Perioperative medicine

Emergency surgery, intraoperative complications and ASA >2 predicted unplanned ICU admission across 75 ICUs

In this prospective study of 55,963 surgical patients across 75 ICUs, 2764 (4.9%) were planned for ICU admission, but 804 could not be admitted because of bed limits. Emergency surgery (OR 12.4), intraoperative complications (OR 3.1) and ASA >2 (OR 2.7) independently raised the risk of unplanned admission; 90-day mortality was 7.5% overall and 18.9% after emergent admission.

Why it matters. Raises the question of whether combining risk scores with intraoperative events could better target scarce postoperative ICU beds.

Limitation. Observational design in one national network; the benefit of ICU care was judged by modified Wang criteria, not tested directly.

One 20-minute virtual reality session cut preoperative anxiety in an ambulatory surgery RCT

In the single-center AMBLUMEEN trial, 106 ambulatory patients with moderate-to-severe anxiety (STAI-YA > 45) were randomized to standard care or a 20-minute immersive VR session. VR reduced STAI-YA scores by an adjusted 18.7 points more than control (95% CI -21.4 to -16.1). Benzodiazepine use, pain and unplanned admission did not differ.

Why it matters. Supports VR as a low-risk, drug-free option for anxious day-surgery patients.

Limitation. Single-center, open-label trial; anxiety was a patient-reported score.

UK enhanced care units with ring-fenced elective beds had fewer surgical cancelations

Across 28 UK hospitals with both enhanced and critical care facilities (4112 referred patients), cancelation rates were usually lower in enhanced care than in critical care. Beds reserved for elective cases (OR 0.54) and multispecialty care (OR 0.48) were linked to fewer cancelations; admitting emergency cases was linked to more (OR 1.61).

Why it matters. Points to structural choices, such as protecting elective beds, that may keep high-risk surgery on schedule.

Limitation. Retrospective data from a 3-month window; associations, not causal effects.

Preoperative cognitive training linked to about half the risk of postoperative delirium in a meta-analysis

Pooling 13 RCTs (1446 patients), preoperative cognitive training was associated with lower postoperative delirium (RR 0.53; 95% CI 0.36-0.77; low certainty) and delayed neurocognitive recovery (RR 0.66; very low certainty). Trial sequential analysis boundaries were not crossed, so false-positive findings remain possible.

Why it matters. Suggests a cheap, nonpharmacologic delirium-prevention strategy that now needs large trials.

Limitation. Several included trials had high risk of bias, and required information sizes were not reached.

Blunted frontal alpha shift at induction tracked with postoperative delirium in older adults

In an exploratory study of 83 older patients with usable EEG under sevoflurane, those who developed delirium (19 of 100 enrolled) lacked the alpha power increase seen before loss of responsiveness (frontal 4.24 vs -0.88 dB) and had less efficient functional brain networks during maintenance.

Why it matters. Raises the possibility of an intraoperative EEG marker of delirium susceptibility.

Limitation. Small single-center exploratory study; 17 patients were excluded for EEG artifacts.

Equivalence of Oral Melatonin and Oral Midazolam in Preoperative Anxiolysis for Pediatric Fast-Track Cardiac Surgery

Phase 2/3 trial planning 100 participants, sponsored by Ain Shams University. Status: active not recruiting. Conditions: Comparative Effectiveness.

Effects of Ciprofol on Perioperative Neurocognitive Function in Elderly Patients Undergoing Daytime Surgery

Phase 4 trial planning 148 participants, sponsored by Second Affiliated Hospital of Wenzhou Medical University. Status: enrolling by invitation. Conditions: PND, POCD - Postoperative Cognitive Dysfunction.

Perioperative Esketamine Safety and Efficacy in Reducing Postoperative ENDometriosis PAIN (the ENDPAIN Trial)

Phase 4 trial planning 1000 participants, sponsored by Region Skane. Status: not yet recruiting. Conditions: Endometriosis.