Weekly ReportJul 13–19, 2026
Anesthesiology, week 29 edition
We read 562 papers and selected 3.
Summary
This week’s anesthesiology research emphasized nonpharmacologic neuromodulation, anesthetic selection, and prevention of perioperative complications. Randomized trials suggested that transcutaneous auricular vagus nerve stimulation may improve postpartum mood, pain, sleep, and postoperative cognitive trajectories, while remimazolam was associated with substantially more emergence delirium than propofol in older adults undergoing lung resection. Additional clinically relevant advances included episode-aware modeling of intraoperative hypotension, opioid-sparing strategies, improved regional anesthesia pathways, and physiology-based risk prediction for delirium, septic shock, and postoperative arrhythmia.
Selected Articles
1. Effectiveness of transcutaneous auricular vagus nerve stimulation in alleviating postpartum blues following cesarean delivery: A randomized double-blind controlled trial.
In a double-blind randomized trial of 100 patients after cesarean delivery, five days of transcutaneous auricular vagus nerve stimulation reduced postpartum blues severity, improved mood, lowered the proportion with Edinburgh Postnatal Depression Scale scores of 13 or higher at one month, reduced acute postoperative pain, and improved sleep quality. Effects were observed across multiple patient-reported outcomes with follow-up to three months.
Impact: This rigorously blinded randomized trial identifies a feasible, nonpharmacologic intervention that simultaneously targets postpartum mood, pain, and sleep—three important outcomes in obstetric anesthesia and enhanced recovery.
Clinical Implications: taVNS could be considered as an adjunct in post-cesarean recovery pathways, particularly for patients at risk of mood disturbance or poor sleep. Larger multicenter trials are needed before routine implementation.
Key Findings
- Postpartum blues severity was significantly lower after five days of active taVNS than sham stimulation.
- The proportion with Edinburgh Postnatal Depression Scale scores of 13 or higher at one month was 4% with taVNS versus 26% with sham.
- Pain scores were lower from 4 to 72 hours and sleep quality improved during postoperative days 1 to 4.
2. Remimazolam vs. propofol anaesthesia for delirium in older patients recovering from lung resections: a randomised non-inferiority trial.
Among 455 adults aged 65 years or older undergoing lung resection, remimazolam was not non-inferior to propofol for postoperative delirium. Delirium occurred in 48% of the remimazolam group versus 31% of the propofol group, with the difference driven mainly by emergence delirium. Delirium after post-anesthesia care unit discharge, hospital stay, and 30-day cognitive outcomes were not meaningfully different.
Impact: This large randomized trial directly challenges assumptions that remimazolam is cognitively safer than propofol and provides clinically actionable evidence for anesthetic selection in older thoracic surgery patients.
Clinical Implications: Propofol may be preferred over remimazolam in older patients undergoing lung resection when minimizing emergence delirium is a priority. Patients receiving remimazolam warrant enhanced PACU observation and delirium-prevention measures.
Key Findings
- Postoperative delirium occurred in 48% with remimazolam versus 31% with propofol.
- The absolute risk difference was 16.5%, exceeding the prespecified 10% non-inferiority margin.
- Emergence delirium occurred in 46% with remimazolam versus 28% with propofol.
3. Transcutaneous auricular vagus nerve stimulation for prevention of postoperative cognitive dysfunction in older adults with gastrointestinal tumors: A randomized controlled trial.
In a double-blind randomized trial of older adults undergoing laparoscopic gastrointestinal tumor surgery, perioperative transcutaneous auricular vagus nerve stimulation improved Montreal Cognitive Assessment trajectories from postoperative day 7 through month 3. It also reduced postoperative IL-1β and S100β concentrations and attenuated mood deterioration, with adverse events similar to sham stimulation.
Impact: This trial combines cognitive outcomes with inflammatory and neural injury biomarkers, supporting a biologically plausible and relatively low-risk strategy for postoperative cognitive protection in older surgical patients.
Clinical Implications: taVNS may become an adjunct to delirium and postoperative cognitive dysfunction prevention bundles for selected older adults, but multicenter studies should establish clinical thresholds, generalizability, and long-term functional benefit.
Key Findings
- MoCA scores were higher with taVNS from postoperative day 7 through month 3, with differences of 2.06 points at month 1 and 2.97 points at month 3.
- Postoperative IL-1β and S100β levels were significantly lower with taVNS.
- Adverse event rates were approximately 4.1% in both groups and consisted mainly of mild local reactions.