Daily Anesthesiology Research Analysis

OBJECTIVE: To develop and internally validate a machine-learning model for the early prediction of postoperative vasoplegia after cardiac surgery. DESIGN: A retrospective cohort study with model development and internal validation. SETTING: Tertiary academic intensive care units (ICUs) using routinely collected perioperative and postoperative clinical data. PARTICIPANTS: Adults admitted to intensive care after cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Incident postoperative vasoplegia (greater than 6 to 48 or less hours after ICU arrival) was defined as either (1) concurrent cardiac index greater than 2.2 L/min/m², systemic vascular resistance less than 800 dyne·s/cm⁵, and mean arterial pressure less than 65 mmHg or (2) cardiac index greater than 2.2 L/min/m² with combined norepinephrine plus epinephrine infusion greater than 0.2 µg/kg/min. Candidate predictors included demographics, comorbidities and perioperative factors, admission vital signs and laboratory tests, and vasoactive infusions within 0-6 hours of ICU arrival. On the held-out test set, the best-performing model achieved moderate discrimination (area under the receiver operating characteristic curve 0.74-0.75) with acceptable calibration. Influential features included underlying hypertension, congestive heart failure, diabetes, male sex, and preoperative angiotensin-converting enzyme inhibitor exposure. CONCLUSIONS: A machine-learning model using routinely available perioperative and early postoperative data accurately predicted postoperative vasoplegia after cardiac surgery. These findings support prospective evaluation for risk stratification and may inform targeted prevention and management strategies.

BACKGROUND: Postoperative pain control after total knee arthroplasty (TKA) remains challenging. Intraoperative dexmedetomidine and ketamine are commonly used in multimodal analgesia to reduce pain and opioid requirements. This study aimed to compare their effects on opioid consumption, pain, hemodynamics and satisfaction. MATERIALS AND METHODS: This prospective, randomized, double-blind study included 104 adults (≥ 18 years) with ASA I-III status undergoing TKA under spinal anesthesia. After all patients had received spinal anesthesia, they were randomized into two equal groups (n = 52). Group D received dexmedetomidine (1 µg/kg loading dose, then 0.5 µg/kg/h); Group K received ketamine (0.1 mg/kg/h without a loading dose). Sedation level was titrated to achieve a modified Observer's Assessment of Alertness/Sedation (OAA/S) score of 3-4. Postoperatively, a single-shot femoral nerve block was administered to all patients. Primary outcome was total opioid consumption in 24 h. Secondary outcomes included Visual Analog Scale (VAS) scores, hemodynamic parameters, side effects and patient satisfaction. RESULTS: Tramadol use in 24 h was similar (Group D: 175.29 ± 44.62 mg; Group K: 155 ± 44.48 mg; p = 0.44). VAS scores were comparable at all time points. Time to ambulation was longer in the ketamine group (Group D: 4.4 ± 1.4 h; Group K: 5.3 ± 2.5 h; p = 0.04). Group D showed significantly lower heart rate and blood pressure values at multiple time points (p < 0.001). Patient satisfaction was high in both groups and no hypotension or bradycardia occurred in any group. CONCLUSION: Although no significant differences were found between dexmedetomidine and ketamine, both agents provided comparable analgesia and opioid consumption, supporting their potential role as adjuvants in multimodal analgesia for patients undergoing TKA. TRIAL REGISTRATION: ISRCTN11906298, retrospectively registered on 13.06.2025.

BACKGROUND: Placental pathologies, particularly placenta accreta spectrum (PAS) disorders and placenta previa, are major causes of maternal morbidity and mortality, largely due to the high risk of massive obstetric hemorrhage. Anesthetic management is crucial in cesarean deliveries involving these conditions, yet limited data exist regarding how anesthesia type influences perioperative outcomes. METHODS: This retrospective cohort study evaluated 70 pregnant women who underwent cesarean section for placenta previa or PAS disorders between June 2024 and April 2025. Patients were categorized into general anesthesia (GA) and regional anesthesia (RA) groups. Clinical, surgical, anesthetic, and neonatal data were collected and compared between groups. Inverse probability of treatment weighting (IPTW) based on the propensity score was applied to minimize baseline confounding, followed by weighted regression analyses to estimate adjusted associations. RESULTS: GA was used in 65.7% of cases, often in patients with placenta percreta and those requiring radical hysterectomy. In unadjusted analyses, GA was associated with higher estimated blood loss (1000 mL vs. 715 mL, p = 0.047), higher transfusion needs (87.0% vs. 54.2%, p = 0.004), increased maternal ICU admission (76.1% vs. 33.3%, p = 0.001), longer ICU (2 vs. 0 days, p = 0.002) and hospital stays (6 vs. 4 days, p = 0.008), and lower neonatal APGAR scores at 1 and 5 min (p = 0.008 and p = 0.009, respectively). After adjustment using IPTW, GA remained significantly associated with a higher likelihood of maternal ICU admission and longer ICU length of stay. Associations between anesthesia type and transfusion requirement, neonatal ICU admission, hospital length of stay, postoperative complications, and maternal mortality were attenuated and did not reach statistical significance after weighting. CONCLUSION: In this retrospective cohort of cesarean deliveries complicated by placenta previa or PAS disorders, RA was associated with more favorable unadjusted maternal and neonatal outcomes. After accounting for baseline differences using IPTW, GA remained associated with increased maternal ICU utilization, reflecting its predominant use in clinically more complex and higher-risk cases. TRIAL REGISTRATION: Not applicable.