Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2023
ReviewArtificial Intelligence for Perioperative Medicine: Perioperative Intelligence.
The anesthesiologist's role has expanded beyond the operating room, and anesthesiologist-led care teams can deliver coordinated care that spans the entire surgical experience, from preoperative optimization to long-term recovery of surgical patients. This expanded role can help reduce postoperative morbidity and mortality, which are regrettably common, unlike rare intraoperative mortality. Postoperative mortality, if considered a disease category, will be the third leading cause of death just after heart disease and cancer. ⋯ Using artificial intelligence technologies, we can critically examine every aspect of perioperative medicine and devise innovative value-based solutions that can potentially improve patient safety and care delivery, while optimizing cost of care. In this narrative review, we discuss specific applications of artificial intelligence that may help advance all aspects of perioperative medicine, including clinical care, education, quality improvement, and research. We also discuss potential limitations of technology and provide our recommendations for successful adoption.
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The global volume of surgery is increasing. Adverse outcomes after surgery have resource implications and long-term impact on quality of life and consequently represent a significant and underappreciated public health issue. ⋯ The association between short- and long-term outcomes, which persists when corrected for base-line risk, has significant implications for patients and providers and warrants further investigation. Candidate mechanisms include sustained inflammation and reduced physician activity, which may, in the future, be mitigated by targeted interventions.
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Anesthesia and analgesia · Apr 2023
Observational StudyEnhanced Recovery After Surgery Program and Opioid Consumption in Pulmonary Resection Surgery: A Retrospective Observational Study.
Pulmonary resection surgery causes severe postoperative pain and usually requires opioid-based analgesia, particularly in the early postoperative period. However, the administration of large amounts of opioids is associated with various adverse events. We hypothesized that patients who underwent pulmonary resection under an enhanced recovery after surgery (ERAS) program consumed fewer opioids than patients who received conventional treatment. ⋯ Patients who underwent pulmonary resection under the ERAS program consumed fewer opioids than those who received conventional management while maintaining no significant differences in clinical outcomes.
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Anesthesia and analgesia · Apr 2023
Digitization of Symbol-Denoted Blood Pressure Data From Intraoperative Paper Health Records in a Low-Middle-Income Country Using Deep Image Segmentation and Associated Postoperative Outcomes: A Feasibility Study.
In low-middle-income countries (LMICs), perioperative clinical information is almost universally collected on paper health records (PHRs). The lack of accessible digital databases limits LMICs in leveraging data to predict and improve patient outcomes after surgery. In this feasibility study, our aims were to: (1) determine the detection performance and prediction error of the U-Net deep image segmentation approach for digitization of hand-drawn blood pressure symbols from an image of the intraoperative PHRs and (2) evaluate the association between deep image segmentation-derived blood pressure parameters and postoperative mortality and length of stay. ⋯ In this study, we report our experience with a deep image segmentation model for digitization of symbol-denoted blood pressure from intraoperative anesthesia PHRs. Our data support further development of this novel approach to digitize PHRs from LMICs, to provide accessible, curated, and reproducible data for both quality improvement- and outcome-based research.