Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2025
ReviewThe Future of Artificial Intelligence Using Images and Clinical Assessment for Difficult Airway Management.
Artificial intelligence (AI) algorithms, particularly deep learning, are automatic and sophisticated methods that recognize complex patterns in imaging data providing high qualitative assessments. Several machine-learning and deep-learning models using imaging techniques have been recently developed and validated to predict difficult airways. ⋯ We explore how these methods could impact clinical practice. Finally, we discuss predictive modeling for difficult laryngoscopy using machine-learning and the future approach with intelligent intubation devices.
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Anesthesia and analgesia · Feb 2025
Meta Analysis Comparative StudySecond-Generation Supraglottic Airway Devices Versus Endotracheal Intubation in Adults Undergoing Abdominopelvic Surgery: A Systematic Review and Meta-Analysis.
Second-generation supraglottic airway (SGA) devices are widely used, but thought to have inferior safety performance to endotracheal tubes (ETTs), but might be equally efficacious while improving patient-centered outcomes. We compared second-generation SGAs with ETTs for perioperative safety, efficacy, and quality of recovery in adults undergoing abdominopelvic surgery under general anesthesia. Our primary objective was to assess safety in the form of major airway complications. Secondary objectives were other safety, efficacy, and quality of recovery outcomes. ⋯ Second-generation SGAs reduce the risk of major airway complications compared with ETTs in adults undergoing abdominopelvic procedures under general anesthesia, with no reported clinically relevant differences in the risk of regurgitation or pulmonary aspiration. Additionally, they improve the quality of postoperative recovery with lower risk of sore throat, hoarseness, and postoperative nausea and vomiting. These data provide an opportunity for clinicians to reassess the implications of conservative airway management, and potentially expand the role of second-generation SGAs in routine clinical practice.
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Anesthesia and analgesia · Feb 2025
Meta Analysis Comparative StudyComparison of Clinical Performance of I-gel and Fastrach Laryngeal Mask Airway as an Intubating Device in Adults: A Systematic Review and Meta-Analysis.
The supraglottic airway device (SGD) was introduced as a breakthrough in airway management. The Fastrach emerged as the first commercially available intubating SGD, drawing extensive investigation. I-gel is a more recent device that has gained popularity, can be used as an intubating SGD, and replaced Fastrach in many institutions. However, there is uncertainty regarding the comparison between these devices in terms of efficacy for intubation and ventilation, and safety in an airway rescue situation. ⋯ Based on our findings, a higher first-pass success rate was observed with the use of Fastrach when compared to I-gel. However, the use of I-gel might result in a better intubation success rate with the flexible scope-guided intubation. There are no significant differences in performance in terms of the success rate for intubation overall, time for device insertion, or time to intubation or complications regardless of the device used.
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Anesthesia and analgesia · Jan 2025
ReviewScoping Review: Anesthesiologist Involvement in Alternative Payment Models, Value Measurement, and Nonclinical Capabilities for Success in the United States of America.
The US healthcare sector is undergoing significant payment reforms, leading to the emergence of Alternative Payment Models (APMs) aimed at improving clinical outcomes and patient experiences while reducing costs. This scoping review provides an overview of the involvement of anesthesiologists in APMs as found in published literature. It specifically aims to categorize and understand the breadth and depth of their participation, revolving around 3 main axes or "Aims": (1) shaping APMs through design and implementation, (2) gauging the value and quality of care provided by anesthesiologists within these models, and (3) enhancing nonclinical abilities of anesthesiologists for promoting more value in care. ⋯ Our results highlight that while payment models are shifting toward value, patient-centered metrics have yet to be widely accepted for use in measuring quality and affecting payment for anesthesiologists. Gaps remain in understanding how anesthesiologists assess their direct impact and strategies for enhancing the sustainability of anesthesia practices. This review underscores the need for future research contributing to the successful adaptation of clinical practices in this new era of healthcare delivery.
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Anesthesia and analgesia · Jan 2025
ReviewScoping Review: Anesthesiologist Involvement in Alternative Payment Models, Value Measurement, and Nonclinical Capabilities for Success in the United States of America.
The US healthcare sector is undergoing significant payment reforms, leading to the emergence of Alternative Payment Models (APMs) aimed at improving clinical outcomes and patient experiences while reducing costs. This scoping review provides an overview of the involvement of anesthesiologists in APMs as found in published literature. It specifically aims to categorize and understand the breadth and depth of their participation, revolving around 3 main axes or "Aims": (1) shaping APMs through design and implementation, (2) gauging the value and quality of care provided by anesthesiologists within these models, and (3) enhancing nonclinical abilities of anesthesiologists for promoting more value in care. ⋯ Our results highlight that while payment models are shifting toward value, patient-centered metrics have yet to be widely accepted for use in measuring quality and affecting payment for anesthesiologists. Gaps remain in understanding how anesthesiologists assess their direct impact and strategies for enhancing the sustainability of anesthesia practices. This review underscores the need for future research contributing to the successful adaptation of clinical practices in this new era of healthcare delivery.