Daily ReportOct 1, 2026
Anesthesiology, October 1 edition
We read 47 papers and selected 3.
Summary
Today's most impactful studies addressed translational assessment of post-anesthetic vigilance, the safety of regional anesthesia for detecting acute compartment syndrome, and perioperative risk after preoperative COVID-19 infection in children. Collectively, these papers combine novel measurement approaches, large-scale evidence synthesis, and propensity-matched national data to refine perioperative decision-making.
Research Themes
- Agent-specific cognitive recovery after anesthesia
- Safety of regional anesthesia in orthopedic trauma
- Perioperative outcomes after preoperative COVID-19 infection in children
Selected Articles
1. Assessment of Vigilance Recovery in Rats Following Anesthesia Using a Touchscreen-Based Continuous Performance Task.
In 16 trained rats, the touchscreen-based rCPT distinguished recovery of vigilance from simple return of the righting reflex after four anesthetic agents. Ketamine and dexmedetomidine significantly delayed vigilance recovery, while dexmedetomidine produced persistent impairments in visual processing speed and reward retrieval for at least 4 hours after emergence.
Impact: This study introduces a translational behavioral endpoint that captures post-anesthetic vigilance, a neurocognitive domain not adequately assessed by conventional emergence measures. It challenges the assumption that return of the righting reflex adequately represents functional recovery.
Clinical Implications: Return of consciousness or motor reflexes may not indicate complete neurocognitive recovery. The findings support further investigation of anesthetic-specific recovery profiles and development of human bedside tests for vigilance before discharge, driving, or cognitively demanding activities.
Key Findings
- The rCPT provided a continuous, translational measure of vigilance recovery after anesthesia.
- Ketamine and dexmedetomidine significantly delayed vigilance recovery compared with baseline, with hazard ratios of 5.34 and 5.33, respectively, both p<0.0001.
- Dexmedetomidine caused persistent impairment in visual processing speed and reward retrieval for at least 4 hours after return of the righting reflex.
Methodological Strengths
- Randomized within-animal administration of four commonly used anesthetic agents reduced between-animal variability.
- The rCPT assessed multiple behavioral domains, including vigilance, visual processing speed, and reward retrieval.
Limitations
- The study included only 16 rats, limiting statistical power and generalizability.
- Rodent touchscreen performance cannot be assumed to directly predict human postoperative cognition or functional readiness.
Future Directions: Future studies should validate rCPT-derived measures against electrophysiological and neurobiological markers, examine dose-response relationships, and translate comparable vigilance tests into human perioperative studies.
BACKGROUND: Cognitive recovery following general anesthesia is clinically important but incompletely understood. Rodent studies in anesthesia research have primarily examined memory and learning, while vigilance and other neurocognitive domains remain underexplored. To address this gap, we employed the rodent Continuous Performance Task (rCPT), a touchscreen-based translational paradigm, to characterize anesthetic-specific recovery trajectories of vigilance following anesthetic emergence. METHODS: Sixteen adult Sprague Dawley rats (8 male, 8 female) were trained to proficiency on the rCPT. Once trained, loss of righting was induced by sevoflurane (3% for 20 min), propofol (10 mg/kg i.v. bolus), ketamine (50 mg/kg i.v. over 10 min), or dexmedetomidine (20 µg/kg i.v. bolus), delivered in a randomized order every other week.
2. Elective Pediatric Surgery in 1350 COVID-Positive Children: A Multiyear National Surgical Quality Improvement Program - Pediatric Analysis of 30-Day Outcomes.
In a national cohort of 412,710 elective pediatric operations under general anesthesia, 1,350 children were preoperatively COVID-19 positive. After propensity matching, composite 30-day morbidity was not significantly different between COVID-positive and COVID-negative children, although prolonged ventilator dependence and unplanned readmission were modestly more frequent in the COVID-positive group.
Impact: This large, contemporary national analysis provides clinically relevant evidence for scheduling elective pediatric surgery after SARS-CoV-2 infection. It suggests that infection status alone may not justify broad cancellation of elective procedures when patient and procedural risk are appropriately considered.
Clinical Implications: Elective pediatric surgery may be considered on an individualized basis rather than automatically deferred solely because of preoperative COVID-19 positivity. Clinicians should nevertheless discuss the small absolute increases in prolonged ventilation and readmission and consider respiratory comorbidity, procedure complexity, and timing from infection.
Key Findings
- Among 412,710 eligible elective pediatric operations, 1,350 children were preoperatively COVID-19 positive.
- After propensity matching of 1,348 pairs, composite 30-day morbidity was 9.0% in COVID-positive versus 8.2% in COVID-negative children, with no significant difference.
- COVID-positive children had higher rates of prolonged ventilator dependence over 48 hours (4.5% versus 3.0%) and unplanned 30-day readmission (7.1% versus 5.0%), without differences in reoperation or mortality.
Methodological Strengths
- The study used a large, multicenter national surgical quality database spanning four years.
- One-to-one propensity matching incorporated demographic, comorbidity, procedural, and surgical complexity variables to reduce measured confounding.
Limitations
- The observational database cannot fully address residual confounding, including symptom severity, vaccination status, viral variant, or exact interval from infection to surgery.
- COVID-19 positivity was uncommon at 0.3% of eligible cases, and the study did not establish an optimal delay interval for elective surgery.
Future Directions: Future prospective studies should evaluate symptom severity, vaccination and variant status, timing from infection, respiratory comorbidities, and procedure-specific risk to develop evidence-based pediatric scheduling recommendations.
INTRODUCTION: Uncertainty persists regarding perioperative risk and scheduling recommendations for children with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to determine whether preoperative COVID-19 status was associated with adverse perioperative outcomes for elective pediatric surgery procedures. METHODS: An analysis of American College of Surgeons National Surgical Quality Improvement Program - Pediatric data was performed for elective operations performed under general anesthesia between 2021 and 2024. Preoperative COVID-positive status was the exposure of interest. The primary outcome was 30-day composite morbidity (respiratory, cardiovascular, renal, neurologic, hemorrhagic, thrombotic, or infectious complications). Secondary outcomes included 30-day unplanned readmission, reoperation, and mortality. COVID-positive patients were propensity-matched at 1:1 ration to COVID-negative patients using demographic, comorbidity, procedural, and surgical complexity variables. RESULTS: Among 412,710 eligible cases, 1350 (0.3%) had preoperative COVID-19. Prior to matching, COVID-positive patients demonstrated greater medical complexity and underwent higher- relative value units procedures.
3. Impact of Regional Anesthesia on the Incidence and Detection of Acute Compartment Syndrome: A Systematic Review.
This systematic review included five studies comprising 105,139 orthopedic trauma patients and found no evidence that regional anesthesia increased acute compartment syndrome incidence or delayed diagnosis compared with general anesthesia. Acute compartment syndrome incidence with regional anesthesia ranged from 0% to 0.1%, supporting regional anesthesia when standardized postoperative surveillance and clinical vigilance are maintained.
Impact: The review addresses a longstanding safety concern that can restrict effective opioid-sparing analgesia for orthopedic trauma. Its large combined population and clinically focused question provide evidence to inform regional anesthesia protocols and monitoring policies.
Clinical Implications: Regional anesthesia should not be withheld solely because of concern that it will mask acute compartment syndrome. Its use should be accompanied by standardized serial examinations, clear escalation pathways, patient education, and a high index of suspicion for evolving compartment syndrome.
Key Findings
- Five eligible studies, including one randomized controlled trial and four retrospective cohorts, involved 105,139 patients.
- Regional anesthesia was associated with an acute compartment syndrome incidence of 0% to 0.1%, with no demonstrated increase versus general anesthesia.
- No included study demonstrated delayed diagnosis of acute compartment syndrome with regional anesthesia; several reported reduced perioperative opioid consumption.
Methodological Strengths
- The search covered six major databases and used independent screening and data extraction by two reviewers.
- The review included a very large combined patient population and formally assessed study quality with established tools.
Limitations
- Only five studies met inclusion criteria, and four were retrospective cohorts, creating substantial risk of confounding and selection bias.
- Methodological heterogeneity prevented quantitative meta-analysis and limited direct comparison of block types, dosing, and surveillance protocols.
Future Directions: Prospective multicenter studies should standardize regional anesthesia techniques, postoperative neurological assessments, compartment pressure testing, and diagnostic time intervals to establish safer and more precise monitoring pathways.
BACKGROUND: Acute compartment syndrome (ACS) is a limb-threatening complication of orthopedic trauma, and the use of regional anesthesia (RA) remains controversial due to concerns that it may delay diagnosis. This systematic review evaluated whether RA influences the incidence or detection of ACS and whether current evidence supports its use in orthopedic trauma patients. MATERIALS AND METHODS: PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched from inception through January 21, 2026. Two reviewers independently screened studies and extracted data. Randomized controlled trials, prospective studies, and retrospective comparative studies evaluating orthopedic trauma patients receiving RA versus non-RA techniques were included. Study quality was assessed using the Methodological Index for Non-randomized Studies and the Newcastle-Ottawa Scale. Owing to methodological heterogeneity, findings were synthesized narratively. RESULTS: Of 1,429 records identified, 185 were screened for title and abstract, 58 full-text articles were assessed, and 5 studies (1 randomized controlled trial and 4 retrospective cohorts) involving 105,139 patients met inclusion criteria.