Daily Anesthesiology Research Analysis
Analyzed 140 papers and selected 3 impactful papers.
Summary
Analyzed 140 papers and selected 3 impactful articles.
Selected Articles
1. Machine learning for prediction of histologic chorioamnionitis (stage ≥II) in parturients receiving labor analgesia: a retrospective multicentre cohort study.
Using electronic health record features available at the onset of epidural-related maternal fever, a random forest model with six inputs accurately predicted stage ≥II histologic chorioamnionitis, maintaining performance on independent external validation. SHAP analysis highlighted BMI as the most influential predictor, supporting interpretable and clinically actionable risk stratification before delivery.
Impact: This study provides a validated, interpretable machine-learning tool for early identification of significant chorioamnionitis during labor analgesia, addressing a diagnostic blind spot at ERMF onset. It has the potential to guide timely antibiotic and obstetric-neonatal team decisions.
Clinical Implications: Could support real-time triage at ERMF onset, informing antibiotics initiation, closer fetal monitoring, and preparation for neonatal evaluation, while reducing unnecessary broad-spectrum therapy in low-risk patients.
Key Findings
- Random forest model using six features achieved AUC 0.945 (internal) and 0.849 (external) for predicting stage ≥II histologic chorioamnionitis.
- Sensitivity and specificity were balanced (0.957 and 0.867), supporting clinical utility.
- SHAP interpretability identified BMI as the most influential predictor among retained features.
Methodological Strengths
- Multicenter dataset with independent external validation enhances generalizability.
- Model interpretability via SHAP supports transparent clinical decision support.
Limitations
- Retrospective design may introduce selection and information biases.
- Clinical thresholds and workflow integration require prospective validation.
Future Directions: Prospective, real-time evaluation of the model at ERMF onset across diverse centers, with impact analyses on antibiotic stewardship, maternal-neonatal outcomes, and cost-effectiveness.
BACKGROUND: Histological chorioamnionitis (HCA) is a serious pregnancy complication, but early diagnosis is challenging, especially in parturients receiving labor analgesia, where identification is even more difficult. Therefore, we developed and validated a machine learning model for early prediction of HCA (stage ≥II) intended for use at the time of epidural-related maternal fever (ERMF) onset, before delivery and confirmatory histopathology. METHODS: This study utilized a multicenter retrospective cohort dataset, including parturients receiving labor analgesia and completed placental pathological examination. Candidate features were extracted from electronic health records (EHR), followed by data preprocessing procedures such as addressing multicollinearity, Z-score standardization, and minority class weighting. Subsequently, three machine learning models-logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost)-were developed and compared, with their performance evaluated through internal and independent external validation. Finally, the SHapley Additive exPlanations (SHAP) method was used to interpret the best-performing model, aiming to clarify the predictive contribution of each feature. RESULTS: A total of 2,715 parturients were included in this study, of which 676 cases (24.9%) were diagnosed with HCA (stage ≥II). After feature selection, the model retained 6 key features. The RF model exhibited the best performance, achieving an Area Under the Curve(AUC) of 0.945 in the internal validation set and an AUC of 0.849 in the independent external validation set, demonstrating balanced sensitivity (0.957) and specificity (0.867). SHAP analysis indicated that body mass index (BMI) was the most important predictive factor. CONCLUSIONS: The RF model performed the best in predicting the risk of HCA (stage ≥II) in parturients receiving labor analgesia. SHAP analysis further revealed that BMI was the most important predictive factor in the model.
2. Ultrasound-guided double-lumen tube size selection improves intubation success and postoperative airway outcomes in thoracic surgery: a randomized controlled study.
Selecting DLT size using ultrasound-measured tracheal diameter reduced 24-hour postoperative sore throat and improved intubation metrics compared with conventional sex/height-based sizing. The strategy also enhanced intraoperative ventilatory parameters.
Impact: Provides randomized evidence for an easily adoptable bedside technique to individualize DLT sizing, with tangible improvements in patient-centered and procedural outcomes.
Clinical Implications: Thoracic anesthesia teams can incorporate ultrasound tracheal diameter measurement to select DLT size, potentially reducing airway morbidity and improving first-pass success, especially in anatomically variable patients.
Key Findings
- Ultrasound-guided DLT sizing significantly reduced 24-hour postoperative sore throat compared with conventional sizing.
- First-attempt intubation success and overall intubation metrics were improved in the ultrasound group.
- Intraoperative ventilatory parameters and surgeon-rated satisfaction with lung collapse were enhanced.
Methodological Strengths
- Prospective randomized controlled design with pragmatic clinical endpoints.
- Direct, objective measurement (ultrasound tracheal diameter) to guide intervention.
Limitations
- Single-center, small sample size limits precision and generalizability.
- Blinding of operators/patients was likely not feasible, introducing performance bias risk.
Future Directions: Larger multicenter RCTs comparing ultrasound-based algorithms and assessing training requirements, cost-effectiveness, and subgroups (e.g., difficult airway or abnormal tracheal anatomy).
BACKGROUND: Appropriate double-lumen tube (DLT) size selection is crucial for safe and effective one-lung ventilation in thoracic surgery. Conventional selection based on sex and height does not account for individual airway variability. This study evaluated whether ultrasound-guided DLT size selection improves intubation success and postoperative airway outcomes. METHODS: In this prospective randomized controlled study, 70 patients undergoing thoracic surgery who required one-lung ventilation were assigned to either a conventional group (DLT size based on sex and height) or an ultrasound group (DLT size based on tracheal diameter measured by ultrasound at the suprasternal notch). The primary outcome was the incidence of postoperative sore throat at 24 h. Secondary outcomes included postoperative cough, first-attempt intubation success, number of attempts, surgeon-rated lung collapse satisfaction, and intraoperative respiratory parameters. RESULTS: Postoperative sore throat was significantly lower in the ultrasound group compared to the conventional group (8.6% vs. 37.1%, CONCLUSION: Ultrasound-guided DLT size selection improves intubation success, reduces postoperative airway complications, and enhances ventilatory parameters. This approach may provide a simple and effective method for optimizing airway management in thoracic surgery.
3. Transurethral Ropivacaine (100 mg) Bladder Irrigation Reduces the Incidence of Bladder Discomfort in Transurethral Resection of Bladder Tumor: A Randomized Double-blind Trial.
A single 10-minute intravesical irrigation with 100 mg ropivacaine after TURBT reduced immediate and 24-hour CRBD, lowered early pain, delayed and decreased rescue analgesia, and improved short-term satisfaction without hemodynamic instability or severe adverse events.
Impact: Offers a low-cost, simple, and opioid-sparing adjunct to improve early recovery after TURBT, supported by a double-blind RCT with clinically meaningful endpoints.
Clinical Implications: Intravesical ropivacaine can be integrated into ERAS protocols for TURBT to reduce CRBD and early pain while minimizing systemic side effects.
Key Findings
- Ropivacaine irrigation increased PACU CRBD-free rates by 14.8% (49.4% vs 34.6%; 95% CI 4.9–24.7).
- At 24 hours, 96.3% in the ropivacaine group were CRBD-free versus 87.7% in controls (difference 8.6%; 95% CI 0.1–17.1).
- Early postoperative pain scores were lower at 3–5 hours; rescue analgesia was less frequent (25.9% vs 42.0%) and administered later (186 vs 143 minutes).
Methodological Strengths
- Prospective, double-blind, randomized controlled trial with adequate sample size for primary endpoint.
- Comprehensive assessment including CRBD incidence/severity, pain, rescue analgesia timing, satisfaction, and safety.
Limitations
- Likely single-center study; generalizability across surgical settings and catheter protocols may be limited.
- Outcomes focused on early postoperative period; long-term effects were not assessed.
Future Directions: Replication in multicenter trials, dose–response exploration, comparison with antimuscarinics, and inclusion within ERAS bundles with cost-effectiveness analyses.
BACKGROUND: Catheter-related bladder discomfort (CRBD) is frequent after transurethral resection of bladder tumor (TURBT) and adversely affects early recovery. Pharmacological strategies exist but are often limited by side effects. We evaluated whether a single intravesical instillation of ropivacaine at the end of TURBT reduces postoperative CRBD. METHODS: In this prospective, double-blind, randomized controlled trial, 162 adults undergoing TURBT under spinal anesthesia were allocated to receive bladder irrigation with either 100 mL of 0.1% ropivacaine (100 mg) or 100 mL of saline for 10 min immediately after surgery. The primary endpoint was the incidence of CRBD in the postanesthesia care unit (PACU). Secondary outcomes included CRBD severity over 24 h, postoperative pain scores (0-6 h), need and timing of rescue analgesia, patient satisfaction at 6 h, urinary symptom-related quality of life at day 10, and safety parameters. RESULTS: Baseline characteristics were similar between groups. Ropivacaine irrigation increased the proportion of patients free of CRBD in the PACU compared with saline (49.4% vs. 34.6%; absolute difference 14.8%, 95% confidence interval [CI]: 4.9-24.7). At 24 h, 96.3% of patients in the ropivacaine group were CRBD-free compared with 87.7% in the control group (difference: 8.6%, 95% CI: 0.1-17.1). Pain scores were lower with ropivacaine at 3-5 h (all P < 0.001). Rescue analgesia was required less frequently (25.9% vs. 42.0%, P = 0.04) and later (186 ± 43 vs. 143 ± 40 min, P < 0.001). Patient satisfaction at 6 h was higher in the ropivacaine group (mean score: 6.3 ± 0.9 vs. 5.5 ± 1.1). Hemodynamic variables remained stable in both groups, and no severe adverse events occurred. CONCLUSION: Intravesical ropivacaine 100 mg given as irrigation at the end of TURBT significantly reduced immediate postoperative CRBD, lowered early pain scores, decreased the need for rescue analgesia, and improved short-term satisfaction without additional safety concerns. This simple and inexpensive intervention may be considered as part of enhanced recovery protocols in urological surgery.