Daily Anesthesiology Research Analysis

BACKGROUND: Effective postoperative pain control in pediatric foot and ankle surgery remains challenging. Popliteal nerve blocks are widely used but limited by their short duration. Systemic dexamethasone may prolong analgesia, yet evidence in pediatric regional anesthesia remains sparse. OBJECTIVE: To assess the analgesic efficacy and safety of two intravenous dexamethasone doses (0.1 mg/kg and 0.2 mg/kg) administered before a single-shot popliteal nerve block in children undergoing ankle or foot surgery. METHODS: In this randomized, triple-blinded clinical trial, 90 pediatric patients were allocated to receive either placebo, 0.1 mg/kg, or 0.2 mg/kg dexamethasone intravenously prior to popliteal nerve block. The primary outcome was time to first opioid requirement. Secondary outcomes included total opioid consumption, FLACC pain scores, inflammatory markers (NLR, PLR), blood glucose, and time to motor recovery. RESULTS: Both dexamethasone groups had significantly longer opioid-free intervals compared to placebo (12.3 ± 2.4 h and 13.7 ± 2.6 h vs. 7.5 ± 2.2 h; p < 0.0001). Opioid consumption was lowest in the 0.2 mg/kg group (p = 0.0292). Pain scores and inflammatory markers were consistently lower in dexamethasone groups. However, blood glucose levels increased dose-dependently, with the highest values in the 0.2 mg/kg group. Motor recovery was also delayed with dexamethasone use. CONCLUSION: Intravenous dexamethasone effectively prolongs analgesia and reduces opioid requirements after pediatric foot and ankle surgery. While 0.2 mg/kg provides maximal benefit, 0.1 mg/kg may offer an optimal balance between efficacy and metabolic safety. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05887765).

BACKGROUND: In frail older adults, the incidence of postoperative delirium (POD) is markedly increased, leading to greater morbidity, prolonged length of stay, and higher healthcare costs. An accurate POD prediction model can direct preventive strategies and improve patient outcomes. Employing advanced machine-learning techniques, this study develops a POD prediction model using comprehensive preoperative and intraoperative data. METHODS: We enrolled 2,089 frail patients aged ≥ 65 years undergoing general anesthesia for noncardiac surgery at Fuyang People's Hospital between February 2023 and February 2025. Thirty-eight baseline, anesthetic, and laboratory variables were extracted; missing data were handled by multiple imputation using chained equations (MICE). The dataset was randomly split 7:3 into training and validation sets. After feature selection with Boruta and LASSO, eight machine-learning models-logistic regression, random forest, support-vector classifier, XGBoost, artificial neural network, naïve Bayes, k-nearest neighbors, and decision tree-were trained and compared, with ROC-AUC as the primary metric, accompanied by accuracy, precision, recall, and F1 score. Model interpretability was achieved using SHAP analysis for the best-performing algorithm. RESULTS: Among 2,089 frail elderly patients, the incidence of POD was 16.52%. After Boruta and LASSO identified 15 key predictors, the XGBoost model achieved an AUC of 0.813, outperforming the other seven algorithms. SHAP analysis identified MMSE score, Charlson Comorbidity Index, and age as the strongest predictors. External validation demonstrated high clinical utility on decision-curve analysis, with an ROC-derived sensitivity of 0.813 and specificity of 0.793, confirming robust performance without overfitting. CONCLUSIONS: This study presents a robust XGBoost-based model for predicting postoperative delirium in frail elderly patients undergoing noncardiac surgery, demonstrating the potential of machine learning for clinical risk stratification. With its balanced performance and high accuracy, the model enables clinicians to identify high-risk patients and initiate timely interventions. Future work should focus on integration into clinical workflows and further external validation.

BACKGROUND: Focused cardiac ultrasound is an effective tool for assessing obstetric patients, but access to phased array transducers is limited in many low-resource settings. This study aimed to determine if curvilinear transducers could produce clinically useful ultrasound images non-inferior to phased array transducers. METHODS: Laboring patients were recruited for focused cardiac ultrasound performed by six anesthesiologists with limited echocardiography experience. Curvilinear and phased array transducers were used to obtain standard views. The first transducer used was randomly assigned. Blinded experts graded the images on a scale of 1 to 5, with grades ≥ 3 sufficient for clinical decisions. The primary outcome was the percentage of patients with sufficient images (grade ≥ 3) in at least two views using curvilinear versus phased array transducers. Secondary outcomes included the clinical utility of individual views and a non-inferiority comparison of transducers. RESULTS: Seventy parturients were scanned. Clinically useful examinations were achieved in 91.4% (95% CI 82.3%, 96.8%) of patients with curvilinear transducers compared to 95.7% (95% CI 88.0%, 99.1%) with phased array transducers. Using a noninferiority margin of 15%, curvilinear transducers were noninferior for clinical decisions (-4.3% 90% CI: -11.9%, -3.3%) largely due to parasternal views. Subcostal and apical views were individually inconclusive and IVC views were inferior. Measures of cardiac dimensions and systolic function were deemed measurable with less frequency on curvilinear images but concordant when measured. CONCLUSIONS: Anesthesiologists can effectively use curvilinear transducers for focused cardiac ultrasound in obstetric patients, although phased array transducers may be superior for measuring cardiac dimensions and function.