Monthly anesthesiology bulletin — October 20, 2026

Colleagues: this issue covers September 20 to October 20, 2026. The month was dominated by ANESTHESIOLOGY 2026, the American Society of Anesthesiologists annual meeting (San Diego, October 16–20). A word of caution on evidence level: most meeting presentations are abstracts without full peer review, and several are observational. We include 9 verified items; three come from Asia (China and South Korea).

1. General anesthesia, airway, and pharmacology

1. Remimazolam did not reduce postoperative delirium in older adults compared with propofol

[Clinical trial] [China]
Single-center, three-arm randomized trial (General Hospital of Northern Theater Command, Shenyang) with patient and assessor blinding, in 186 patients aged 60 to 80 undergoing elective laparoscopic gastrointestinal surgery (62 per arm; all 186 analyzed). Induction used remimazolam 0.15 mg/kg, remimazolam 0.3 mg/kg, or propofol 1.5 mg/kg. Delirium within 5 days was 12.9%, 11.3%, and 6.5%, respectively (P = .467). With remimazolam, blood pressure after induction was higher, treated hypotension was less frequent (12.9% and 14.5% vs 30.6%), bradycardia was less frequent (4.8% and 6.5% vs 25.8%), and vasopressor requirements were lower. Funded by public research grants from Shenyang and Liaoning Province.
Why it matters: this is a negative result; the study was underpowered (33% delirium was assumed with propofol and 6.5% was observed), so it neither rules out nor proves an effect, but it supports the drug's hemodynamic profile; in the Dominican Republic remimazolam is not in routine use and cost limits its uptake.
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1992969/abstract
(Registration: ChiCTR2400082176)

2. Regional anesthesia and pain

2. Popliteal plexus block as an add-on for knee surgery: meta-analysis

[Meta-analysis] [South Korea]
Meta-analysis from Seoul National University Bundang Hospital of 8 randomized trials and 684 adults (6 total knee arthroplasty and 2 arthroscopic ACL reconstruction trials). Adding a popliteal plexus block to another block (5 pooled trials) reduced pain at 12 hours (mean difference −1.32) and at 24 hours (−0.52), 24-hour opioid consumption (SMD −1.32), and postoperative nausea and vomiting (RR 0.21; 95% CI 0.08–0.55).
Why it matters: heterogeneity is very high (I² near 95% for opioids) and certainty is low for opioid sparing, which becomes borderline non-significant when one study is excluded; the technique is inexpensive, ultrasound-guided, and feasible in resource-limited settings, but robust comparisons with IPACK and other blocks are still lacking.
https://www.epain.org/journal/view.html?doi=10.3344%2Fkjp.26265
(Korean Journal of Pain, published online October 1, 2026)

3. Perioperative medicine and safety

3. GLP-1 receptor agonists linked to fewer cardiovascular complications and infections after elective surgery

[Meeting] [United States]
Retrospective cohort (UTHealth Houston) using Epic Cosmos records, 2016–2024: 2,028,601 adults undergoing elective surgery lasting more than 60 minutes with a stay of at least 24 hours, of whom 145,610 were taking GLP-1 receptor agonists. Compared with matched nonusers, GLP-1 use was associated with 11% lower odds of major cardiovascular complications (myocardial infarction, myocardial injury, stroke, or death) and 8% lower odds of postoperative infections.
Why it matters: it is observational, prone to healthy-user bias, and reports no aspiration data, which remains the anesthesiologist's main concern; it does not change fasting or drug-management recommendations, but it adds nuance to the debate over routine discontinuation.
https://www.asahq.org/about-asa/newsroom/news-releases/2026/10/glp-1-drugs-linked-to-lower-risk-of-serious-heart-related-complications-and-infections-after-surgery

4. Noise-canceling headphones during surgery reduce nausea and vomiting

[Clinical trial] [Meeting] [China]
Randomized trial (First Affiliated Hospital of Soochow University) in 192 patients aged 18 to 65 undergoing minimally invasive gynecologic surgery under general anesthesia with standard antiemetic prophylaxis. Postoperative nausea and vomiting within 48 hours occurred in 35.4% with headphones vs 52.1% without (about 17 fewer cases per 100 patients), with no increase in adverse events.
Why it matters: cheap and risk-free, but it is a single-center meeting abstract in a high-risk population and blinding is impossible; it deserves replication before recommendation, although its low cost makes it easy to adopt in the Dominican Republic.
https://www.asahq.org/about-asa/newsroom/news-releases/2026/10/wearing-headphones-during-surgery-may-reduce-nausea-and-vomiting-afterward

5. Frequent walking and exercise before cancer surgery associated with half the risk of postoperative delirium

[Meeting] [United States]
Retrospective matched case-control study presented by investigators from the University of South Florida and Moffitt Cancer Center in 258 patients who underwent tumor resection in 2024–2025; 64 developed delirium. Patients who combined walking with moderate or vigorous activity at least seven times a week (self-reported) had a 50% lower risk of postoperative delirium than less active patients.
Why it matters: this is an association based on self-reported activity, without absolute rates or published adjustment, and highly prone to confounding (more active patients tend to be healthier); it supports the idea of prehabilitation but does not show that prescribing walking prevents delirium.
https://www.newswise.com/articles/could-staying-active-before-surgery-help-prevent-postoperative-delirium-d/?sc=c104
https://theprint.in/science/walking-before-cancer-surgery-can-cut-risk-of-postoperative-delirium-by-50-finds-study/3076685/

6. Postoperative mobile app monitoring: 22% fewer major complications

[Meeting] [Canada]
Analysis of 38 studies with 7,507 patients (University of Toronto) comparing app- or web-based monitoring with standard care. It was associated with a 22% lower risk of major complications, 22% lower risk of emergency department visits, and 15% lower risk of readmission, although the total number of complications did not decrease significantly. Readmission reductions appeared only when a clinician reviewed the submitted data.
Why it matters: the benefit depends on someone reading and acting on the information, which requires staff and organization; in settings like ours, messaging-based follow-up with clinical review could be a practical route, though it has not been formally evaluated.
https://www.asahq.org/about-asa/newsroom/news-releases/2026/10/mobile-app-monitoring-may-reduce-serious-complications-after-surgery

4. Obstetric, pediatric, and subspecialty anesthesia

7. Ketamine or esketamine during or after cesarean delivery and early depressive symptoms

[Meta-analysis] [Meeting] [United States]
Meta-analysis of 6 randomized trials (published 2015–2025) including 1,832 women undergoing elective cesarean delivery. Ketamine or esketamine was associated with a small-to-moderate reduction in depressive symptoms measured with the Edinburgh Postnatal Depression Scale between days 3 and 14 (standardized mean difference −0.36).
Why it matters: the outcome is a screening score, not a diagnosis of postpartum depression, and the authors themselves caution that it is too early to say ketamine prevents clinically diagnosed postpartum depression; ketamine is widely available, but dose, timing, and maternal adverse effects remain undefined.
https://www.newswise.com/articles/ketamine-during-or-after-c-sections-may-ease-early-postpartum-depression-symptoms-new-study-suggests

8. Inhaled cannabis and higher propofol doses during upper endoscopy

[Meeting] [United States]
Single-center records review of 280 endoscopic procedures (264 with cannabis-use data: 217 nonusers, 38 inhaled users, and 9 oral users). In upper endoscopy, the mean initial propofol dose was 192.8 mg in inhaled users vs 151.4 mg in nonusers; there were no meaningful differences in colonoscopy, nor when all users were pooled.
Why it matters: small sample, no published P values, and unbalanced groups; it is a reminder to ask about route of use in the pre-sedation assessment, not a basis for dose adjustment.
https://www.newswise.com/articles/smoking-or-vaping-cannabis-but-not-edibles-linked-to-need-for-more-anesthesia-during-upper-endoscopy-study-suggests
https://www.news-medical.net/news/20261019/Cannabis-smokers-may-need-more-anesthesia-during-upper-endoscopy.aspx

Cross-cutting

9. Greener anesthesia: emissions nearly halved and 40% lower inhaled-agent spending

[Meeting] [United States]
Before-and-after comparison at a six-site academic health system (Carilion Clinic, Virginia) covering 145,917 anesthetic episodes: baseline year 2021 and intervention period January 2022 through October 2025. Mean emissions per episode fell from 57.6 to 31.6 kg CO2e (−45%), desflurane use dropped from 23.8% to 9.81% of cases, and inhaled anesthetic spending fell from $628,588 in 2021 to $379,010 in 2024 (nearly 40%), with no increase in recovery room or hospital stay, reintubation, awareness, or nausea and vomiting.
Why it matters: the before-and-after design does not control for other changes, but the message is practical and saves money: phasing out desflurane and using low fresh gas flows is feasible in any operating room.
https://www.newswise.com/articles/greener-anesthesia-cuts-operating-room-emissions-in-half-slashes-anesthetic-costs-nearly-40
https://www.news-medical.net/news/20261019/Hospitals-can-lower-surgical-emissions-through-greener-anesthesia-choices.aspx

Upcoming meetings and dates

ANESTHESIOLOGY 2026 runs October 16–20 in San Diego; ASA offers annual meeting sessions on demand through its OnDemand platform.
https://www.asahq.org/annualmeeting/education/anesthesiology-annual-meeting-ondemand

*Anesthesiology Bulletin — October 2026*
Greetings, colleagues. The month's highlights, with much of what was presented at ANESTHESIOLOGY 2026 (San Diego, October 16–20).

💉 *General anesthesia*
*Remimazolam did not reduce delirium in older adults*
Chinese RCT, 186 patients aged 60–80: delirium 12.9% and 11.3% with remimazolam vs 6.5% with propofol (no significant difference); less hypotension, bradycardia, and vasopressor use.
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1992969/abstract

🎯 *Regional and pain*
*Popliteal plexus block for knee surgery*
Korean meta-analysis, 8 RCTs, 684 patients: less pain at 12 h and less PONV (RR 0.21); weak evidence on opioids.
https://www.epain.org/journal/view.html?doi=10.3344%2Fkjp.26265

🏥 *Perioperative*
*GLP-1 and complications*
More than 2 million elective surgery patients (US): 11% lower odds of major cardiovascular complications and 8% lower odds of infections with GLP-1. Observational.
https://www.asahq.org/about-asa/newsroom/news-releases/2026/10/glp-1-drugs-linked-to-lower-risk-of-serious-heart-related-complications-and-infections-after-surgery
*Headphones against PONV*
Chinese RCT, 192 patients: PONV 35.4% vs 52.1%.
https://www.asahq.org/about-asa/newsroom/news-releases/2026/10/wearing-headphones-during-surgery-may-reduce-nausea-and-vomiting-afterward
*Physical activity and delirium*
258 cancer surgery patients: walking plus moderate or vigorous activity at least 7 times a week was associated with a 50% lower risk of delirium. Observational.
https://www.newswise.com/articles/could-staying-active-before-surgery-help-prevent-postoperative-delirium-d/?sc=c104
*App-based follow-up*
38 studies, 7,507 patients: 22% lower risk of major complications.
https://www.asahq.org/about-asa/newsroom/news-releases/2026/10/mobile-app-monitoring-may-reduce-serious-complications-after-surgery

🤰 *Obstetrics and sedation*
*Ketamine in cesarean delivery*
Meta-analysis of 6 RCTs, 1,832 women: fewer early depressive symptoms (SMD −0.36).
https://www.newswise.com/articles/ketamine-during-or-after-c-sections-may-ease-early-postpartum-depression-symptoms-new-study-suggests
*Cannabis and propofol in upper endoscopy*
264 procedures with use data: mean initial dose 192.8 mg in inhaled users vs 151.4 mg in nonusers.
https://www.newswise.com/articles/smoking-or-vaping-cannabis-but-not-edibles-linked-to-need-for-more-anesthesia-during-upper-endoscopy-study-suggests

🌍 *Cross-cutting*
*Greener anesthesia*
145,917 anesthetics: emissions −45% and inhaled-agent spending nearly −40%, with no worse outcomes.
https://www.newswise.com/articles/greener-anesthesia-cuts-operating-room-emissions-in-half-slashes-anesthetic-costs-nearly-40

Full bulletin and audio: https://boletinesmedicos.com/en/anesthesiology/2026-10-20.html
MedBulletins · boletinesmedicos.com

Monthly anesthesiology bulletin — October 2026
9 verified items from the past month: ANESTHESIOLOGY 2026 (ASA), Frontiers in Medicine, and Korean Journal of Pain.

Three worth your time:
• GLP-1 receptor agonists in more than 2 million elective surgery patients: 11% lower odds of major cardiovascular complications and 8% lower odds of infections. Observational, with no aspiration data.
• Noise-canceling headphones in the OR: nausea and vomiting fell from 52.1% to 35.4% in a 192-patient randomized trial. Single center, meeting abstract.
• Remimazolam vs propofol in older adults: no reduction in delirium (12.9% and 11.3% vs 6.5%), but less hypotension and bradycardia. Underpowered trial.

Full bulletin, with a critical appraisal of each study and links to sources:
https://boletinesmedicos.com/en/anesthesiology/2026-10-20.html

#Anesthesiology #PerioperativeMedicine #GLP1 #PostoperativeDelirium #ASA2026

Anesthesia, Oct 2026: GLP-1 RAs linked to 11% lower odds of major cardiovascular complications in more than 2 million surgical patients (observational); OR headphones cut nausea/vomiting from 52% to 35% in an RCT.
https://boletinesmedicos.com/en/anesthesiology/2026-10-20.html