring could help identify patients at high delirium risk and guide anesthetic titration and postoperative surveillance.
Key Findings
- Lower anaesthetic-dose-adjusted frontoparietal alpha power increased odds of postoperative delirium (OR 1.44, 95% CI 1.09–1.89).
- Association also held for moderate-to-severe delirium (OR 1.44, 95% CI 1.04–2.00).
- No association with CSF pTau-181, Aβ1-42, or pTau-181/Aβ1-42.
- Dose-adjusted alpha power correlated with preoperative timed processing speed/executive function, not with untimed attention/memory.
Methodological Strengths
- Anaesthetic dose-adjusted EEG metric tailored to individual anesthetic exposure
- Multimodal assessment including CSF AD biomarkers and neurocognitive testing
Limitations
- Modest sample size (n=82) limits precision and generalizability
- Observational design susceptible to residual confounding despite adjustments
Future Directions: Validate dose-adjusted alpha thresholds in larger multicentre cohorts and test whether alpha-guided titration reduces delirium in randomized trials.
2. Comparison of the incidence and severity of postoperative sore throat and subglottic airway injury with cylindrical versus tapered cuff endotracheal tubes in women undergoing surgery for breast cancer: a randomized controlled trial.
In a double-blind RCT of 174 women undergoing breast cancer surgery, tapered-cuff ETTs reduced the incidence and severity of postoperative sore throat across 1–48 hours without increasing subglottic airway injury, and improved anesthesia satisfaction.
Impact: Pragmatic evidence supporting a simple airway device choice to improve patient-reported outcomes without added harm.
Clinical Implications: Prefer tapered-cuff endotracheal tubes for routine breast surgery to reduce postoperative sore throat; findings may extend to other short elective procedures pending confirmation.
Key Findings
- Tapered-cuff ETTs lowered overall 48-hour postoperative sore throat incidence versus cylindrical cuffs.
- Severity and incidence of sore throat were significantly lower at 1, 6, 12, 24, and 48 hours postoperatively in the tapered group.
- No significant difference in subglottic airway injury between groups.
- Anesthesia satisfaction was higher in the tapered-cuff group.
Methodological Strengths
- Prospective randomized double-blind design with trial registration
- Repeated standardized assessments across multiple postoperative time points
Limitations
- Single surgical population (female breast cancer) limits generalizability
- Follow-up limited to 48 hours; not powered for rare airway injuries
Future Directions: Replicate in diverse surgical populations and assess cost-effectiveness and long-term outcomes (voice quality, airway morbidity).
3. Association between serum chemokines levels and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a nested case-control study.
Among 144 elderly non-cardiac surgery patients, matched analyses (21 pairs) showed higher preoperative CCL11 and lower postoperative CCL5 in those with dNCR, with larger perioperative CCL11 decreases. No differences were seen for CCL2 or CXCL8.
Impact: Identifies candidate inflammatory chemokines linked to early postoperative cognitive trajectory, informing risk stratification and mechanistic hypotheses.
Clinical Implications: Perioperative measurement of CCL11 and CCL5 could help flag older adults at risk for dNCR for targeted prevention and follow-up, pending external validation.
Key Findings
- Preoperative serum CCL11 was higher in dNCR cases than matched controls (P=0.039).
- Postoperative serum CCL5 was lower in dNCR than controls (P=0.030).
- Perioperative absolute decrease in CCL11 and postoperative-to-preoperative ratios for CCL5 and CCL11 were greater/lower in dNCR (P=0.046 and P=0.046, 0.005).
- No significant differences for CCL2 or CXCL8 between groups.
Methodological Strengths
- Pre- and postoperative paired biomarker sampling with matched case-control design
- Prospective registration and standardized neuropsychological testing
Limitations
- Small matched sample size (21 pairs) limits power and precision
- Retrospective nested case-control design susceptible to selection bias; short 1-week cognitive follow-up
Future Directions: Validate CCL11/CCL5 signatures in larger cohorts with longer follow-up and assess whether anti-inflammatory strategies modifying these chemokines improve dNCR.