Weekly ReportOct 5–11, 2026
Anesthesiology, week 41 edition
We read 243 papers and selected 3.
Summary
This week’s anesthesiology literature emphasized individualized, data-driven perioperative care, spanning digital-twin-assisted consent, personalized opioid prescribing, adaptive drug delivery, and protocolized physiologic monitoring. Large clinical and implementation studies also supported institution-wide enhanced recovery, selective rather than age-based preoperative echocardiography, and targeted delirium-prevention strategies. Important negative findings showed that passive AI decision support did not reduce delirium and that simple educational tools produced limited additional improvement when baseline lung-protective ventilation adherence was already high. Overall, the field is moving toward precision anesthesia while requiring stronger multicenter validation and workflow integration before widespread adoption.
Selected Articles
1. Digital Twin-Assisted Risk Disclosure in Adults Undergoing Elective Bronchoscopy: Multicenter Randomized Controlled Trial.
In a multicenter randomized trial of 122 adults undergoing elective bronchoscopy, patient-specific digital-twin visualization derived from computed tomography was compared with conventional consent. Digital-twin-assisted disclosure produced a greater reduction in preprocedural anxiety and a modest improvement in postprocedural satisfaction. The study demonstrates a clinically feasible application of precision visualization, although objective comprehension, cost, workflow effects, and equity were not established.
Impact: This is randomized evidence for a novel patient-specific approach to informed consent that directly addresses perioperative anxiety while preserving physician-led communication. It represents a paradigm shift from generic procedural explanations toward individualized anatomical risk communication.
Clinical Implications: Digital-twin visualization may be used as an adjunct to physician-led bronchoscopy consent, particularly for patients who have difficulty understanding anatomy or procedural risks. Implementation should be accompanied by evaluation of consultation time, infrastructure, objective comprehension, cost-effectiveness, and accessibility.
Key Findings
- The multicenter trial randomized 122 adults, with 61 participants in each group.
- Digital-twin-assisted disclosure reduced anxiety more than conventional disclosure, with a group-by-time coefficient of -15.89.
- Postprocedural satisfaction improved modestly, but objective comprehension and implementation outcomes were not established.
2. Age-Based Preoperative Transthoracic Echocardiography, Intraoperative Hypotension, and Postoperative Outcomes in Older Adults Undergoing Noncardiac Surgery: A Regression Discontinuity Analysis.
In 7,270 elective noncardiac surgery patients aged 60–89 years, a policy threshold at age 75 increased preoperative transthoracic echocardiography use by 43.1 percentage points but did not clearly reduce intraoperative hypotension. Effects on mortality, acute kidney injury, critical care admission, and hospital stay were imprecise. The findings challenge routine age-only testing and support risk-based cardiac imaging.
Impact: The fuzzy regression discontinuity design addresses confounding by indication more effectively than conventional observational comparisons. Its findings have direct implications for preoperative testing policy and may reduce low-value age-based echocardiography.
Clinical Implications: Routine transthoracic echocardiography should not be ordered solely because a patient is 75 years or older. Imaging should instead be guided by symptoms, functional capacity, cardiovascular disease, surgical risk, and established guideline-based indications.
Key Findings
- Among 7,270 patients, the probability of preoperative echocardiography increased by 43.1 percentage points at age 75.
- The estimated reduction in intraoperative hypotension was 24.8 minutes, but the 95% confidence interval ranged from a 71.1-minute reduction to a 21.5-minute increase.
- Effects on mortality, acute kidney injury, unplanned critical care admission, and hospital stay were inconclusive.
3. Personalized Opioid Prescribing With an Individualized Tapering Protocol Following Orthognathic Surgery Reduces the Amount of Unused Opioid.
In a prospective randomized trial of 201 adults undergoing orthognathic surgery, postoperative opioid prescriptions based on inpatient opioid use and individualized tapering were compared with fixed-dose prescribing. Among 151 completers, median unused hydromorphone was 4.0 mg with personalized prescribing versus 29.0–36.5 mg with standard prescribing. Pain scores remained similar, indicating that individualized prescribing can substantially reduce surplus opioids without compromising analgesia.
Impact: This randomized trial provides a simple, scalable opioid-stewardship intervention with a large reduction in unused medication and no apparent worsening of pain. It directly addresses medication waste, diversion risk, and the transition from inpatient to outpatient prescribing.
Clinical Implications: Postoperative opioid prescriptions may be based on actual inpatient requirements followed by an individualized taper rather than a fixed dose. Implementation should include reliable follow-up, patient education, safe disposal instructions, and validation across different procedures and healthcare settings.
Key Findings
- The trial enrolled 201 patients, with 151 completing the 2-week assessment.
- Median unused hydromorphone was 4.0 mg with personalized prescribing versus 29.0–36.5 mg with standard prescribing.
- Personalized prescribing reduced opioid consumption without worsening pain, and satisfaction was higher after double-jaw surgery.