Anesthetic Risk Research Articles

A Comparative Study of Trochanteric Fractures Treated with Hip Hemiarthroplasty or Proximal Femoral Nail — A Secondary Publication

Objective: The aim of this study was to compare the clinical and functional outcomes of patients treated with partial hip prosthesis (PHP) or double lag screw proximal femoral nailing (PFN) for unstable femoral intertrochanteric region fractures. Material and method: In this study, the data of 101 patients who developed grade 3-4-5 femoral intertrochanteric fractures according to the Evans-Jensen classification between 2019–2020 and were treated with cemented PHP or double screw PFN were evaluated retrospectively. The patients were evaluated in terms of postoperative follow-up time, age, gender, trauma side, American Anesthesia Society Anesthesia Risk Scale (ASA), number of comorbid diseases, total hospitalization time, amount of intraoperative bleeding, duration of surgery, and postoperative complications. Results: 101 patients evaluated within the scope of the study were divided into groups of 51 patients who underwent PHP (Group 1) and 50 patients who underwent PFN (Group 2). When the results were compared in terms of mean length of hospital stay, duration of surgery, amount of intraoperative bleeding, and postoperative 1-year mortality, the results were found to be statistically significant. Conclusion: Our study results showed that the PFN method has clinical advantages over PHP. The PFN technique is a method that can be applied quickly and safely.

Impact of Exogenous Factors and Anesthetic Risk in Premature Birth during the Pandemic Period.

Premature birth remains a public health problem worldwide, involving a broader context and a multidisciplinary team aimed at combating this phenomenon as much as possible. The consumption of addictive substances by women who are pregnant can occur in different social contexts and at different stages of their lives, which modulate its extent. Obstetricians and anesthetists should consider the anesthetic maternal risks that may arise due to these addictive behaviors. The maternal anesthetic risk is higher in women who are pregnant with a medium-level of education, imbalanced nutrition, stress associated with physical or mental activity, affected sleep hygiene, and failed marriages. The objectives of the study refer to analyzing the impact of exogenous factors and the anesthetic risk on premature birth for women who were pregnant during the pandemic period and in women who were pregnant without COVID-19 infection. The authors studied a significant sample of 3588 women who were pregnant without COVID-19 infection, among whom 3291 gave birth at term and 297 gave birth prematurely. The methods analyzed consist of studying the specialized literature regarding the impact of exogenous factors and parturient's anesthetic risk on premature birth and identifying the regional risk profile of women who are pregnant in the southeast region of Romania compared to that identified in the specialized literature. In the analytical methods, we used a linear regression to study the incidence of exogenous risk factors on anesthetic risk in women who were pregnant with premature births compared to those with full-term births. The results confirm the significant impact of exogenous factors on anesthetic risk and the significant impact of anesthetic risk on premature births. The novelty of the study lies in highlighting the modification of the regional exogenous risk profile during the pandemic period in southeast Romania due to unfavorable socio-economic causes and the translation of grade I and II prematurity events to higher frequencies with an increased level of maternal anesthetic risk. The study findings show that the anesthetic risk is maximized in parturients with a middle school education. Additionally, the anesthetic risk of patients who are pregnant increases with the intensification of smoking adherence and its maintenance throughout the pregnancy at the same intensity. Our study aims to provide a basis for the diversification and development of community intervention programs in the post-COVID-19 era, considering the reshaping of social models and the repositioning of social principles and values. Obstetricians and anesthetists must know and promote family values to harmonize the lives of family members and provide a better life for the mother and child.

Pharmacologic venous thromboembolism prophylaxis for preterm prelabor rupture of membranes

BACKGROUNDPregnant patients with preterm prelabor rupture of membranes (PPROM) may experience prolonged hospitalization, which is an indication for pharmacologic venous thromboembolism (VTE) prophylaxis according to certain international guidelines. The proportion of patients who deliver unexpectedly and within a period during which pharmacologic prophylaxis would be expected to impact coagulation is unknown. OBJECTIVETo estimate the proportion of patients with PPROM who would deliver within 12 hours of typical dosing of pharmacologic VTE prophylaxis if administered routinely for antepartum admissions >72 hours. STUDY DESIGNThis is a retrospective cohort study from a database including patients admitted for expectant management of PPROM January 2011 to September 2020. The outcome of the study was the proportion of patients who remained undelivered 72 hours after admission and experienced an unplanned delivery potentially within 12 hours of enoxaparin administration. We evaluated patients undelivered after 72 hours due to international recommendations to initiate VTE prophylaxis in hospitalized patients after 72 hours. Unplanned delivery was defined as onset of spontaneous labor or other indication for immediate delivery. Timing of delivery was analyzed based on usual timing of enoxaparin administration daily at approximately 8 am and the recommendation to withhold regional anesthesia until 12 hours after a prophylactic dose. RESULTS1381 deliveries were identified as PPROM out of the 49,322 deliveries in our database. 139 cases were included after the following exclusions: delivery >35 weeks (N=641), rupture of membranes >34 weeks (N=145), delivery <72 hours after admission (N=409), insufficient data (N=35), and duplicates (N=12). Sixty of the 139 (43%) had an unplanned delivery, while 33 of these (24% of total) occurred within 12 hours of enoxaparin administration. CONCLUSIONA quarter of patients admitted for PPROM had an unplanned delivery within 12 hours of typical enoxaparin dosing. This cohort may experience harm (ineligibility for regional anesthesia, risks of general anesthesia, increased risk of bleeding) if given routine pharmacologic VTE prophylaxis. Risk/benefit considerations should be discussed with patients in considering pharmacologic versus mechanical prophylaxis during prolonged hospitalization for PPROM.

A systematic review on safety and surgical and anesthetic risks of elective abdominal laparoscopic surgery in infants to guide laparoscopic ovarian tissue harvest for fertility preservation for infants facing gonadotoxic treatment.

Infertility is an important late effect of childhood cancer treatment. Ovarian tissue cryopreservation (OTC) is established as a safe procedure to preserve gonadal tissue in (pre)pubertal girls with cancer at high risk for infertility. However, it is unclear whether elective laparoscopic OTC can also be performed safely in infants <1 year with cancer. This systematic review aims to evaluate the reported risks in infants undergoing elective laparoscopy regarding mortality, and/or critical events (including resuscitation, circulatory, respiratory, neurotoxic, other) during and shortly after surgery. This systematic review followed the Preferred reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting guideline. A systematic literature search in the databases Pubmed and EMbase was performed and updated on February 15th, 2023. Search terms included 'infants', 'intubation', 'laparoscopy', 'mortality', 'critical events', 'comorbidities' and their synonyms. Papers published in English since 2000 and describing at least 50 patients under the age of 1 year undergoing laparoscopic surgery were included. Articles were excluded when the majority of patients had congenital abnormalities. Quality of the studies was assessed using the QUIPS risk of bias tool. The Pubmed and Embase databases yielded a total of 12,401 unique articles, which after screening on title and abstract resulted in 471 articles to be selected for full text screening. Ten articles met the inclusion criteria for this systematic review, which included 1778 infants <1 years undergoing elective laparoscopic surgery. Mortality occurred once (death not surgery-related), resuscitation in none and critical events in 53/1778 of the procedures. The results from this review illustrate that morbidity and mortality in infants without extensive comorbidities during and just after elective laparoscopic procedures seem limited, indicating that the advantages of performing elective laparoscopic OTC for infants with cancer at high risk of gonadal damage may outweigh the anesthetic and surgical risks of laparoscopic surgery in this age group.

Prostate Surgery for Benign Prostatic Syndrome >200 ml: Endoscopic, Robotic, or Open Approach

Surgical approaches for benign prostatic hyperplasia have evolved and diversified over the past decades. While numerous studies document the efficacy of surgical procedures for moderate prostate sizes, there remains insufficient data for large prostate volumes >200 ml, leaving important questions unanswered regarding their effectiveness and safety. Consequently, selecting and adapting suitable therapeutic options for this specific patient group often poses a significant challenge. In this context, this review comprehensively summarizes and discusses current insights into surgical treatment options for large prostate volumes (>200 ml) following an extensive literature review.In summary, the surgical treatment of prostate volumes >200 ml is a challenge regardless of the chosen surgical method. Minimally invasive approaches should be considered standard practice today. Anatomical endoscopic enucleation of the prostate is a size-independent method and has the lowest morbidity. As it may be performed in spinal anaesthesia, endoscopic enucleation is feasible in patients with an increased anaesthetic risk. In extremely large prostate glands, the procedure poses challenges even for highly experienced surgeons. Especially in obese patients, the surgeon should be familiar with different exit strategies. Robot-assisted simple prostatectomy provides a minimally invasive alternative that may also treat pathologies such as diverticula or large bladder stones in the same surgical session. Due to its transabdominal approach, the morbidity and anaesthetic risk is comparatively higher. Each centre and surgeon should individually decide in which method they have the greatest expertise and which option is best suited for the specific case. In cases of limited expertise, it is advisable to refer patients to a centre with appropriate specialization.

Anaesthesia management of interventional cardiac catheterisation for pulmonary atresia with intact ventricular septum and critical pulmonary stenosis: a retrospective analysis.

Pulmonary atresia with intact ventricular septum and critical pulmonary stenosis usually have to undergo treatment in the neonatal period. Compared to traditional surgical intervention, catheter-based cardiac interventions may achieve similar or superior outcomes for neonates with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, there is limited literature on anaesthesia techniques, challenges, and risks associated with cardiac catheterisation in this population. This article retrospectively analysed the clinical data of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis neonates who were treated with interventional cardiac catheterisation in our hospital from January 2015 to October 2022. Clinical outcomes considered were haemodynamic or pulse oxygen saturation instability, vasoactive requirements, prolonged intubation (>24 h postoperatively), and cardiovascular adverse events. A total of 63 patients met the inclusion criteria. All patients survived the intervention. Among the patients with critical pulmonary stenosis, 40 successfully received percutaneous balloon pulmonary valvuloplasty, while three patients received ductal stenting due to moderate right ventricular dysplasia at the same time. For patients with pulmonary atresia with intact ventricular septum, 17 of the 23 patients successfully underwent percutaneous pulmonary valve perforation and percutaneous balloon pulmonary valvuloplasty. Of these, five patients underwent ductal stenting due to unstable pulmonary blood flow. Three patients only underwent ductal stenting. In addition, three patients received hybrid therapy. There are various clinical techniques and risk challenges in the interventional cardiac catheterisation of neonatal pulmonary atresia with intact ventricular septum and critical pulmonary stenosis. However, by mastering the physiological and pathophysiological characteristics of the disease, adequately preparing for the perioperative period, and predicting the procedure process and potential complications, anaesthesia and surgical risks can be effectively managed.

#2189 Percutaneous peritoneal dialysis catheter implantation

Abstract Background and Aims There are three main techniques to implant a peritoneal dialysis catheter (PDC): percutaneously, laparoscopically or through open surgery; and current guidelines recommend individualising according to previous abdominal surgeries and anaesthetic risk. Recent metanalysis show the percutaneous technique to be safe, non-inferior in catheter survival, and with an equal incidence in mechanic complications (within &amp;lt;3 months after implantation) and infectious complications (within &amp;lt;1 month after implantation) to laparoscopic technique. On the other side, as the percutaneous PDC implantation is a minimal intervention that requires neither surgery room nor over 24h hospitalisation, it allows for a lower waiting time to PDC implantation, a shorter period until usage, and it's economically efficient. Considering these benefits and its non-inferiority described in the literature, our centre started using this technique since 2018. In this study we analyse our results. Method This is an observational retrospective unicentric study, which included the first PDC implantation in adult patients between January 2019 and August 2023, were we analysed the mechanical and infectious complications associated with the implantation technique. All PDC were double-cuff straight Tenckhoff, placed using Seldinger technique with radioscopy. A single dose of prophylactic antibiotic was used. We considered as mechanic complication all those non-infectious incidences that required repositioning or replacement of the PDC within 3 months of implantation (excluding those patients whose catheter was removed because of kidney transplantation, death by other reasons non related to the procedure, or trespass to haemodialysis); and we considered as infectious complications all those peritonitis diagnosed the first month after implantation. Results We analysed a total of 147 patients, 71.4% were male, mean age was 61 years old, and mean kidney function at implantation time was 11.5 ml/min/1.73 m2. We found a total of 8.1% of mechanical complications (33% required repositioning and 66% required replacement) and 5.4% infectious complications. There were no deaths related to percutaneous PDC technique. Conclusion In this study we observe that mechanic or infectious complications associated with percutaneous PDC technique are similar to those published in the literature: ISPD guidelines recommend the incidence of peritonitis associated to catheter implantation to be less than 5%. And though there is no clear percentage of mechanical complications that are considered acceptable or unavoidable, many studies report a survival of 76-86% PDC at 90 days of implantation in percutaneous and laparoscopic procedures, without significant differences between them.

Risk assessment in equine anesthesia: a first evaluation of the usability, utility and predictivity of the two-part CHARIOT

IntroductionAn accurate risk score that can predict peri-anesthetic morbidity and mortality in equine patients could improve peri-operative management, outcome and client communication.Materials and methodsThree hunded horses underwent pre-anesthetic risk assessment using the American Society of Anesthesiologists-Physical Status augmented with equine-specific diseases (ASA-PS-Equine), a multifactorial 10-part rubric risk scale (10-RS), and a combination of both, the Combined horse anesthetic risk identification and optimization tool (CHARIOT). Intra-and post-anesthetic complications, the recovery phase and mortality were recorded over a period of 7 days following general anesthesia. To compare the utility and predictive power of the 3 scores, data were analyzed using binominal logistic regression (p ≤ 0.05) and receiver operating characteristic curve analysis. In addition, inter-observer reliability, speed, safety, ease of use and face validity of the ASA-PS-Equine and the 10-RS were analyzed based on five hypothetical patients.ResultsAll scores showed statistically significant associations with various intra-anesthetic complications and parameters of the recovery phase. The discriminant ability of the scores related to the occurrence of intra-anesthetic (AUC = 0.6093–0.6701) and post-anesthetic (AUC = 0.5373–0.6194) complications was only low. The highest diagnostic accuracy for all scores was observed for overall mortality (AUC = 0.7526–0.7970), with the ASA-PS-Equine differentiating most precisely (AUC = 0.7970; 95% CI 0.7199–0.8741). Inter-observer reliability was fair for the 10-RS (κ = 0.39) and moderate for the ASA-PS-Equine (κ = 0.52). Patient assignment to the CHARIOT was predominantly rated as rather easy and quick or very quick.Limitations and conclusionThe main limitations of the study are the monocentric study design and failure to obtain the full range of points. In conclusion, all 3 scores provide useful information for predicting the mortality risk of equine patients undergoing general anesthesia, whereas intra-and postoperative complications cannot be predicted with these scores.

The Update on the Role of Cesarean Myomectomy in an Old Primigravida with Huge and Painful Myoma: a Challenging Case for Fertility-Preserving Surgery

Abstract There is no established protocol for reducing maternal and perinatal morbidities in myoma during pregnancy. The opinions regarding performing myomectomy during cesarean section have been inconsistent and hot topic of discussion. The recent trends regarding the pro and cons outcomes are caused by potential risk of massive hemorrhage, repeat operation and anesthesia, less time away from work, prolong duration of operation and hospital stay, need of transfusion, increased overall cost, and morbidity. We presented a case of 42-year-old primigravida at 37-38 weeks of singleton live pregnancy with intramural myoma, and then performed successfully cesarean section and myomectomy without complication. The results of the operation showed a safe outcome when performed by an experienced obstetrician and selective case, and helped maintain fertility sparing in the future. Keywords: Uterine myoma, Cesarean myomectomy, Old primigravida

The 90% minimum effective concentration of ropivacaine for ultrasound‐guided interscalene brachial plexus block in children aged 1–10 years: A biased coin design up‐and‐down sequential allocation trial

AbstractRopivacaine is a commonly used local anesthetic for brachial plexus blocks in children, but the minimum effective dose of ropivacaine for interscalene brachial plexus blocks has not been reported. The aim of this study was to determine the 90% minimum effective concentration (MEC90) of ropivacaine for an ultrasound‐guided interscalene brachial plexus block (ISB). A total of 155 patients, aged from 1 to 10 years, underwent unilateral surgical procedures on areas of the upper extremity not innervated by the ulnar nerve. The biased coin design up‐and‐down sequential method (BCD‐UMD) was used to determine the MEC90 of ropivacaine for ultrasound‐guided ISB. In our study, the initial concentration of ropivacaine was 0.07% in the toddler group and 0.09% in the preschool and school‐age groups. During the trial, the concentration of ropivacaine for each subsequent patient was determined by the blocking effect of the previous patient. In case of failure, the concentration for the next patient was increased by 0.01%. Otherwise, the concentration was either decreased by 0.01%, with a probability of 0.11, or kept the same, with a probability of 0.89. Overall, the MEC90 of ropivacaine was 0.104% (95% confidence interval (CI), 0.070%–0.106%) in the toddler group, 0.114% (95% CI, 0.090%–0.117%) in the preschool group, and 0.133% (95% CI, 0.099%–0.136%) in the school‐age group. No adverse events occurred. Our study showed that lower concentrations of ropivacaine could provide effective nerve blocks and reduce the risk of local anesthetics.

Personalized anesthesia and precision medicine: a comprehensive review of genetic factors, artificial intelligence, and patient-specific factors.

Precision medicine, characterized by the personalized integration of a patient's genetic blueprint and clinical history, represents a dynamic paradigm in healthcare evolution. The emerging field of personalized anesthesia is at the intersection of genetics and anesthesiology, where anesthetic care will be tailored to an individual's genetic make-up, comorbidities and patient-specific factors. Genomics and biomarkers can provide more accurate anesthetic protocols, while artificial intelligence can simplify anesthetic procedures and reduce anesthetic risks, and real-time monitoring tools can improve perioperative safety and efficacy. The aim of this paper is to present and summarize the applications of these related fields in anesthesiology by reviewing them, exploring the potential of advanced technologies in the implementation and development of personalized anesthesia, realizing the future integration of new technologies into clinical practice, and promoting multidisciplinary collaboration between anesthesiology and disciplines such as genomics and artificial intelligence.

Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture.

According to Vancouver classification, B2 type fractures are most often treated with removal of the loose stem and implantation of a long stem that bypasses the fracture site. However, there is a controversy about the stem fixation that should be used: cemented or cementless. Hence, this study aims to compare cemented and cementless stems in prosthetic revision due to Vancouver B2 (VB2) periprosthetic hip fracture. A retrospective study was done including all the patients treated with stem exchange due to VB2 periprosthetic hip fracture in a tertiary hospital between 2015 and 2022. Patients were divided into two groups according to the stem fixation used: cemented or cementless. Functional outcomes, hospital stay, surgical time, complication rate, and mortality were compared between the two groups of patients. Of the 30 included patients, 13 (43.4%) were treated with cementless stems and 17 (56.7%) with cemented stems. There were no statistically significant differences in age, gender, anesthesia risk scale (ASA) or functional capacity prior to the intervention. Patients treated with cementless stems had a higher complication and reintervention rate than those treated with cemented stems: 62 and 45% versus 34 and 6% (p = 0.035; p = 0.010), respectively. Furthermore, in the group of cementless stems a higher proportion of non-union was found (53.8% vs. 17.6%; p = 0.037). Also, the hospital stay (33 vs. 24days; p = 0.037) and the time to full weight-bearing (21days vs. 9days; p < 0.001) were longer in the cementless stem group. Cemented fixation in stem revision due to Vancouver B2 periprosthetic hip fracture could be an optimal option with faster recovery which could decrease the rate of complications and reintervention, without compromising the fracture healing and patient mortality. Thus, this option can be considered when an anatomical reduction can be obtained, especially in elderly patients with multiple comorbidities in which a less aggressive surgical option should be considered.

Thoracic Segmental Spinal Anesthesia for Laparoscopic Cholecystectomy

Laparoscopic surgery is normally performed under general anesthesia. Thoracic segmental spinal anesthesia (TSSA) can be a suitable alternative to general anesthesia for patients with respiratory diseases, as it avoids the risk of general anesthesia. We successfully managed a 74-year-old lady with COPD undergoing elective laparoscopic cholecystectomy with TSSA at T8-T9 interspace using 1.7 ml of hyperbaric bupivacaine 0.5% with 0.3 ml (15mcg) of fentanyl. Some discomfort was managed with 1mg midazolam and 50 mcg fentanyl intravenously. There was no neurological deficit and major hemodynamic fluctuations intra and post-operatively and recovery was uneventful.

Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa

BackgroundThere has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003–2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH.MethodsA retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded.ResultsAnalysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59; 45.38) pmol/l, alkaline phosphatase 117.5 (89; 145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26; 62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008).ConclusionsThe proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.

Evaluating the accuracy of ChatGPT-4 in predicting ASA scores: A prospective multicentric study ChatGPT-4 in ASA score prediction

BackgroundThis study investigates the potential of ChatGPT-4, developed by OpenAI, in enhancing medical decision-making processes, particularly in preoperative assessments using the American Society of Anesthesiologists (ASA) scoring system. The ASA score, a critical tool in evaluating patients' health status and anesthesia risks before surgery, categorizes patients from I to VI based on their overall health and risk factors. Despite its widespread use, determining accurate ASA scores remains a subjective process that may benefit from AI-supported assessments. This research aims to evaluate ChatGPT-4's capability to predict ASA scores accurately compared to expert anesthesiologists' assessments. MethodsIn this prospective multicentric study, ethical board approval was obtained, and the study was registered with clinicaltrials.gov (NCT06321445). We included 2851 patients from anesthesiology outpatient clinics, spanning neonates to all age groups and genders, with ASA scores between I-IV. Exclusion criteria were set for ASA V and VI scores, emergency operations, and insufficient information for ASA score determination. Data on patients' demographics, health conditions, and ASA scores by anesthesiologists were collected and anonymized. ChatGPT-4 was then tasked with assigning ASA scores based on the standardized patient data. ResultsOur results indicate a high level of concordance between ChatGPT-4 predictions and anesthesiologists' evaluations, with Cohen's kappa analysis showing a kappa value of 0.858 (p = 0.000). While the model demonstrated over 90% accuracy in predicting ASA scores I to III, it showed a notable variance in ASA IV scores, suggesting a potential limitation in assessing patients with more complex health conditions. DiscussionThe findings suggest that ChatGPT-4 can significantly contribute to the medical field by supporting anesthesiologists in preoperative assessments. This study not only demonstrates ChatGPT-4's efficacy in medical data analysis and decision-making but also opens new avenues for AI applications in healthcare, particularly in enhancing patient safety and optimizing surgical outcomes. Further research is needed to refine AI models for complex case assessments and integrate them seamlessly into clinical workflows.

Treatment of Warthin's Tumors of the Parotid Gland With Radiofrequency Ablation: A Systematic Review of the Current Literature.

Objective: Warthin's tumors of the parotid gland can be safely observed. Definitive treatment usually requires parotidectomy under general anesthesia. The decision to operate on Warthin's tumors of the parotid gland can be complicated in patients who wish to avoid risks of surgery and general anesthesia. This systematic review explores the potential of radiofrequency ablation (RFA) as a minimally invasive alternative. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model was used to collect 3 relevant studies that focused on RFA treatment for Warthin's tumors. The cumulative averages for tumor size and cosmetic scores were then quantified for patients with Warthin's tumors who underwent RFA therapy. The PRISMA systematic review method was employed to the PubMed and EMBASE databases. The comprehensive search term "Warthin Tumor Treatment" yielded 1299 articles from the years 1955 to 2023, 3 of which met inclusion criteria and were then selected. Results: The 3 quantitative studies collectively assessed 37 patients with Warthin's tumors treated with RFA. Patients experienced an average tumor size reduction of 85.03% at 12 months post-RFA. There were minimal complications associated with RFA in these patients. Conclusion: This study suggests that RFA is an alternative to parotidectomy for the symptomatic treatment of Warthin's tumors. RFA procedures demonstrated substantial tumor size reduction with few complications. However, further meta-analysis and comparison with alternative treatments is warranted to establish RFA's role in treatment of Warthin's tumors. The study is limited by its reliance on only 2 databases and a lack of comprehensive examination of different RFA settings.

Super-Selective Trans-Catheter Arterial Embolization (TAE) of the Vesical Arteries in the Management of Intractable Hematuria Secondary to Advanced Bladder and Prostate Cancers.

This article was previously presented as an abstract at the 18th UAA Congress, Seoul, October 15-17, 2020, and the abstract was published in The International Journal of Urology. It was also presented as an e-posterat the 2021 BAUS Annual Meeting on June 22, 2021. Introduction In frail patients intractable hematuria secondary to advanced pelvic malignancies is a clinical challenge. Super-selective TAE of the vesical arteries is a suitable minimally invasive option. We present our experience in this patient cohort. Patients and methods All patients who underwent TAE from January 2014 to December 2019 were included. Super-selective TAE of the superior and inferior vesical arteries was done using 300-500µ polyvinyl alcohol(PVA) particles. Demographic data, cancer stage, associated urinary system obstruction, pre-embolization palliative treatment, chemotherapy, and radiotherapy were recorded. Technical and clinical success, time to cessation of hematuria, recurrence of hematuria, and complications were recorded. Data are presented as mean ± standard deviation, and statistical significance is set at p<0.05. Results From 2014 to 2019, seven patients underwent eight procedures. The average patient's age was 60.6±10.3 years. All presented with gross hematuria, six due to locally advanced and/or metastatic bladder cancer, and one due to prostate cancer. The average time of hematuria clearance was 60 hours. The average hemoglobin levels at the time of the procedure, one month, and six months post-embolization were 9.6±1.7 g/dL, 10.6±1.5 g/dL (p<0.05), and 9.6±0.9 g/dL, respectively (p>0.05). Packed red blood cell (PRBC) requirements decreased from 7±2 units to 5±3units after the procedure (p >0.05). The patients were followed up for an average of 13.6 months and four had a recurrence at an average of four months post-embolization. Conclusion Super-selective TAE is an effective palliative method in controlling intractable hematuria. The risks of major surgery and anesthesia are omitted, and the procedure can be repeated as needed. Furthermore, post-embolization complications, using this technique, are minor and manageable.

Machine learning approach for predicting post-intubation hemodynamic instability (PIHI) index values: towards enhanced perioperative anesthesia quality and safety

BackgroundAdequate preoperative evaluation of the post-intubation hemodynamic instability (PIHI) is crucial for accurate risk assessment and efficient anesthesia management. However, the incorporation of this evaluation within a predictive framework have been insufficiently addressed and executed. This study aims to developed a machine learning approach for preoperatively and precisely predicting the PIHI index values.MethodsIn this retrospective study, the valid features were collected from 23,305 adult surgical patients at Peking Union Medical College Hospital between 2012 and 2020. Three hemodynamic response sequences including systolic pressure, diastolic pressure and heart rate, were utilized to design the post-intubation hemodynamic instability (PIHI) index by computing the integrated coefficient of variation (ICV) values. Different types of machine learning models were constructed to predict the ICV values, leveraging preoperative patient information and initiatory drug infusion. The models were trained and cross-validated based on balanced data using the SMOTETomek technique, and their performance was evaluated according to the mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE) and R-squared index (R2).ResultsThe ICV values were proved to be consistent with the anesthetists’ ratings with Spearman correlation coefficient of 0.877 (P < 0.001), affirming its capability to effectively capture the PIHI variations. The extra tree regression model outperformed the other models in predicting the ICV values with the smallest MAE (0.0512, 95% CI: 0.0511–0.0513), RMSE (0.0792, 95% CI: 0.0790–0.0794), and MAPE (0.2086, 95% CI: 0.2077–0.2095) and the largest R2 (0.9047, 95% CI: 0.9043–0.9052). It was found that the features of age and preoperative hemodynamic status were the most important features for accurately predicting the ICV values.ConclusionsOur results demonstrate the potential of the machine learning approach in predicting PIHI index values, thereby preoperatively informing anesthetists the possible anesthetic risk and enabling the implementation of individualized and precise anesthesia interventions.

Dental treatment of children with special healthcare needs: A retrospective study of 10 years of treatment.

Children with special healthcare needs (CSHCN) often face oral health challenges. This retrospective cross-sectional study at a university hospital aimed to determine CSHCN's medical spectrum, dental treatment needs, and mode of treatment: general anesthesia (GA) or outpatient dental care (ODC). Data from the Department of Conservative Dentistry, Heidelberg University Hospital, 2012-2022, were reviewed, considering age, gender, International Classification of Diseases-10 diagnoses, caries experience (dmft/DMFT), restorative parameters, and treatment under GA/ODC. For patients under GA, their American Society of Anesthesiologists (ASA) classification was considered. Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U-test and logistic regression were utilized. Of 669 patients, congenital and chromosomal malformations (34.7%), diseases of the nervous system (19.1%), and mental and behavioral disorders (16.0%) were mainly diagnosed. Dentin caries prevalence was high at 79.1%, with treatments performed mainly under GA (51.4%). The odds of receiving treatment under GA decreased with patient age and increased with higher dmft/DMFT scores. Most under GA were classified as ASA 3 (51.7%), indicating high anesthesia risks. Children with special healthcare needs often have diseases that can lead to higher challenges related to cooperation. The high prevalence of dentin caries underscores the substantial need for dental treatments, which were consequently often performed under GA, despite the associated risks. These findings stress the need for trained dental professionals.

Anaesthesia for Emergent Caesarean Section: A Population-based Study on Icelandic and Migrant Women during 2007-2018

General anaesthesia for emergent caesarean section, though uncommon, is vital in expediting deliveries. Studies indicate higher complication risks among pregnant migrant women. This research investigates if migrant women in Iceland are more likely to undergo general anaesthesia for emergent caesarean section compared to their Icelandic counterparts. This population-based cohort study analysed 4,415 emergency caesarean sections in Iceland between 2007 and 2018, sourced from the National Birth Registry. Participants were categorized by citizenship, with migrants further stratified by their country's Human Development Index (HDI). NCSP-IS and ICD-10 codes indexed diseases, interventions, and complications. The impact of variables was assessed through multiple logistic regression analysis. Migrant women received general anaesthesia in 16.1% of cases, slightly surpassing Icelandic women's 14.6%. Adjusting for risk factors showed no increased risk for migrant women. However, they had a higher likelihood of urgent caesarean sections (OR 1.45, 95% CI 1.08-1.94, p=0.015), a known risk factor for general anaesthesia, despite fewer comorbidities. Adjusting for confounders revealed reduced odds with a history of previous caesarean section (aOR 0.73, 95% CI 0.59-0.89, p=0.003) and placement of epidural anaesthesia in the delivery room (aOR 0.49, 95% CI 0.40-0.60, p< 0.001). Migrant women in Iceland do not face increased risks of general anaesthesia for emergent caesarean sections. However, their elevated risk of urgent caesarean sections suggests potential challenges, including language barriers or inadequate antenatal care. Early information dissemination and targeted interventions may mitigate these risks in this vulnerable community.