Evidence map›Paper›PMID 41857647›Full record

ArticlePerioperative medicine (London, England)2026

Effect of preoperative intranasal insulin on postoperative delirium in adult surgical patients: a systematic review, meta-analysis, and trial sequential analysis.

Emmanuel Mark M Velasco, Vinicius Sepúlveda Lima, Tulio Caldonazo, Felipe S Passos, Paulo Ricardo Gessolo Lins, Iago Teles Costa Grillo, Pedro Tanaka, Alex Macario, Aleksandar R Zivkovic, João da ManoelSilva and 2 more

Abstract read
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In one paragraph

Article in Perioperative medicine (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Emmanuel Mark M VelascoDepartment of Anesthesiology and Pain Medicine, Toronto General Hospital, Toronto, Canada.
Vinicius Sepúlveda LimaCentro de Ensino E Treinamento Do Hospital Português - Clínica de Anestesia de Salvador, Salvador, Brazil.
Tulio CaldonazoDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany.
Felipe S PassosDepartament of Thoracic Surgery, MaterDei Hospital, Salvador, Brazil.
Paulo Ricardo Gessolo LinsDisciplina de Medicina de Urgência E Medicina, Baseada Em Evidências- Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil.
Iago Teles Costa GrilloUniversity of Buenos Aires, Buenos Aires, Argentina.
Pedro TanakaDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, 300 Pasteur Dr Rm H3577MC 5640, Stanford, CA, 94305, USA.
Alex MacarioDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, 300 Pasteur Dr Rm H3577MC 5640, Stanford, CA, 94305, USA.
Aleksandar R ZivkovicMedical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Heidelberg, Germany.
João da ManoelSilvaPostgraduate in Anesthesiology, Surgical Sciences and Perioperative Medicine, University of São Paulo, São Paulo, Brazil.
Johannes Ehler *Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University, Jena, Germany. Johannes.Ehler@med.uni-jena.de.
Ricardo Esper Treml *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, 300 Pasteur Dr Rm H3577MC 5640, Stanford, CA, 94305, USA. rictreml@stanford.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPostoperative delirium (POD) is a frequent and serious complication, especially in older adults and high-risk surgical patients. Intranasal insulin has emerged as a potential neuroprotective intervention, possibly modulating neuroinflammation and preserving cognitive function. This study aimed to evaluate the efficacy and safety of preoperative intranasal insulin in reducing POD incidence.

methodsA systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched through March 2025 for randomized controlled trials (RCTs) comparing intranasal insulin versus placebo in adult surgical patients. The primary outcome was the incidence of POD. Secondary outcomes included inflammatory biomarkers (IL-6, TNF-α, CRP), glucose levels, and insulin resistance (HOMA-IR). Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. Trial Sequential Analysis (TSA) was also performed.

resultsEight RCTs from China involving 888 patients (481 intranasal insulin, 407 placebo) were included. Intranasal insulin significantly reduced the risk of POD (OR 0.24; 95% CI 0.17 to 0.34; p < 0.001; I2 = 0%). TSA confirmed the robustness of this finding. Significant reductions in IL-6 (MD -2.52; 95% CI -3.45 to -1.58) and TNF-α (MD -5.02; 95% CI -8.67 to -1.36) were observed. No significant differences were found in serum or CSF glucose, or HOMA-IR. No hypoglycemia or serious adverse events were reported.

conclusionPreoperative intranasal insulin is a safe and effective strategy to reduce POD, likely through central anti-inflammatory mechanisms, without compromising glycemic stability.

Indexed as

Intranasal insulinNeuroinflammationPerioperative neuroprotectionPostoperative delirium

Identifiers

PMID41857647
PMCPMC13063771

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.