Among older, non-frail patients undergoing moderate and high-risk noncardiac surgery, an automated anesthetic management using the combination of three independent closed-loop systems outperformed manual control and may have an impact on delayed neurocognitive recovery. However, given the study design, it is impossible to draw strong conclusions on the impact of each controller’s individual effect on the cognition score.

Future studies are needed to further assess the impact of this approach in more vulnerable patients and on other postoperative complications.

43 controls and 44 closed-loop patients were assessed for the primary outcome.

In this single-center, patient-and-evaluator-blinded, two-arm, parallel, randomized controlled, superiority study, 90 patients having noncardiac surgery under general anesthesia were randomly assigned to one of two groups.

In the control group, anesthesia management was performed manually while in the closed-loop group, the titration of anesthesia, analgesia, fluids, and ventilation was performed by three independent controllers.

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