Daily Anesthesiology Research Analysis
Analyzed 52 papers and selected 3 impactful papers.
Summary
A single-center randomized trial in cardiac surgery found that ultra fast-track extubation did not change a composite of major outcomes but improved several key postoperative metrics. An interpretable, open-access machine learning model using only preoperative variables predicted postoperative delirium with high sensitivity, and a network meta-analysis mapped comparative benefits of regional blocks for open hepatectomy analgesia, showing small but consistent opioid-sparing and antiemetic effects.
Research Themes
- Fast-track cardiac anesthesia and enhanced recovery
- Perioperative neurocognitive risk prediction (postoperative delirium)
- Comparative effectiveness of regional anesthesia for major abdominal surgery
Selected Articles
1. Evaluation of clinical impact of ultra fast-track versus conventional extubation in patients undergoing nonemergency cardiac surgery: 'CARDU-FAST': A randomised clinical trial.
In 612 randomized cardiac surgery patients, ultra fast-track extubation did not significantly change a composite of major adverse outcomes versus early ICU extubation but shortened ICU and hospital stays and reduced prolonged intubation, need for noninvasive ventilation, reoperation for bleeding, and low cardiac output syndrome. Safety signals were not worse, supporting UFT use in carefully selected patients within standardized pathways.
Impact: This is a large randomized evaluation of immediate on-table extubation in contemporary cardiac anesthesia, providing actionable evidence on recovery metrics without compromising safety.
Clinical Implications: Centers with standardized perioperative care may implement UFT for selected cardiac surgery patients to reduce ventilation duration and length of stay while monitoring for predefined safety criteria.
Key Findings
- Primary composite outcome: 6.5% (UFT) vs 10.1% (FT), P=0.105 (no significant difference).
- UFT reduced prolonged intubation >24 h (2.0% vs 7.5%; P=0.001) and need for noninvasive ventilation (5.6% vs 11.1%; P=0.013).
- UFT decreased reoperations for bleeding (2.6% vs 6.9%; P=0.013) and postoperative low cardiac output syndrome, and shortened ICU and hospital length of stay.
Methodological Strengths
- Randomized trial with large sample size and intention-to-treat analysis.
- Standardized perioperative and anesthetic management in a tertiary center; prospectively registered.
Limitations
- Single-center design may limit generalizability across varying practices.
- Open-label nature inherent to extubation timing and potential for performance bias; primary endpoint not met.
Future Directions: Multicenter pragmatic RCTs assessing UFT within enhanced recovery pathways, cost-effectiveness analyses, and refined selection criteria (e.g., hemodynamic stability thresholds) are warranted.
BACKGROUND: Immediate extubation in the operating theatre (Ultra Fast-Track, UFT), compared with early extubation in the intensive care unit (ICU) (Fast-Track, FT), has been proposed as a strategy to improve postoperative recovery after cardiac surgery. However, its effect on major clinical outcomes remains unclear. OBJECTIVE: To compare the risk of a composite outcome including perioperative all-cause mortality, respiratory complications, and acute kidney injury between UFT and FT in patients undergoing major nonemergency cardiac surgery. DESIGN: Single-centre, randomised clinical trial conducted between February 2023 and November 2024. SETTING: A tertiary cardiovascular centre with standardised perioperative and anaesthetic management. PARTICIPANTS: A total of 612 adult patients undergoing major cardiac surgery were randomised to UFT (n = 306) or FT (n = 306). INTERVENTION: Patients in the UFT group were extubated in the operating theatre, whereas patients in the FT group underwent early extubation in the ICU. MAIN OUTCOMES AND MEASURES: The primary endpoint was a composite outcome of all-cause mortality, respiratory complications (prolonged intubation >24 h, reintubation, pneumonia), and stage III acute kidney injury (AKIN III). RESULTS: The primary composite endpoint occurred in 6.5% of patients in the UFT group and 10.1% in the FT group, with no statistically significant difference (P = 0.105). Compared with FT, UFT was associated with shorter ICU and hospital length of stay, lower rates of prolonged intubation (2.0 versus 7.5%; P = 0.001), reduced need for noninvasive ventilation (5.6 versus 11.1%; P = 0.013), fewer reoperations for bleeding (2.6 versus 6.9%; P = 0.013) and a lower incidence of postoperative low cardiac output syndrome. CONCLUSIONS: Although UFT did not significantly reduce the primary composite outcome in the intention-to-treat (ITT) analysis, it was not associated with an increased risk of adverse events but was associated with improvements in several secondary outcomes. These findings suggest potential benefits of UFT in carefully selected cardiac surgery patients. TRIAL REGISTRATION: Evaluation of clinical impact of UFT versus conventional extubation in patients undergoing cardiac surgery. CARDU-FAST clinical trial. ClinicalTrials.gov Identifier: NCT05706857.
2. Post-operative delirium risk estimation and assessment with machine learning: development and validation of the Open-DREAM Model: A peri-operative dataset analysis.
Using 748 older adults, an interpretable, open-access XGBoost model based solely on preoperative variables predicted postoperative delirium with AUC 0.80 and 0.89 sensitivity at an optimal threshold. SHAP-guided feature reduction to 15 predictors preserved performance; anesthesia type (spinal vs general) emerged as the strongest predictor.
Impact: It delivers a practical, interpretable, and open tool for POD risk stratification that can be integrated into preoperative workflows without additional testing.
Clinical Implications: Preoperative deployment can flag high-risk patients for targeted delirium prevention bundles, guide anesthetic planning, and inform shared decision-making, pending external validation.
Key Findings
- Calibrated XGBoost achieved AUC 0.80 with sensitivity 0.89 at probability threshold 0.35.
- SHAP-based feature selection reduced inputs from 55 to 15 without loss of discrimination.
- Type of anesthesia (spinal vs general) was the strongest predictor among preoperative variables.
Methodological Strengths
- Prospectively collected routine-care dataset with explicit calibration and interpretability via SHAP.
- Direct comparison of multiple algorithms and parsimonious feature set enabling practical implementation.
Limitations
- Single-center study without external validation limits generalizability.
- Observational design precludes causal inference; Nu-DESC-based outcome may misclassify hypoactive delirium.
Future Directions: External validation across diverse health systems, integration with EHRs, and interventional trials testing risk-guided prevention strategies are needed.
BACKGROUND: Postoperative delirium (POD) is a common and serious complication in older surgical patients, associated with increased morbidity, prolonged hospitalisation and increased healthcare costs. Existing predictive models have limited clinical adoption due to implementation costs, suboptimal accuracy and poor generalisability. OBJECTIVES: To develop an open-access, interpretable machine learning (ML) model using only preoperative data to predict the risk of POD in patients aged at least 60 years undergoing surgery. DESIGN: Observational diagnostic study using prospectively collected routine care data. SETTING: Single secondary care hospital in Switzerland, January 2023 to January 2024. PATIENTS: A total of 1425 patients were screened; 748 met the inclusion criteria (≥60 years, noncardiac, nonintracranial surgery, no preoperative delirium). INTERVENTIONS: None. MAIN OUTCOME MEASURE: POD, defined as a Nursing Delirium Screening Scale (Nu-DESC) score at least 2 at any peri-operative assessment. RESULTS: Three ML algorithms were trained and compared: Support Vector Machines; Logistic Regression and XGBoost. The calibrated XGBoost model achieved an area under the receiver operating characteristic curve (AUC) of 0.80, with a sensitivity of 0.89 at the optimal probability threshold of 0.35. Feature selection using SHapley Additive exPlanations (SHAP)-derived rankings reduced the predictor set from 55 to 15 features without loss of AUC. Type of anaesthesia (spinal vs. general) was the strongest predictor. CONCLUSIONS: An open-access ML-based model using routinely collected preoperative variables can predict POD with high sensitivity and preserved interpretability. External validation is warranted. Future research should explore causal inference for modifiable risk factors, acknowledging the limitations of observational data. This open-access application is currently intended for research and educational use only until external validation confirms its performance in independent patient groups.
3. Peripheral Nerve Blocks Following Open Hepatectomy: A Systematic Review and Network Meta-Analysis.
Across 17 RCTs (n=1056), continuous TAPB and continuous TPVB lowered 24-hour morphine consumption, while ESPB and TANB improved early resting pain and reduced PONV. Movement pain reduction varied by timepoint and block type. Differences between techniques were small, and overall certainty ranged from low to moderate.
Impact: This NMA synthesizes comparative effectiveness across commonly used blocks in open hepatectomy, guiding multimodal analgesia selection with opioid-sparing and antiemetic considerations.
Clinical Implications: Clinicians may prioritize cTAPB or cTPVB for opioid-sparing goals and consider ESPB or TANB to improve early pain and reduce PONV, while tailoring to anatomy, expertise, and resources. Expect modest absolute differences.
Key Findings
- Continuous TAPB and continuous TPVB significantly reduced 24-hour morphine consumption after open hepatectomy.
- ESPB and TANB reduced early resting VAS (6–12 h), and ESPB/TANB decreased PONV incidence.
- Movement VAS decreased with ESPB/cTPVB at 6 h, ESPB/sTAPB at 12 h, and TANB/EOIPB at 24 h; overall differences among techniques were small with low-to-moderate certainty.
Methodological Strengths
- Network meta-analysis of RCTs enables indirect and direct comparisons across multiple techniques.
- PRISMA-based systematic approach with predefined outcomes and multiple pain timepoints.
Limitations
- Heterogeneity in study designs, block techniques, and analgesic protocols; low-to-moderate certainty.
- Limited applicability to laparoscopic hepatectomy; potential publication bias.
Future Directions: Head-to-head multicenter RCTs with standardized analgesic regimens, patient-centered outcomes (mobilization, ERAS metrics), and cost-effectiveness analyses.
BACKGROUND: This network meta-analysis (NMA) was conducted to evaluate the analgesic efficacy of various nerve blocks in patients undergoing open partial hepatectomy. METHODS: We retrieved randomized controlled trials (RCTs) assessing different peripheral nerve blocks in patients undergoing open partial hepatectomy from databases including PubMed, Embase, Web of Science, and the Cochrane Library, spanning from inception until December 2025. The NMA was performed using STATA 17.0 software. RESULTS: A total of 17 RCTs involving 1056 patients and 8 techniques were included in the analysis. Continuous Transversus Abdominis Plane Block (cTAPB) and continuous Thoracic Paravertebral Block (cTPVB) significantly decreased morphine consumption within 24 hours. The Erector Spinae Plane Block (ESPB) and Thoracoabdominal Nerve Block (TANB) reduced resting Visual Analog Scale (VAS) scores at 6 hours. At 12 hours, resting VAS scores were decreased by ESPB and subcostal Transversus Abdominis Plane Block (sTAPB), while at 24 hours, resting VAS scores were lowered by TANB and cTAPB. For movement VAS scores, reductions were observed at 6 hours with ESPB and cTPVB, at 12 hours with ESPB and sTAPB, and at 24 hours with TANB and External Oblique Intercostal Plane Block (EOIPB). Additionally, ESPB and TANB were associated with a decrease in the incidence of postoperative nausea and vomiting (PONV). CONCLUSION: While cTAPB and cTPVB ranked higher in terms of reducing 24-hour morphine consumption, the clinical difference between these techniques and other interventions was small. ESPB was more likely to reduce VAS within the first 12 hours and the PONV incidence. Nevertheless, the certainty of evidence for these findings remains low to moderate, and further high-quality randomized controlled trials are warranted to confirm their clinical utility. LIMITATION: The studies included in our review exhibited inconsistencies in study design and analgesia protocols, which may introduce bias into our findings. The results may not be directly applicable to laparoscopic procedures. The absence of these unpublished data or ongoing trials could limit the comprehensiveness of our analysis.