Remimazolam meets noninferiority to propofol for delirium; esketamine cuts chronic pain after thoracoscopic resection; VR eases preoperative anxiety

• Research Oct 29, 2026
  Remimazolam-based anesthesia is noninferior to propofol for delirium after neurovascular surgery in 686-patient trial
  In a single-center, double-blind randomized trial of adults having elective neurovascular surgery, published Oct. 29 in the British Journal of Anaesthesia, remimazolam-based total intravenous anesthesia with flumazenil reversal met noninferiority to propofol-based anesthesia for delirium within five days, the primary end point. Delirium occurred in 12.8% (44 of 344) with remimazolam and 10.8% (37 of 342) with propofol (risk difference 1.97 percentage points; 95% CI -2.85 to 6.80), within a 10-point margin. Extubation in the operating room was more frequent with remimazolam (85.2% versus 67.3%). The authors said delirium was less common than anticipated when the margin was set.
  Sources: British Journal of Anaesthesia, PubMed
• Research Oct 28, 2026
  Perioperative low-dose esketamine lowers three-month chronic pain to 14.7% from 21.2% after thoracoscopic lung resection
  In a multicenter, double-blind randomized trial registered in China, published Oct. 28 in the British Journal of Anaesthesia, low-dose esketamine given as a bolus at induction, an intraoperative infusion and a 48-hour postoperative infusion reduced chronic pain three months after video-assisted thoracoscopic lung resection to 14.7% from 21.2% with saline (adjusted odds ratio 0.62; 95% CI 0.43 to 0.90; P = .013), the primary end point. Of 914 randomized adults, 873 were analyzed. The authors said esketamine did so without increasing adverse effects.
  Sources: British Journal of Anaesthesia, PubMed
• Technology Oct 26, 2026
  Single 20-minute virtual reality session cuts preoperative anxiety scores in 106-patient ambulatory surgery trial
  In the single-center, open-label AMBLUMEEN randomized trial in Lyon, France, published Oct. 26 in Anesthesia & Analgesia, 106 ambulatory surgery patients with moderate to severe anxiety received standard care with or without one 20-minute immersive virtual reality session before surgery. The adjusted mean between-group difference in change in State-Trait Anxiety Inventory score was -18.7 points (95% CI -21.4 to -16.1) in favor of virtual reality, the primary end point. Benzodiazepine use, postoperative pain and unplanned overnight admission were comparable between groups.
  Sources: Anesthesia & Analgesia, PubMed

The weekly innovation roundup for anesthesiology, published every Sunday for the week before; every item links to its sources. Latest anesthesiology news · All specialties