Artificial Intelligence-Supported Systems in Anesthesiology and Its Standpoint to Date—A Review

Artificial intelligence (AI) is the technique that enables computers to solve problems and perform tasks that traditionally require human intelligence. The availability of large amounts of medical data from electronic medical records and powerful modern microcomputers enables the development of AI in medicine. AI has proven its applicability in many different medical areas, such as drug discovery, diagnostic radiology and pathology, as well as interventional applications in cardiology and surgery. However, until today, AI is scarcely used in the clinical practice of anesthesiology. Although there has been a significant body of research published on AI applications for anesthesiology in the literature, the number of developed robot systems for commercial use or those ready for clinical trials remains limited. The limitations of AI systems are identified and discussed, which include incorrect medical data formatting, individual patient variability, the lack of ability of current AI systems, anesthesiologist inexperience in AI usage, system unreliability, unexplainable AI conclusions and strict regulations. In order to ensure anesthesiologists’ trust in AI systems and improve their implementation in daily practice, strict quality control of the systems and algorithms should be undertaken. Further, anesthesiology personnel should play an integral role in the development of AI systems before we are able to see more AI integration in clinical anesthesiology.

Application Research of Fragmented Case Teaching in Standardized Training of Residents in Anesthesiology Department

Objective:To explore the effect of fragmented case teaching in the standardized training of residents in anesthesiology department.Methods:80 doctors who participated in the standardized training of residents in anesthesiology department from January 2021 to January 2022 were selected as the research objects,and the 80 doctors were divided into experimental groups according to the clinical teaching mode(n=40,implemented case fragmented teaching method)and the control group(n=40,traditional teaching method).The training lasted for 2 months,and the medical history collection,medical record analysis,practical operation ability,theoretical assessment results,and the degree of satisfaction towards the training of the two groups of doctors were compared.Results:After 2 months of training,the theoretical knowledge and operational ability of the doctors in the two groups have improved to a certain extent,but the medical history collection,medical record analysis,practical operation ability,theoretical assessment results and satisfaction of the doctors in the experimental group were significantly better than those in the control group(P<0.05).Conclusion:The effect of the fragmented case teaching method in the standardized training of anesthesiology residents is significantly better than the traditional teaching mode.The abilities of doctors have significantly improved after the training.Hence,the fragmented case teaching method is worthy of promotion in clinical practice.

Effect Analysis of WeChat Platform Combined with PBL Teaching Method for Standardized Training of Residents in Anesthesiology Department

Objective: To explore and analyze the effect of the WeChat platform combined with the PBL teaching method in the standardized training of anesthesia residents. Methods: 120 anesthesiology residents from January 2018 to the end of December 2019 were selected, and divided into a control group and an observation group of 60 each according to the time sequence of admission. The control group adopted the conventional teaching mode, and the observation group adopted the WeChat platform combined PBL teaching method. The scores of theoretical knowledge and anesthesia skills operation after training, the scores of the teaching interest survey, and the satisfaction with the teaching mode between the two groups were compared. Results: The scores of theoretical knowledge and anesthesia skills operation in the observation group were significantly higher than those in the control group, and the indicators of teaching interest in the observation group were also higher than those in the control group. The differences were statistically significant (P < 0.05). The satisfaction degree of the observation group was significantly higher than that of the control group, and the difference was also statistically significant (P < 0.05). Conclusion: The WeChat platform combined with the PBL teaching method is beneficial to improve the training effect of anesthesiology residents, stimulating autonomous learning ability, ensuring the effective practice of theoretical knowledge, and promoting them to move towards a higher standard of anesthesia skills.

Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients

BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery.Emergence agitation(EA)is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative complications.Pre-anesthetic anxiety may be associated with the development of EA,but studies in this area are lacking.AIM To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer(NSCLC).METHODS Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently sampled.We used the Hospital Anxiety and Depression Scale’s(HADS)anxiety subscale(HADS-A)to determine patients’anxiety at four time points(T1-T4):Patients’preoperative visit,waiting period in the surgical waiting room,after entering the operating room,and before anesthesia induction,respectively.The Riker Sedation-Agitation Scale(RSAS)examined EA after surgery.Scatter plots of HADS-A and RSAS scores assessed the correlation between patients’pre-anesthesia anxiety status and EA.We performed a partial correlation analysis of HADS-A scores with RSAS scores.RESULTS NSCLC patients’HADS-A scores gradually increased at the four time points:7.33±2.03 at T1,7.99±2.22 at T2,8.05±2.81 at T3,and 8.36±4.17 at T4.The patients’postoperative RSAS score was 4.49±1.18,and 27 patients scored≥5,indicating that 33.75%patients had EA.HADS-A scores at T3 and T4 were significantly higher in patients with EA(9.67±3.02 vs 7.23±2.31,12.56±4.10 vs 6.23±2.05,P<0.001).Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and T4.Partial correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4(r=0.296,0.314,P<0.01).CONCLUSION Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxiety at the time of entering the operating room and before anesthesia induction.

A Case Report: Emergency Management of a Pregnant Trauma Patient—An Anesthesiologist’s Perspective and Role

Trauma is the leading cause of death for all women of childbearing age. Motor vehicle accidents account for almost two-thirds of all maternal non-obstetric, trauma-related deaths, while falls and domestic violence comprise a large percentage of the rest. The leading causes of obstetric trauma are motor vehicle accidents, falls, assaults, and gunshots, and ensuing injuries are classified as blunt abdominal trauma, pelvic fractures, or penetrating trauma . The causes are different with different life styles and different socio-economic and cultural background. Pregnant trauma victims tend to be younger, less severely injured, and more likely African American or of Hispanic descent compared with nonpregnant victims of trauma. Drugs and alcohol are a factor in about 20 percent of maternal trauma. With pregnancy comes the challenge and responsibility of caring for two patients at once, the mother and the fetus. In general, providing optimal maternal care is the best strategy to optimize fetal survival. Decision-making including the condition of the mother, gestational age, status of the fetus, and interventions are based on these key factors. Many providers are involved in the care of the pregnant patient: at the trauma scene, in the emergency department, and in the operating room. The anesthesiologist plays a key role in the care and management of the pregnant trauma patient. All anesthesiologists have ample training in obstetric anesthesia during their residency and frequently cover obstetric units in hospitals where pregnant patients are cared for. On the other hand, most nonobstetric physicians have little obstetric exposure and may be uncomfortable caring for the pregnant patient because of unfamiliarity with the physiologic changes of pregnancy or the evaluation of fetal well-being. This is not only a source of stress for other trauma providers, but can put maternal well-being at risk. Non-obstetric physicians may hesitate to order necessary diagnostic and therapeutic interventions for fear of doing the “wrong thing,” all because the patient is pregnant. A multidisciplinary approach to the pregnant trauma patient involving trauma surgeons, obstetricians, anesthesiologists, emergency medicine, and other providers, is critical to deliver optimal care and achieve the best outcomes for both the mother and the baby. In summary, a multidisciplinary approach to provide optimal maternal care will facilitate to achieve the best outcomes for the mother and is also the best strategy for optimizing fetal survival. The following is a case report of a pregnant trauma patient who needed immediate intervention because of massive placental abruption when only a minimal workup was completed because of the urgency of the situation.

ANESTHESIOLOGY^(TM) 2013 Annual Meeting

Time:October 12-16,2013Venue:Moscone Center,San Francisco,California,USA Website:https://www.asahq.org/Annual-Meeting.aspx The theme of ANESTHESIOLOGYTM2013 Annual Meeting is'Global Partners in Quality Outcomes and Patient Safety',which offers a glimpse of what’s to come as the American Society of Anesthesiologists(ASA)hopes to share world expertise

The Third Year Anesthesiology Residents’ Knowledge Regarding Pediatric Postoperative Pain Management

Background: There are six Anesthesiology training centers in Thailand that are approved to operate the training program. An evidence of residents’ knowledge about pediatric postoperative pain management is needed for improving the program. Objective: To assess the third year anesthesiology residents’ knowledge about pediatric postoperative pain management. Materials and Methods: The questionnaire was adapted from previous studies. The questionnaire has 35 questions consisted of 17 multiple choice questions and 18 true or false questions to cover 2 domains: 1) use of age-appropriate pediatric pain assessment (10 questions) and 2) pediatric pain treatment (25 questions). Minimal passing level of the questionnaire rated by three young anesthesiology staffs was 76.2%. All 62 participants were the 3rd year anesthesiology residents from 6 training centers. Data were analyzed by descriptive statistics. Results: The response rate was 95.2%. Seventy-one percent of participants reported that they had learned about pediatric pain treatment. Of those, 55.9% rated their remaining knowledge at median level. The proportion of the correct score was 67.7% (mean 23.7 ± 2.9 SD) which was lower than the minimal passing level. The highest score was 29 and the lowest score was 16. For pain assessment domain;the mean proportion of correct score was 65% (range 90%-40%). For pain treatment domain;the mean proportion of correct score was 68.8% (range 88%-44%). Conclusion: Anesthesiology residents’ knowledge about pediatric postoperative pain management needs to be improved.

What is the purpose of launching World Journal of Anesthesiology?

The launch of World Journal of Anesthesiology(WJA)is great news for the community of anesthesiology.Anesthesiology is a rapidly evolving medical specialty.The practice of anesthesia is broad and has an important impact on our society.Thus,it is necessary to have a multi-modal system to rapidly disseminate anesthesiology-related knowledge.WJA’s preparatory work was initiated on December 3,2010,will be published on December 27,2011.The WJA Editorial Board has now been established and consists of 121 distinguished experts from 28 countries.It will publish various formats of papers including original studies,review,commentary,guidelines,case report,book review and letters to the editor.The publication of the accepted papers will be quick and it is free of charge for readers to download and read any articles in the journal.Thus,WJA should be an excellent choice for anyone to consider publishing anesthesiology-related papers.Congratulations to the birth of WJA,a new member of World series journal family.

What Factors Influence the Choice of Anesthesiology in a Moroccan Medical School?

Objective: To determine factors influencing anesthesiology choice among resident doctors at the medical school of Marrakech. Materials and Methods: We have conducted a descriptive cross-sectional study based on an anonymous questionnaire. Results: A total of 406/672 questionnaires were returned, with a female/male sex ratio of 1.07. The duration of the training (OR: 3.3;CI 95%: 1.74 - 6.23;p < 0.001), intellectual challenge (OR: 3.02;CI 95%: 1.69 - 5.37;p < 0.001), doctor-patient relationship (OR: 2.22;CI 95%: 1.02 - 4.84;p: 0.04), and financial aspects (OR: 2.14;CI 95%: 1.09 - 4.21;p: 0.02) were independent factors that influenced the choice of anesthesiology. Conclusion: we recommend the succeeding: 1) Support students in their choice;2) Correct misconceptions about certain specialties;3) Promote clinical clerkship;4) Encourage mentorship;5) Increase the salary of at-risk specialties.

《国外医学·麻醉学与复苏分册》与《Anesthesiology》杂志正式合作

为了加强国际交流与合作,并解决我国加入WTO后面临的知识产权等新问题,2003年10月16日,我刊主编曾因明教授与美国《Anesthesioloav》主编Dr.Michael Todd及出版《Anesthesiology》杂志的Lippincott Williamo&Wilkins(LWW)

Paradoxical vocal fold motion masquerading as post-anesthetic respiratory distress:A case report

BACKGROUND Functional vocal cord disorders can be a differential diagnosis for postoperative upper airway obstruction requiring urgent intervention.However,this may be unfamiliar to anesthesiologists who would favor inappropriate airway intervention and increased morbidity.CASE SUMMARY A 61-year-old woman underwent cervical laminectomy,followed by laparoscopic cholecystectomy 10 mo later.Despite adequate reversal of neuromuscular blockade,the patient experienced repetitive respiratory difficulty with inspiratory stridor after extubation.After the second operation,the patient was diagnosed with paradoxical vocal fold motion(PVFM)by an otolaryngologist based on the clinical features and fiberoptic bronchoscopy results,and the patient was successfully treated.CONCLUSION PVFM should be considered a differential diagnosis if a patient presents with stridor after general anesthesia.

Effect of anesthesia induction with butorphanol on postoperative nausea and vomiting:A randomized controlled trial

BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of butorphanol on PONV in this patient population.METHODS A total of 110 elderly patients(≥65 years old)who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol(40μg/kg)or sufentanil(0.3μg/kg)during anesthesia induction in a 1:1 ratio.The measured outcomes included the incidence of PONV at 48 h after surgery,intraoperative dose of propofol and remifentanil,Bruggrmann Comfort Scale score in the postanesthesia care unit(PACU),number of compressions for postoperative patientcontrolled intravenous analgesia(PCIA),and time to first flatulence after surgery.RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group,when compared to the sufentanil group(T1:23.64%vs 5.45%,T2:43.64%vs 20.00%,P<0.05).However,no significant variations were observed between the two groups,in terms of the clinical characteristics,such as the PONV or motion sickness history,intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters,intraoperative dose of propofol and remifentanil,number of postoperative PCIA compressions,time until the first occurrence of postoperative flatulence,and incidence of PONV at 48 h post-surgery(all,P>0.05).Furthermore,patients in the butorphanol group were more comfortable,when compared to patients in the sufentanil group in the PACU.CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly,simultaneously improving patient comfort in the PACU.

Efficacy of Low Dose Naltrexone on Pain Reduction in Chronic Pain Syndromes: A Meta Analysis

Chronic pain is a multifaceted debilitating experience often associated with significant physical and emotional burden. Low dose naltrexone (LDN) has gained attention in recent years for its potential utility in the management of fibromyalgia, irritable bowel syndrome, multiple sclerosis, and painful diabetic neuropathy. LDN’s analgesic effects have been associated with its ability to increase the production of endorphins while reducing the production of tumor necrosis factor-alpha, interleukin-6, reactive oxygen species and nitric oxide. This meta-analysis aims to systematically review and synthesize the available evidence on efficacy of LDN as an analgesic in pain syndromes, with a focus on chronic (neuro) inflammatory diseases. The goal is to provide clinicians with a more comprehensive estimate of the effectiveness of LDN as a non-opioid option for managing chronic pain and guide future research in the area. Thirteen randomized control trials, published from 1990 to 2022, were selected for the analysis that satisfied inclusion criteria. The overall effects in these studies were calculated using the standardized mean difference (SMD) between the LDN and placebo groups. We found an overall SMD of -10.77 (95% CI: -13.96 to -7.58) with a p-value of 0.002. This indicated that the LDN group experienced a statistically significant reduction in pain compared to placebo. This meta-analysis provides evidence for the potential efficacy of low dose naltrexone in reducing pain and enhancing analgesia in various pain syndromes. LDN may be a useful treatment option for patients suffering from chronic pain, particularly with fibromyalgia, multiple sclerosis, or diabetic neuropathy. However, further research is needed to confirm the efficacy and safety of low dose naltrexone for chronic pain conditions, especially with larger sample sizes, standardized dosing regimens and treatment durations.

A Survey of Surgical Patient’s Perception about Anesthesiologist in a Large Scale Comprehensive Hospital in China

Objectives This study aim to evaluate patient’s perception about anesthesiologists’ job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cross-sectional survey study and delivered questionnaire forms to adult in-patients who were scheduled for elective surgery before pre-operative anesthetic visit the day before surgery.We collected information of respondents’ demographic data,education background,health literacy and previous experience of anesthesia,perception of anesthesiologist’s job,the expectation on anesthesia care.Descriptive analyses,χ^2 test and multiple linear regression analysis were used for data analysis.Results Of 550 participants,521(94.7%)completed the questionnaire.In these respondents,335 (64.3%) considered anesthesiology as an independent medical discipline,225 (43.2%) believed that anesthesiology department was an independent clinical department,and 243 (46.6%) recognized anesthesiologists as qualified doctors.Only 21.5% of them knew that anesthesiologists also work in the intensive care unit and 26.9% of them knew that anesthesiologists also work in pain clinic as well.Younger patients (β=-0.044,P<0.001),those with higher education (β=1.200,P<0.001),or with better health literacy (β=0.781,P=0.005) had significant more knowledge about the job roles of anesthesiologists.Most patients demanded pre-anesthetic visit (80.5%),expected availability of preoperative anesthetic clinic (74.1%),wished to receive more information about anesthesia (91.3%) and anesthesiologist (77.4%).Conclusions Patients’ perception about anesthesiologists might be limited.Efforts should be made on education about anesthesia,especially for elderly patients and those under-educated patients.Preoperative anesthetic clinic is expected by most in-patients.

Endoscopic sphincterotomy in acute biliary pancreatitis:A question of anesthesiological risk

Two consecutive surveys of acute pancreatitis in Italy,based on more than 1000 patients with acute pancreatitis,reported that the etiology of the disease indicates biliary origin in about 60% of the cases.The United Kingdom guidelines report that severe gallstone pancreatitis in the presence of increasingly deranged liver function tests and signs of cholangitis(fever,rigors,and positive blood cultures) requires an immediate and therapeutic endoscopic retrograde cholangiopancreatography(ERCP).These guidelines also recommend that patients with gallstone pancreatitis should undergo prompt cholecystectomy,possibly during the same hospitalization.However,a certain percentage of patients are unfit for cholecystectomy because advanced age and presence of comorbidity.We evaluated the early and longterm results of endoscopic intervention in relation to the anesthesiological risk for 87 patients with acute biliary pancreatitis.All patients underwent ERCP and were evaluated according to the American Society of Anesthesiology(ASA) criteria immediately before the operative procedure.The severity of acute pancreatitis was positively related to the anesthesiological grade.There was no significant relationship between the frequency of biliopancreatic complications during the follow-up and the ASA grade.The frequency of cholecystectomy was inversely related to the ASA grade and multivariate analysis showed that the ASA grade and age were significantly related to survival.Finally,endoscopic treatment also appeared to be safe and effective in patients at high anesthesiological risk with acute pancreatitis.These results further support the hypothesis that endoscopic sphincterotomy might be considered a definitive treatment for patients with acute biliary pancreatitis and an elevated ASA grade.

Use of anesthesia on the rise in gastrointestinal endoscopy

Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time's deep sedation is required for procedures such as endoscopic retrograde cholangiography which necessitates higher doses of narcotics and benzodiazepines or even use of other medications such as ketamine. Given its pharmacologic properties, pro-pofol was rapidly adopted worldwide to gastrointestinal endoscopy for complex procedures and more recently to routine upper and lower endoscopy. Many studies have shown superiority for both the physician and patient compared to standard sedation. Nevertheless, its use remains highly controversial. A number of studies worldwide show that propofol can be given safely by endoscopists or nurses when well trained. Despite this wealth of data, at many centers its use has been pro-hibited unless administered by anesthesiology. In this commentary, we review the use of anesthesia support for endoscopy in the United States based on recent data and its implications for gastroenterologists world-wide.

Wavelet and pain rating index for inhalation anesthesia: A randomized controlled trial

BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia.METHODS This randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018.A random number generator was used to assign the eligible patients to three groups:Systolic blood pressure(SBP)monitoring group,WLi monitoring group,and PRi monitoring group.The main anesthesiologist was aware of the patient grouping and intervention used.The primary endpoint was anesthesia recovery time.Secondary endpoints included extubation time,sevoflurane consumption,number of unwanted events/interventions,number of adverse events and postoperative visual analogue scale for pain.RESULTS A total of 62 patients were included in the final analysis(SBP group,n=21;WLi group,n=21;and PRi group,n=20).There were no significant differences among the three groups in patient age,gender distribution,body mass index,American Society of Anesthesiologists class,duration of surgery,or duration of anesthesia.Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups.Extubation time was shorter in the WLi and PRi groups than in the SBP group.Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group.Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSION Regulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time,extubation time and sevoflurane consumption without intraoperative unwanted events.

Clinical challenges of glycemic control in the intensive care unit:A narrative review

Glucose control in patient admitted to the intensive care unit has been a topic of much debate over the past 20 years.The harmful effects of uncontrolled hyperglycemia and hypoglycemia in critically ill patients is well established.Although a large clinical trial in 2001 demonstrated significant mortality and morbidity benefits with tight glucose control in this patient population,the results could not be replicated by other investigators.The“Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation”trial in 2009 established that tight glucose control was not only of no benefit,but in fact harmful due to the significant risk of hypoglycemia.The current guidelines suggest a moderate approach with the initiation of intravenous insulin therapy in critically ill patients when the blood glucose level is above 180 mg/dL.The most important factor that underpins glycemic management in intensive care unit patients is the consequent prevention of hypoglycemia.Robust glucose monitoring strategies and insulin protocols need to be implemented in order to achieve this goal.

Anesthesia and acupuncture

Using acupuncture instead of anesthetics to induce analgesia was performed in China many years ago in surgical anesthetization. Although many medical units in China's cities and rural areas are applying these techniques in operations, it should be pointed out that acupuncture anesthesia is still in the process of development and is of next to no practical and even less scientific value in the western world. However, acupuncture-assisted anesthesia can be useful also in countries other than China.

Intraoperative patient information handover between anesthesia providers

Currently,no reported studies have evaluated intraoperative handover among anesthesia providers.Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and,in many instances,significant intraoperative events are disregarded.An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide（120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs） and a smaller survey selection of CRNAs（10 institutions about 300 CRNAs in the metropolitan area of Detroit,MI,USA） to collect information on handover practices.The response rate to this survey（n=216） was comprised of approximately 5%（n = 71） of the resident population in US anesthesia programs,5%（n=87） of MDAs,and 20%（n=58） of the CRNAs.Out of all respondents（n=212）,49.1%had no hand-over protocol at their institution and 88%of respondents who did have institutional handover protocols believed them insufficient for effective patient handover.In addiiton,84.8%of all responders reported situations where there was insufficient information received during a patient handover.Only 7%of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs.In contrast,60%reported rarely having complications,31%reported sometimes having complications,and 3%reported frequent complications.In conclusion,handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room.Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety.