Daily Anesthesiology Research Analysis

OBJECTIVE: The aim of this study prospective diagnostic study with central adjudication was to (1) determine the incidence and phenotypes of cardiac complications after arterial vascular surgery, (2) investigate possible heterogeneity, and (3) assess short- and long-term mortality and major adverse cardiac events (MACEs) according to different phenotypes of these cardiac complications. METHODS: Consecutive high-risk patients (age >65 years or with known cardiovascular disease) undergoing arterial vascular surgery were included between 2014 and 2019. Cardiac complications including perioperative myocardial infarction/injury (PMI) were centrally adjudicated by two independent physicians. PMI etiologies were hierarchically classified into extracardiac if caused by a primarily extracardiac disease such as severe sepsis or pulmonary embolism, or cardiac, and further subtyped into type 1 MI, tachyarrhythmia, postoperative acute heart failure (pAHF), or likely type 2 MI. All-cause death and MACE, including acute MI, pAHF, life-threatening arrhythmia, and cardiovascular death, were assessed during 1-year follow-up. RESULTS: Among 2'265 patients (median age 71 years, 27% female), PMI occurred in 423 (18.7%) with substantial heterogeneity. The highest incidence was seen after open thoracic, thoracoabdominal and abdominal aortic aneurysm repair (42%) and the lowest after carotid endarterectomy (11%). Open and endovascular peripheral revascularization procedures were associated with PMI rates of 17% and 14%, respectively. Within 1 year, 267/2'265 patients (11.8%) died and at least one MACE occurred in 325/2'265 patients (14.3%). Long-term outcomes differed substantially according to etiology: in patients with extracardiac PMI, type 1 MI, tachyarrhythmia, pAHF, and likely type 2 MI, 67%, 24%, 45%, 47%, and 18% died and 63%, 50%, 73%, 73%, and 20% had MACE within 1 year, respectively, in comparison with 8% and 10% (all P < .001) in patients without a PMI. CONCLUSIONS: The incidence of cardiac complications after arterial vascular surgery procedures is high and is associated with high rates of mortality and MACE, with extracardiac PMI, pAHF, and tachyarrhythmias being associated with a particularly poor prognosis, underscoring the urgent need for appropriate diagnosis and treatment.

BACKGROUND: Smart glasses can provide real-time ultrasonographic images without additional head-eye movement. We investigated whether smart glasses combined with ultrasonography could improve interscalene brachial plexus block (ISB) procedural efficiency. METHODS: This prospective, randomised trial enrolled 151 patients undergoing upper limb surgery requiring interscalene brachial plexus block. Four anaesthesiologists received standardised training in smart glasses-assisted (smart glasses group) or conventional (control group) ultrasound guidance. The primary outcome was total procedure time. RESULTS: Five participants were excluded, and 146 participants were included in the analysis. The total puncture time was shorter in the smart glasses group compared with the control group (124.0 [98.0-155.5 ] s vs 153.0 [123.0-197.5] s; P<0.001). In addition, the ultrasound probe imaging time was better in the smart glasses group than in the control group (19.0 [13.5-30.0] s vs 31.0 [20.0-51.0 ] s; P<0.001), and the period from the first skin puncture to reaching the target area was also shorter (16.0 [12.5-24.5] s vs 26.0 [18.5-33.5] s; P<0.001). Hand-eye coordination was significantly better in the smart glasses group compared with the control group, which included fewer operator head movements (1.0 [1.0-2.0] vs 5.0 [3.0-8.0]; P<0.001); more consistent needle redirections (3.00 [2.0-3.0] vs 3.0 [2.0-4.0]; P=0.004). Pain scores remained similarly low in both groups, with no significant differences in adverse event rates. Ergonomic satisfaction scores (rated 4 or 5) were higher in the smart glasses group (56.2% [41/73] vs 24.7% [18/73]; P<0.001). CONCLUSIONS: Smart glasses reduced the procedure time for experienced anaesthetists performing interscalene brachial plexus block compared with the control group, and improved their hand-eye coordination and satisfaction. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400091595).

BACKGROUND: Postinduction hypotension (PIH) is a common complication of general anesthesia with potential clinical consequences. A recent meta-analysis suggested that the peripheral perfusion index (PPI) has a high predictive value for PIH. However, this was limited by small sample sizes and significant heterogeneity. We aimed to evaluate the predictive performance of preinduction PPI for PIH in a large surgical cohort. METHODS: In this retrospective single-center study, we analyzed 6653 adult patients who had general anesthesia between May 2022 and May 2023. PIH was defined as mean arterial pressure < 65 mmHg within 20 min after induction. We assessed the predictive performance of preinduction PPI for estimating PIH using the area under the receiver operating characteristic curve (AUC). A multivariable logistic regression was conducted to identify independent predictors of PIH. RESULTS: The overall incidence of PIH was 51.5 %. Preinduction PPI values were similar between patients who developed PIH and those who did not (1.22 [0.69-2.23] vs. 1.23 [0.75-2.13], P = 0.284). PPI demonstrated poor predictive performance for PIH (AUC 0.51, 95 % CI 0.49-0.52), with low sensitivity (31 %) and modest specificity (72 %) at the optimal cutoff (0.81). This poor discrimination persisted across all postinduction time intervals and patient subgroups. In contrast, independent predictors of PIH included preinduction mean arterial pressure, advanced age, higher ASA physical status, and emergency surgery. CONCLUSION: Despite promising results from smaller studies, we found that preinduction PPI had no significant predictive value for PIH in a large, diverse surgical population. Anesthesiologists should focus on established risk factors rather than PPI when assessing PIH risk.