{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:00:03Z","timestamp":1790312403395,"version":"4.1.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Older patients undergoing radical esophagectomy may experience marked postoperative endocrine stress, inflammation, pain, and short-term cognitive decline. We evaluated whether a routine anesthetic strategy combining dexmedetomidine with remifentanil was associated with a smaller POD3 serum cortisol increase than remifentanil- or dexmedetomidine-based strategies alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort screened 426 consecutive patients aged \u226565 years who underwent elective radical esophagectomy from January 2023 to December 2025. Of these, 347 had verifiable pathway-based POD3 biomarker and POD7 MoCA data after predefined clinical, laboratory, and follow-up exclusions. The primary analysis used a prespecified balanced common-support analytic cohort drawn from the naturally occurring REM (continuous remifentanil without dexmedetomidine), DEX (dexmedetomidine with non-remifentanil opioid analgesia and without continuous remifentanil), and Dex-REM (both infusions) exposure strata (100 patients each). The primary endpoint was morning serum cortisol change from preoperative day 1 to postoperative day 3 (POD3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>POD7 screening-based cognitive decline occurred in 51 patients in the balanced common-support cohort. Mean cortisol change was +164.0 nmol\/L in REM,\u00a0+\u00a0126.0 nmol\/L in DEX, and +86.0 nmol\/L in Dex-REM. After adjustment, Dex-REM was associated with lower cortisol change than REM (adjusted mean difference, -78.4 nmol\/L; 95% CI, -103.2 to -53.6; p&amp;lt;0.001) and DEX (-39.6 nmol\/L; 95% CI, -64.1 to -15.1; p=0.002). Dex-REM also showed lower 24-h VAS AUC than REM (adjusted mean difference, -5.8 point-hours; 95% CI, -9.3 to -2.3; FDR q=0.006), while POD7 MoCA-decline risk was numerically lower but imprecise (12.0% vs. 22.0%; adjusted risk ratio, 0.52; 95% CI, 0.26 to 1.05; p=0.071).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The real-world Dex-REM anesthetic pathway was associated with a smaller POD3 morning serum cortisol increase. This pathway-level association does not establish an agent-specific effect, pharmacologic synergy, or attenuation of the complete surgical-stress trajectory. Clinical and screening-based cognitive secondary outcomes were exploratory and require prospective multicenter confirmation before causal or neuroprotective conclusions are drawn.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1911323","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:27:29Z","timestamp":1790310449000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of a routine dexmedetomidine-remifentanil anesthetic strategy with POD3 morning cortisol change in older patients undergoing radical esophagectomy"],"prefix":"10.3389","volume":"17","author":[{"given":"Yuling","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University","place":["Zhangzhou, Fujian, 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