Daily Anesthesiology Research Analysis
Three impactful anesthesiology-related studies stood out: a deep learning model using intraoperative EEG robustly predicted postoperative delirium, pre-induction low-dose esketamine plus dexmedetomidine improved lung mechanics and inflammation during one-lung ventilation in COPD patients, and prior COVID-19 history increased postoperative delirium risk while vaccination was protective. Together, these findings advance perioperative neurocognitive risk stratification and lung-protective anesthesi
Summary
Three impactful anesthesiology-related studies stood out: a deep learning model using intraoperative EEG robustly predicted postoperative delirium, pre-induction low-dose esketamine plus dexmedetomidine improved lung mechanics and inflammation during one-lung ventilation in COPD patients, and prior COVID-19 history increased postoperative delirium risk while vaccination was protective. Together, these findings advance perioperative neurocognitive risk stratification and lung-protective anesthesia strategies.
Research Themes
- Perioperative neurocognition and delirium risk prediction
- Lung-protective anesthetic strategies in thoracic surgery
- AI-enabled intraoperative monitoring
Selected Articles
1. Development of a deep learning-based prediction model for postoperative delirium using intraoperative electroencephalogram in adults.
Using 34,550 intraoperative EEG cases, a deep learning model predicted postoperative delirium with AUROC 0.87 and outperformed a logistic regression baseline using burst suppression. Despite class imbalance (low AUPRC), results support EEG-based perioperative risk stratification, pending external validation.
Impact: This large-scale, methodologically rigorous model leverages raw intraoperative EEG to predict delirium, moving beyond simple processed indices and enabling targeted prevention strategies.
Clinical Implications: If externally validated and prospectively integrated, the model could provide real-time delirium risk alerts to guide depth of anesthesia, analgesia, and non-pharmacologic prevention bundles.
Key Findings
- Deep learning on 6-lead intraoperative EEG achieved AUROC 0.870 and AUPRC 0.038 for POD prediction.
- Significantly outperformed logistic regression based on burst suppression ratio (AUROC 0.729; AUPRC 0.013).
- Model trained on 34,550 surgical cases with 5-fold cross-validation; external validation still needed.
Methodological Strengths
- Very large cohort with standardized 6-lead intraoperative EEG
- Direct comparator against a clinically used baseline (burst suppression) with statistical superiority
Limitations
- No external validation; generalizability uncertain
- Low event rate yields low AUPRC; calibration and clinical utility thresholds not reported
Future Directions: Prospective, multi-center external validation with real-time deployment, cost-effectiveness analysis, and evaluation of whether risk-informed interventions reduce delirium.
Postoperative delirium (POD) is associated with increased morbidity and mortality. This study aims to develop a deep learning-based model (DELPHI-EEG) to predict postoperative delirium using intraoperative electroencephalogram (EEG) waveform. A total of 34,550 surgical cases (267 event cases), with 6-lead intraoperative EEG monitoring between 2022 and 2024, were included for model development. During 5-fold cross-validation, the DELPHI-EEG model showed an area under the receiver operating characteristic (AUROC) curve of 0.870 (95% confidence interval [CI]: 0.789-0.935) and the area under the precision-recall curve (AUPRC) of 0.038 (95% CI: 0.017-0.084), significantly outperforming the logistic regression model using burst suppression ratio with AUROC of 0.729 (95% CI: 0.624-0.825, p = 0.004) and AUPRC of 0.013 (95% CI: 0.007-0.026, p = 0.002). The DELPHI-EEG model might serve as a risk predictor for postoperative delirium, potentially enabling targeted preventive interventions for surgical patients; nonetheless, external validation in diverse clinical settings is required.
2. Effects of esketamine combined with dexmedetomidine on oxidative stress and lung function during one-lung ventilation in patients with mild to moderate COPD undergoing thoracoscopic surgery.
In a 4-arm randomized trial (n=60), pre-induction low-dose esketamine, alone or with dexmedetomidine, improved pulmonary mechanics and oxygenation and reduced inflammatory and oxidative stress markers during one-lung ventilation in COPD patients. The combination also stabilized hemodynamics and reduced postoperative pain.
Impact: Demonstrates a potentially translatable lung-protective anesthetic strategy for high-risk COPD patients during thoracic surgery, with mechanistic biomarker support.
Clinical Implications: Anesthesiologists may consider low-dose esketamine (± dexmedetomidine) before induction for COPD patients undergoing VATS with one-lung ventilation to improve mechanics, oxygenation, and recovery, while monitoring for hemodynamic and psychotomimetic effects.
Key Findings
- At 2 hours of one-lung ventilation, Ppeak/Pplat were lower and Cdyn higher in esketamine and combination groups vs control and dexmedetomidine alone (P<0.05).
- Inflammatory (IL-6, IL-8, TNF-α) and oxidative stress (MDA↓, SOD↑) profiles improved with esketamine±dexmedetomidine; IL-10 increased.
- Combination therapy supported hemodynamic stability and reduced postoperative pain, suggesting enhanced recovery.
Methodological Strengths
- Randomized, four-arm parallel-group design with defined dosing
- Comprehensive physiologic and biomarker endpoints during OLV
Limitations
- Single-center, small sample size (n=60) limits generalizability
- Short-term outcomes; blinding and long-term pulmonary endpoints not reported
Future Directions: Larger, multicenter blinded RCTs with standardized OLV protocols and long-term respiratory outcomes; dose–response and safety profiling across COPD severities.
BACKGROUND: This study evaluated the lung-protective effects of esketamine and dexmedetomidine administered before anesthesia induction in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) undergoing video-assisted thoracoscopic surgery (VATS). METHODS: Sixty patients with mild-to-moderate COPD scheduled for VATS who completed the study and were included in the statistical analysis were randomly assigned to four groups (n = 15 per group): Control (Group C, saline), Dexmedetomidine (Group D, 0.8 μg/kg), Esketamine (Group E, 0.25 mg/kg), and Combination (Group ED, dexmedetomidine 0.8 μg/kg plus esketamine 0.25 mg/kg). Arterial blood gases, peak airway pressure (Ppeak), plateau pressure (Pplat), dynamic lung compliance (Cdyn), heart rate (HR), and mean blood pressure (MBP) were measured at different time points. Inflammatory markers (IL-6, IL-8, IL-10, TNF-α), oxidative stress markers (MDA, SOD), intraoperative drug use, postoperative recovery, pain scores, and adverse events were recorded. RESULTS: At T4 (2 h after one-lung ventilation), peak airway pressure (Ppeak) and plateau pressure (Pplat) were significantly lower, and dynamic lung compliance (Cdyn) significantly higher, in Groups E and ED compared to Groups C and D (P < 0.05). At the same time point, levels of IL-6 and IL-8 were significantly lower in Groups E and ED than in Groups C and D (P < 0.05). TNF-α levels were significantly lower in Groups E and ED compared to Group C, and significantly lower in Group ED than in Group D (P < 0.05). IL-10 levels were significantly higher in Groups E and ED than in Groups C and D, with Group E showing higher levels than Group ED (P < 0.05). Similarly, SOD levels were significantly elevated in Groups E and ED compared to Groups C and D, and higher in Group E than in Group ED (P < 0.05). MDA levels were significantly reduced in Groups E and ED compared to Group C, and lower in Group ED than in Group D (P < 0.05). Additionally, PaO CONCLUSIONS: Low-dose esketamine combined with dexmedetomidine, administered before anesthesia induction, improved intraoperative pulmonary mechanics and oxygenation, and attenuated inflammation and oxidative stress in patients with mild-to-moderate COPD undergoing VATS. The combination also helped maintain hemodynamic stability and reduced postoperative pain, contributing to enhanced perioperative recovery.
3. Postoperative delirium and delayed neurocognitive recovery in older adults with prior coronavirus disease: a prospective cohort study.
In 578 older adults undergoing major abdominal surgery, prior COVID-19 history was associated with higher postoperative delirium risk (OR 3.09), while vaccination reduced risk (OR 0.47) and acute postsurgical pain partially mediated the relationship. No significant association was found with delayed neurocognitive recovery at 30 days.
Impact: Identifies a modifiable perioperative pathway—pain control—and supports vaccination as protective against delirium in older surgical patients with prior COVID-19.
Clinical Implications: Incorporate prior COVID-19 history into delirium risk stratification, promote vaccination, and prioritize aggressive multimodal analgesia to mitigate delirium risk.
Key Findings
- Prior COVID-19 increased POD risk (OR 3.09; 95% CI 1.19–7.98).
- COVID-19 vaccination reduced POD risk (OR 0.47; 95% CI 0.26–0.86).
- Acute postsurgical pain increased POD risk (OR 1.51) and partially mediated the COVID–POD association.
- No significant association between prior COVID-19 and 30-day delayed neurocognitive recovery.
Methodological Strengths
- Prospective cohort with multivariable modeling and E-value sensitivity analysis
- Mediation analysis clarifying the role of acute postsurgical pain
Limitations
- Potential residual confounding and single-country setting limit generalizability
- Timing/severity of prior COVID-19 and variants not fully characterized
Future Directions: Validate across surgical specialties and regions; test whether vaccination promotion and enhanced analgesia reduce delirium in interventional trials.
BACKGROUND: Since the outbreak of coronavirus disease (COVID-19), accumulating evidence has indicated alterations in cognitive function after infection with SARS-CoV-2 (the causative agent of COVID-19). However, the specific effect of a prior COVID-19 history on postoperative neurocognitive outcomes remains elusive. In this study, we aimed to establish the correlation between COVID-19 history and the onset of postoperative delirium (POD) and delayed neurocognitive recovery (DNR) among older adults. METHODS: This study enrolled a total of 578 older adults (aged ≥ 60 years) who were scheduled for major abdominal surgeries. The primary outcome was POD incidence. Secondary outcomes included the frequency, duration, and subtype of POD; DNR occurrence; acute postsurgical pain (APSP); and other prognosis-related indicators. RESULTS: Patients with prior COVID-19 exhibited an increased risk of developing POD (odds ratio [OR]: 3.09; 95% confidence interval [CI]: 1.19-7.98; P = 0.02). The risk of DNR 30 days after surgery was not significantly associated with COVID-19 (OR: 0.54; 95% CI: 0.23-1.26; P = 0.15). Both APSP (OR: 1.51; 95% CI: 1.06-2.16; P = 0.02) and COVID-19 vaccination (OR: 0.47; 95% CI: 0.26-0.86; P = 0.01) were identified as independent influencing factors for POD. E-value analysis supported the robustness of the primary finding. Mediation analysis further revealed that APSP had a significant indirect effect (0.12; 95% CI: 0.02-0.27) in the relationship between COVID-19 and POD. CONCLUSION: Prior SARS-CoV-2 infection was independently associated with an increased risk of POD, which was potentially mediated by APSP. In contrast, no significant association was observed between prior COVID-19 and DNR incidence. In addition, full COVID-19 vaccination significantly reduced the risk of POD, suggesting that perioperative COVID-19 vaccine promotion is a potential public health strategy for improving the prognosis of the elderly.