30-Second Takeaway
- Propofol maintenance was associated with less postoperative delirium than sevoflurane in older adults, even with longer burst suppression.
- Wearable TEAS outperformed IV metoclopramide for established moderate–severe PONV without reported adverse events.
- Recent ambient ozone exposure modestly increased pediatric perioperative respiratory events, especially with reactive airways or intercurrent infection.
- Routine comprehensive preoperative evaluation for low-risk cataract surgery remains nonbeneficial and can delay vision-restoring procedures.
- Simple nonpharmacologic devices can match low-dose ketamine in reducing propofol injection pain without drug-related adverse effects.
Week ending January 31, 2026
Perioperative brain, heart, and airway risk: new data on anesthetic choice, PONV rescue, low-value testing, and simple bedside tweaks
In older adults, sevoflurane was linked to more delirium than propofol, despite shorter burst suppression duration
In this prospective cohort of 265 patients older than 70, sevoflurane was associated with more postoperative delirium than propofol (44% vs 30%). Burst suppression duration was shorter with sevoflurane, yet overall delirium incidence was not reduced by the lower suppression burden. Burst suppression under sevoflurane carried 3.8-fold higher delirium risk than burst suppression under propofol. Sevoflurane with burst suppression increased delirium odds 9.3-fold compared with propofol without burst suppression, suggesting suppression reflects brain vulnerability rather than causality.
Wearable TEAS was superior to IV metoclopramide for rescue of moderate–severe PONV after neck surgery
This randomized, double-dummy trial enrolled 232 women with established moderate to severe PONV after thyroid or anterior cervical surgery under general anesthesia. Patients received either active transcutaneous electrical acupoint stimulation at PC6 with placebo injection or sham stimulation plus 10 mg IV metoclopramide. The TEAS group had a higher 2-hour remission rate (77.6% vs 55.2%) and a lower 24-hour relapse rate (12.2% vs 56.3%) than metoclopramide. No adverse events were reported with TEAS, supporting it as a safe, effective nonpharmacologic rescue option for PONV.
Preoperative ambient ozone exposure modestly increased perioperative respiratory events in children having elective anesthesia
This single-centre retrospective cohort included paediatric patients presenting from home for elective surgery or imaging over four years. Ground-level ozone exposure for the preceding 15 days was quantified using local air quality sensors and categorized into exposure groups. The overall incidence of perioperative respiratory adverse events was 5.7%, and was higher in the high-ozone group than the low-ozone group (8.0% vs 5.6%). High ozone exposure was associated with a relative risk of 1.43 for respiratory events, including in children with reactive airway disease or active infection.
Routine comprehensive preoperative evaluation for cataract surgery remains nonbeneficial and often delays care
This review summarizes evidence showing no benefit from comprehensive preoperative medical evaluations before low-risk cataract surgery performed with topical anesthesia and light sedation. In 2019, CMS removed the requirement for a history and physical within 30 days for ambulatory surgeries regardless of risk. Guidelines from the Society for Ambulatory Anesthesia and American Academy of Ophthalmology discourage routine extensive preoperative assessment for cataract surgery. Despite aligned evidence and policy, implementation is inconsistent, and unnecessary evaluations delay vision-restoring care and burden vulnerable patients.
References
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Additional Reads
Optional additional studies from this edition.