Daily Anesthesiology Research Analysis
Analyzed 117 papers and selected 3 impactful papers.
Summary
Three clinically impactful anesthesia-related studies stand out today: a multicenter cohort shows untreated preoperative sleep disturbance strongly predicts postoperative delirium and long-term cognitive decline; a randomized trial demonstrates that a nasopharyngeal airway significantly reduces hypoxemia in overweight/obese patients undergoing sedated endoscopy; and a multicenter analysis links long-term preoperative beta-blocker prescriptions with higher postoperative ischemic stroke risk in noncardiac surgery.
Research Themes
- Perioperative neurocognition and prehabilitation
- Airway/oxygenation strategies in procedural sedation
- Preoperative medication risk stratification and outcomes
Selected Articles
1. Impact of preoperative sleep disturbance on perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery: A multicenter prospective cohort study.
In a prospective multicenter cohort of 535 older adults undergoing major noncardiac surgery, untreated preoperative sleep disturbance significantly increased the risk of POCD at 7, 30, 90, and 180 days and postoperative delirium (days 1–3). A PSQI≥10 optimally identified high-risk patients, and sleep disturbance was associated with poorer QoR-15 and persistent insomnia.
Impact: Identifies a modifiable, screenable perioperative risk factor (sleep disturbance) that robustly predicts both early delirium and persistent cognitive decline, enabling targeted prehabilitation.
Clinical Implications: Incorporate routine PSQI screening (flag PSQI≥10) into preoperative assessment for older adults, refer high-risk patients for sleep optimization (CBT-I, sleep hygiene, OSA evaluation), and adjust perioperative plans to mitigate delirium/POCD risk.
Key Findings
- Preoperative sleep disturbance increased POCD risk at day 7 (41.7% vs 27.1%; RR 1.44), day 30 (36.1% vs 18.2%; RR 1.73), day 90 (25.7% vs 13.0%; RR 1.66), and day 180 (19.4% vs 8.9%; RR 1.75).
- Sleep disturbance increased postoperative delirium (29.9% vs 18.6%; RR 1.43) and worsened QoR-15 by 8 points.
- PSQI≥10 provided optimal discrimination for POCD risk (sensitivity 71.8%, specificity 69.4%).
Methodological Strengths
- Prospective multicenter design with predefined outcomes at multiple time points up to 6 months
- Appropriate multivariable modeling using generalized estimating equations
Limitations
- Observational design susceptible to residual confounding
- Sleep disorder phenotyping (e.g., objective OSA metrics) not fully detailed
Future Directions: Randomized trials of preoperative sleep optimization (e.g., CBT-I, OSA treatment) to reduce delirium/POCD; integration of objective sleep measures to refine risk models.
BACKGROUND: Perioperative neurocognitive disorders (PND) significantly affect recovery in older adult surgical patients. However, whether untreated preoperative sleep disturbance (SD) independently contributes to postoperative cognitive dysfunction (POCD) remains unclear. METHODS: This multicenter prospective cohort study involving 535 patients aged ≥60 years undergoing major non-cardiac surgery (≥2 hours) was conducted between June 30, 2024 and May 31, 2025. Patients were stratified by Pittsburgh Sleep Quality Index (PSQI): SD (PSQI>7, n = 288) or non-SD (PSQI≤7, n = 247). The primary outcome was POCD assessed on postoperative days 7, 30, 90, and 180. Secondary outcomes included postoperative delirium (days 1-3), 15-item quality of recovery (QoR-15) scores, and insomnia severity (days 30, 90, and 180). Generalized estimating equations identified independent predictors of POCD. RESULTS: Compared with non-SD patients, SD pa
2. Effect of nasopharyngeal airway on hypoxemia in overweight and obese patients undergoing sedated endoscopy: A randomized trial.
In a randomized trial of 256 overweight/obese patients undergoing sedated GI endoscopy, nasopharyngeal airway use significantly reduced hypoxemia compared with standard nasal cannula (15.6% vs 40.6%). This supports proactive airway adjunct placement in high-risk sedation cases.
Impact: Provides randomized evidence for a simple, scalable airway intervention that halves hypoxemia in a high-risk, high-volume procedural setting.
Clinical Implications: For overweight/obese patients undergoing SGIE, consider routine nasopharyngeal airway placement to prevent hypoxemia, alongside standard monitoring and oxygen supplementation.
Key Findings
- Randomized comparison (n=256) of nasopharyngeal airway vs nasal cannula during sedated GI endoscopy.
- Nasopharyngeal airway reduced hypoxemia events from 40.6% to 15.6% (absolute reduction 25.0%).
- Demonstrates efficacy of a low-cost airway adjunct in overweight/obese, a population at high risk for sedation-related hypoxemia.
Methodological Strengths
- Prospective randomized design in a relevant high-risk population
- Clear, clinically meaningful primary outcome (hypoxemia)
Limitations
- Abstract truncated; details on blinding, sedation protocols, and secondary outcomes not provided
- Single trial; generalizability across endoscopy settings and sedative regimens needs confirmation
Future Directions: Multicenter trials to validate efficacy across sedative regimens, assess airway intervention bundles, and quantify impacts on rescue maneuvers and procedure interruptions.
Hypoxemia is common during sedated gastrointestinal endoscopy (SGIE), especially in overweight and obese patients, yet the effectiveness of nasopharyngeal airways (NAs) for prevention remains unclear. This prospective randomized trial compared NA with standard nasal cannula (NC) in 256 overweight and obese patients. Results revealed that the NA group demonstrated a statistically significant reduction of hypoxemia (20/128 [15.6%] vs. 52/128 [40.6%];
3. Preoperative beta blocker use and postoperative ischaemic stroke risk in noncardiac surgery: a multicentre retrospective cohort study.
Across two academic healthcare networks (2005–2021), long-term preoperative beta-blocker prescriptions were associated with higher postoperative ischemic stroke risk at 30 days (RRadj 1.26) and 365 days (RRadj 1.22) after noncardiac surgery, with stronger associations in ASA 1–2 patients and no association in severe heart failure.
Impact: Challenges assumptions about chronic beta-blocker safety in the perioperative period and delineates populations where risk is amplified, informing medication reconciliation and shared decision-making.
Clinical Implications: Reassess routine continuation of beta blockers for low- to moderate-risk (ASA 1–2) noncardiac surgical patients without compelling cardiac indications; emphasize individualized risk–benefit assessment and stroke prevention strategies.
Key Findings
- Long-term beta-blocker prescriptions within 1 year preop were associated with increased postoperative ischemic stroke at 30 days (RRadj 1.26) and 365 days (RRadj 1.22).
- Effect was stronger in ASA 1–2 (RRadj 1.96) vs ASA 3–4 (RRadj 1.20); no association in severe heart failure.
- Modified Poisson regression with robust variances used; multicenter dataset across two academic health networks.
Methodological Strengths
- Large multicenter cohort with modern regression (modified Poisson) and effect modification analyses
- Assessment of short- and longer-term (30 and 365 days) postoperative stroke outcomes
Limitations
- Retrospective design with potential residual confounding and confounding by indication
- Medication adherence, dose, and intraoperative hemodynamics not fully captured
Future Directions: Prospective studies to clarify causality and identify modifiable perioperative factors; decision-support tools integrating stroke risk when managing chronic beta-blockers.
BACKGROUND: A previous large clinical trial demonstrated an increased risk of perioperative stroke with beta blockers initiated just before surgery. This study evaluated the association between long-term beta blocker prescription and ischaemic stroke after noncardiac surgery. METHODS: We conducted a multicentre retrospective study of male and female adults undergoing noncardiac surgery between 2005 and 2021 at two academic healthcare networks in the USA. The primary exposure was long-term beta blocker prescription within 1 yr before surgery. We assessed postoperative ischaemic stroke risk at 30 and 365 days using modified Poisson regression with robust error variances, and conducted effect modification analyses. RESULTS: Long-term beta blocker prescription was associated with an increased risk of postoperative stroke at 30 days (adjusted relative risk [RRadj] 1.26, 95% confidence interval [CI] 1.17-1.36, P<0.001) and 365 days (RRadj 1.22, 95% CI 1.16-1.28, P<0.001). For stroke within 365 days of surgery, this association was amplified in patients with ASA physical status of 1-2 (RRadj 1.96, 95% CI 1.56-2.45, P<0.001) compared with that in patients with ASA physical status of 3-4 (RRadj 1.20, 95% CI 1.15-1.26, P<0.001; P for interaction <0.001). No significant association was observed in patients with severe heart failure. CONCLUSIONS: Long-term beta blocker prescription was associated with increased risk of ischaemic stroke within 30 days and up to 365 days after surgery. No association of beta blocker use and ischaemic stroke risk was observed in patients with severe heart failure, or a history of stroke.