Daily Anesthesiology Research Analysis
Analyzed 111 papers and selected 3 impactful papers.
Summary
Three studies stand out today in anesthesiology and perioperative medicine: an interpretable machine-learning tool (MBD-Check) that streamlines preoperative prediction of mild bleeding disorders; a multicenter prospective study linking pre-existing cerebral small-vessel disease on MRI to higher postoperative delirium risk; and a triple-blind RCT showing distinct analgesic and anti-inflammatory profiles for dexamethasone vs. dexmedetomidine as erector spinae plane block adjuvants in lumbar spine surgery.
Research Themes
- Preoperative risk stratification and decision support
- Perioperative brain health and delirium prevention
- Mechanism-informed optimization of regional anesthesia adjuvants
Selected Articles
1. Development, validation, and user-centric evaluation of an interpretable machine learning decision support tool for the preoperative prediction of mild bleeding disorders (MBD-Check): a prospective diagnostic prediction study.
An interpretable ML tool (MBD-Check) using activated partial thromboplastin time, epinephrine-collagen PFA, sex, and a streamlined bleeding history achieved AUROC 0.85 in external validation, with 90.2% sensitivity and 54.3% specificity. Median completion time was 72 seconds and usability was excellent (median SUS 82.5), supporting real-world deployment to streamline preoperative referrals.
Impact: Provides an explainable, fast, and externally validated tool to better triage patients for bleeding workup at pre-anesthesia evaluation, potentially reducing unnecessary testing and delays.
Clinical Implications: Integrate MBD-Check into preoperative workflows to identify high-sensitivity candidates for hematology referral while minimizing over-referral. It uses readily available tests, facilitating implementation without new infrastructure.
Key Findings
- Selected predictors were activated partial thromboplastin time, PFA (epinephrine-collagen), sex, and a streamlined bleeding history.
- External validation showed AUROC 0.85 with 90.2% sensitivity and 54.3% specificity.
- Usability testing across surgeons, anesthesiologists, and hematologists showed a median SUS score of 82.5 and a 72-second median completion time.
Methodological Strengths
- Prospective development with external validation in an independent cohort
- Explainable model with user-centered usability evaluation (SUS) and stakeholder-driven variable selection
Limitations
- Developed and validated in two Swiss centers; generalizability to broader, multi-national settings needs confirmation
- Moderate specificity may still lead to some over-referral; impact on outcomes and costs requires prospective implementation studies
Future Directions: Multicenter implementation trials to assess impact on diagnostic yield, perioperative bleeding outcomes, and cost-effectiveness; calibration in diverse populations; integration with EHR and reflex testing.
BACKGROUND: Mild bleeding disorders are the most common inherited bleeding disorders, often leading to perioperative haemorrhages. Preoperative screening for mild bleeding disorders remains challenging due to the limitations of existing screening tools, resulting in a substantial proportion of patients being referred for preoperative investigations. The aim of this study was to develop, externally validate, and implement an easy-to-use, explainable machine learning-based decision support tool for the prediction of mild bleeding disorders. METHODS: Clinical and laboratory data were collected in two independent, prospective cohort studies, including consecutive patients, aged 18 years or older, referred for suspected mild bleeding disorders. The training cohort was recruited at Inselspital, Bern University Hospital (Bern, Switzerland). Diagnostic investigations followed current guidelines, with final diagnoses established by an expert panel. Multiple machine learning algorithms were trained, and the best performing model underwent external validation in a second cohort recruited at Cantonal Hospital Lucerne (Lucerne, Switzerland). To evaluate usability, we created a survey platform incorporating four case vignettes and the System Usability Scale (SUS), a validated software usability questionnaire. FINDINGS: The training cohort included 555 patients...
2. Cerebral small-vessel disease and postoperative delirium in elderly non-cardiac surgical patients.
In 804 elderly patients, higher preoperative cerebral small-vessel disease burden on MRI was associated with increased postoperative delirium (adjusted OR 1.95). Lacunes (aOR 2.96) and white matter hyperintensities (aOR 3.32) showed strong associations. Delirium risk reached 28% in the most severely affected, with an attributable risk percentage of 44% in this cohort.
Impact: Identifies a quantifiable, imaging-based brain vulnerability that substantially elevates delirium risk, enabling targeted prevention strategies in older adults.
Clinical Implications: Consider integrating preoperative MRI small-vessel markers into risk stratification for elderly patients; intensify delirium prevention (sleep, analgesia optimization, depth of anesthesia titration, anticholinergic avoidance) in those with high burden.
Key Findings
- Higher cerebral small-vessel disease burden doubled odds of postoperative delirium (adjusted OR 1.95, P=0.023).
- Lacunes (aOR 2.96) and white matter hyperintensities (aOR 3.32) were especially associated with delirium.
- Attributable risk percentage was 44%, with delirium incidence up to 28% in the highest burden group.
Methodological Strengths
- Prospective multicenter cohort with masked neuroradiology assessment
- Standardized twice-daily CAM-ICU delirium evaluations with adjusted analyses
Limitations
- MRI-based assessment may limit feasibility and generalizability in some settings
- Delirium was assessed during the first 3 postoperative days; later-onset delirium not captured
Future Directions: Evaluate pragmatic screening pathways (e.g., existing MRI reads) and test enriched prevention bundles in patients with high small-vessel disease burden; explore EEG-guided dosing in high-burden patients.
BACKGROUND: Postoperative delirium is common in elderly surgical patients and is associated with complications and prolonged hospitalization. Cerebral small-vessel disease, a leading cause of dementia, is highly prevalent in elderly surgical patients. However, the relationship between cerebral small-vessel disease and postoperative delirium remains unknown. We therefore test the primary hypothesis that cerebral small-vessel disease is associated with postoperative delirium in elderly non-cardiac surgical patients. METHODS: We prospectively evaluated patients 65 to 85 years old who had inpatient elective non-cardiac surgery at five academic centers in China. Independent neuroradiologists, masked to clinical data, quantified preoperative magnetic resonance markers of cerebral small-vessel disease, including lacune, white matter hyperintensity, perivascular space, cerebral microbleed, to estimate vascular abnormalities which were converted into a cerebral small-vessel disease burden score. Postoperative delirium was assessed twice daily during the initial 3 postoperative days using the Confusion Assessment Method for Intensive Care patients. RESULTS: Between July 8, 2020, and Sep 30, 2024, we enrolled 804 patients of whom 69 (9%) had a postoperative delirium...
3. Do Perineural Dexamethasone and Dexmedetomidine Improve Analgesia and Inflammatory Response After Lumbar Spine Surgery?
In a triple-blind RCT (n=90) of posterior lumbar decompression and fusion, both perineural dexamethasone and dexmedetomidine prolonged time to first opioid versus ropivacaine alone (12.7 h and 15.5 h vs 6.2 h). Pain scores were reduced in both adjuvant groups, while dexamethasone more effectively attenuated systemic inflammatory indices and reduced cumulative opioid consumption.
Impact: Provides head-to-head randomized evidence to guide choice of ESPB adjuvants, supporting mechanism-informed, time-profiled analgesic strategies.
Clinical Implications: Consider dexmedetomidine when prioritizing prolonged early analgesia, and dexamethasone when aiming to reduce overall opioid use and systemic inflammation after lumbar spine surgery.
Key Findings
- Time to first rescue opioid: 6.2 h (ropivacaine) vs 12.7 h (dexamethasone) vs 15.5 h (dexmedetomidine), both P<0.001 vs control.
- Both adjuvants reduced postoperative pain scores at all time points compared to ropivacaine alone.
- Dexamethasone more effectively reduced systemic inflammatory indices and cumulative opioid consumption than dexmedetomidine.
Methodological Strengths
- Prospective randomized triple-blind controlled design
- Clinically relevant outcomes including analgesia timing, opioid consumption, and systemic inflammatory indices
Limitations
- Single-center study may limit generalizability
- Short follow-up window (48 h) precludes assessment of longer-term outcomes (e.g., chronic pain)
Future Directions: Multicenter trials to confirm findings, optimize dosing, and test combined or sequential adjuvant strategies; evaluate longer-term pain and functional outcomes.
BACKGROUND: Postoperative pain after lumbar spine surgery often requires substantial opioid use. Perineural adjuvants such as dexamethasone and dexmedetomidine are increasingly used to prolong the duration of regional blocks and improve analgesic quality; however, their comparative effects remain uncertain. Ultrasound-guided erector spinae plane block (ESPB) is widely used as part of multimodal analgesia, but the selection of perineural adjuvants remains uncertain. QUESTIONS/PURPOSES: (1) Does adding adjuvants (dexamethasone or dexmedetomidine) to the ESPB result in longer time to first rescue opioid? (2) Do patients who received adjuvants have lower total opioid consumption in the first 48 hours after surgery, and do they have lower pain scores? (3) Does dexamethasone or dexmedetomidine result in lower postoperative systemic inflammatory indices? METHODS: This study was conducted at a tertiary academic referral center... The primary outcome was time to first rescue opioid administration...