Daily Anesthesiology Research Analysis

IMPORTANCE: Liver transplants are performed around the clock, often associated with substantial disutility for patients and clinicians. While short-duration dual hypothermic oxygenated machine perfusion (short-DHOPE) mitigates ischemia-reperfusion injury and related complications, prolonged DHOPE (DHOPE-PRO) may further extend preservation time and facilitate daytime liver transplant. OBJECTIVE: To assess whether the use of DHOPE-PRO is associated with an increased proportion of daytime liver transplants without compromising graft or patient outcomes. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study conducted at a large academic liver transplant center in the Netherlands included adult and pediatric recipients of liver grafts received from donation after brain death (DBD), donation after circulatory death (DCD), or living donors. The study compared all liver transplants performed between January 1, 2023, and December 31, 2024, following routine DHOPE-PRO implementation, with a control cohort of all consecutive liver transplants performed between January 1, 2021, and December 31, 2022. Follow-up continued through December 31, 2025. Outcomes were stratified by graft type. EXPOSURES: Grafts underwent DHOPE-PRO, with or without viability assessment depending on graft risk, or short-DHOPE (for DCD livers) or no perfusion (for DBD livers). MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in the percentage of daytime liver transplants, defined as surgery starting at or after 8 am and either (1) reperfusion occurring before 8 pm or (2) completion by midnight, between the 2021-2022 and 2023-2024 cohorts. Secondary outcomes included 1-year patient and graft survival, intraoperative parameters, and postoperative complications, stratified by graft type. RESULTS: A total of 330 liver transplants (median [IQR] age, 45 [13-62] years; 186 [56.4%] male) were included in the analyses: 155 transplants in the 2021-2022 cohort and 175 transplants in the 2023-2024 cohort. Following DHOPE-PRO implementation, the percentage of daytime transplants increased from 48.4% (75 of 155) to 84.6% (148 of 175) for reperfusion (P < .001) and from 53.5% (83 of 155) to 89.1% (156 of 175) for completion (P < .001). Median (IQR) DHOPE duration increased from 2.1 (1.6-4.1) to 10.2 (5.1-13.1) hours (P < .001), with total preservation times up to 31.4 hours. Use of DHOPE-PRO showed no association with postoperative complications (eg, new-onset acute kidney injury; odds ratio, 0.64 [95% CI, 0.37-1.07]; P = .09]). One-year patient survival exceeded 90% in all subgroups. Use of DHOPE-PRO was not associated with either graft (hazard ratio, 1.28 [95% CI, 0.59-2.74]; P = .53) or patient (hazard ratio, 2.05 [95% CI, 0.75-5.59]; P = .16) survival. CONCLUSIONS AND RELEVANCE: In this prospective cohort study, routine implementation of DHOPE-PRO was associated with increased proportions of daytime liver transplants and with improved surgical logistics. It was also associated with outcomes similar to those after short-duration DHOPE, supporting its broader application in clinical practice.

OBJECTIVES: Recent studies have showed that intravenous lidocaine is associated with reducing postoperative pain. However, the mechanism of action of intravenous lidocaine as a part of multi-modal analgesic regimen on patients undergoing laparoscopic surgery remains unclear. The primary aim was to demonstrate the effects of intravenous lidocaine on postoperative pain score in adults undergoing laparoscopic surgery. METHODS: Databases of MEDLINE, EMBASE, and CENTRAL were searched since 1947 until May 2023. Randomized clinical trials (RCT) comparing intravenous lidocaine and placebo in adults undergoing surgery were included. RESULTS: Forty-five RCTs (n=2,599) were included. Intravenous lidocaine group was associated with significantly lower postoperative pain scores at rest (MD: -0.27, 95% CI: -0.45 to -0.08, P=0.005) at the 24-hour after surgery and during movement (MD: -0.58, 95% CI: -0.89 to -0.27, P<0.001). Intravenous lidocaine significantly decreased fentanyl consumption (MD: -14.46, 95% CI: -18.11 to -10.81, P<0.001) and morphine consumption (MD: -3.63, 95% CI: -5.12 to -2.13, P<0.001) postoperatively. It also significantly lowered the incidence of nausea and vomiting (RR: 0.66, 95% CI: 0.54 to 0.81, P<0.001) and reduced time to flatus (MD: -5.90, 95% CI: -8.18 to -3.62, P<0.001). DISCUSSIONS: This systematic reinforces the potential role of adding intravenous lidocaine as part of multimodal analgesia in the reduction of postoperative pain, opioid consumption, incidence of nausea and vomiting, and the time to flatus. However, our findings should be interpreted with caution owing to low level of evidence and high degree of heterogeneity.

OBJECTIVES: Identifying patients likely to benefit from an echocardiogram before surgery is prudent in resource-limited settings. Recently, artificial intelligence has facilitated the diagnosis of low ejection fraction (EF) from electrocardiograms. This multicenter study aimed to evaluate the diagnostic accuracy of a single-lead electrocardiogram-based algorithm obtained by an electronic stethoscope (Eko CORE 500) for identifying individuals with reduced left ventricular ejection fraction (LVEF) (≤40%) during preoperative evaluation. DESIGN: Multicenter, prospective, observational diagnostic accuracy study. SETTINGS: Ten tertiary care-level hospitals across India. PARTICIPANTS: Nine hundred eighty-one preoperative patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients referred for a 2-dimensional echocardiogram as part of a preoperative workup were eligible. An Eko CORE 500 stethoscope was used to collect paired single-lead electrocardiograms and heart sounds at the pulmonic auscultation position. After data collection concluded, all recordings were analyzed using the Eko application. If a recording passed an automated electrocardiogram signal quality check, the algorithm categorized it as either LVEF ≤ 40% or LVEF > 40%. Performance was assessed against an echocardiogram-derived LVEF ≤ 40%. A total of 981 subjects undergoing various surgical procedures were included. After 114 recordings deemed to have poor electrocardiogram signal were excluded, the final cohort consisted of 867 subjects. One hundred thirty-eight patients had EF ≤ 40% as determined by echocardiography. The algorithm detected LVEF ≤ 40% with an area under the receiver operating characteristic curve (AUC-ROC) of 0.73 (95% confidence interval [CI], 0.67-0.78), sensitivity of 60.1% (95% CI, 51.8%-67.9%), and specificity of 81.3% (95% CI, 78.4%-84.0%). When patients were stratified by type of surgery, performance was superior in the noncardiac group (AUC-ROC of 0.75 [95% CI, 0.59-0.92] in noncardiac group v 0.70 [95% CI, 0.64-0.75] in cardiac group for LVEF ≤ 40%). CONCLUSIONS: The Eko digital stethoscope shows promise as a clinical decision-making tool for preoperative assessment. The ability to accurately detect reduced EF, especially in the setting of noncardiac surgery, suggests the algorithm's potential utility as a rule-out test to optimize resource allocation for preoperative screening. These findings suggest that its use could be considered in specific patient populations, particularly in resource-limited settings.