Weekly ReportOct 26 – Nov 1, 2026
Anesthesiology, week 44 edition
We read 314 papers and selected 3.
Summary
This week’s anesthesiology literature emphasized safer airway management, delirium-conscious anesthetic selection, and prevention of perioperative psychological complications. A multicentre randomized trial showed that videolaryngoscopy improved first-attempt nasotracheal intubation success in infants undergoing cardiac procedures, while randomized evidence supported remimazolam as a hemodynamically favorable alternative to propofol without increased delirium in neurovascular surgery. A separate randomized trial found that preoperative intranasal oxytocin substantially reduced probable acute stress disorder after traumatic fracture surgery. Across the week, evidence also supported processed EEG-guided anesthesia, dexmedetomidine-based delirium prevention, individualized GLP-1 management, advanced respiratory monitoring, and AI-assisted risk prediction, although external validation and prospective implementation remain necessary.
Selected Articles
1. Videolaryngoscopy versus direct laryngoscopy for nasotracheal intubation in infants undergoing cardiac procedures (NasoVISI): a multicentre, randomised controlled trial.
In this multicentre randomized trial of 673 evaluable infants undergoing cardiac procedures, first-attempt nasotracheal intubation success was higher with videolaryngoscopy than with direct laryngoscopy, 83% versus 75%, with an adjusted absolute improvement of 8.2%. First-attempt and cumulative complication rates were similar, and no cardiac arrest or death occurred in either group.
Impact: This high-quality multicentre randomized evidence addresses an important unanswered pediatric airway question and demonstrates a clinically meaningful improvement in first-attempt success. Reducing repeated airway manipulation may improve safety in a vulnerable population.
Clinical Implications: Videolaryngoscopy should be strongly considered as the initial device for nasotracheal intubation in infants undergoing elective cardiac procedures when appropriate equipment and trained operators are available. Generalization to emergency cases, anticipated difficult airways, and non-specialist centers requires caution.
Key Findings
- First-attempt nasotracheal intubation success was 83% with videolaryngoscopy versus 75% with direct laryngoscopy.
- The adjusted absolute difference in first-attempt success was 8.2% (95% CI, 2.0%-14.3%; P = 0.0093).
- Complication rates were similar, and no cardiac arrest or death occurred in either group.
2. Effect of remimazolam versus propofol anaesthesia on postoperative delirium in neurovascular surgery: a randomised noninferiority trial.
In a single-centre, double-blind randomized noninferiority trial of 686 patients undergoing elective neurovascular surgery, postoperative delirium occurred in 12.8% of patients receiving remimazolam and 10.8% receiving propofol. Remimazolam met the prespecified noninferiority criterion and was associated with less hypotension and more frequent operating-room extubation.
Impact: This rigorous trial directly evaluates whether a reversible benzodiazepine can be used in high-risk neurovascular surgery without worsening delirium. It separates a meaningful hemodynamic advantage from the concern that remimazolam might increase postoperative cognitive complications.
Clinical Implications: Remimazolam-based total intravenous anesthesia may be considered when minimizing hypotension, facilitating operating-room extubation, or enabling rapid reversal is important. Delirium surveillance and familiarity with flumazenil reversal remain necessary.
Key Findings
- Postoperative delirium occurred in 12.8% of the remimazolam group and 10.8% of the propofol group.
- Remimazolam was noninferior to propofol for postoperative delirium using a 10-percentage-point noninferiority margin.
- Remimazolam reduced hypotensive burden and increased the frequency of operating-room extubation.
3. Preoperative Intranasal Oxytocin and Probable Acute Stress Disorder After Traumatic Fracture Surgery: A Randomized Clinical Trial.
In this double-blind randomized clinical trial of 328 adults undergoing traumatic fracture surgery, a single 40-IU dose of intranasal oxytocin before anesthesia induction reduced the 3-day incidence of screening-positive probable acute stress disorder from 30.5% to 15.9%. The risk ratio was 0.52 and the adjusted hazard ratio was 0.45, with no serious adverse events observed.
Impact: The study addresses a common but under-treated psychological consequence of traumatic surgery and demonstrates a large preventive effect using a simple, low-burden intervention. It broadens anesthesiology’s focus from physiologic outcomes to perioperative mental health.
Clinical Implications: Preoperative intranasal oxytocin is a promising candidate for prevention of acute stress symptoms after traumatic fracture surgery, but routine use is premature because the trial was single-centre, follow-up was short, and the endpoint was a screening-positive probable disorder rather than a confirmed long-term diagnosis.
Key Findings
- Among 328 randomized adults, probable acute stress disorder at 3 days occurred in 15.9% with oxytocin versus 30.5% with placebo.
- The risk ratio was 0.52 and the adjusted hazard ratio was 0.45.
- No serious adverse events were observed during the study period.