Journal of clinical anesthesia
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Multicenter Study
Development and validation of a machine learning ASA-score to identify candidates for comprehensive preoperative screening and risk stratification.
The ASA physical status (ASA-PS) is determined by an anesthesia provider or surgeon to communicate co-morbidities relevant to perioperative risk. Assigning an ASA-PS is a clinical decision and there is substantial provider-dependent variability. We developed and externally validated a machine learning-derived algorithm to determine ASA-PS (ML-PS) based on data available in the medical record. ⋯ We created and validated a machine learning physical status based on preoperatively available data. The ability to identify patients at high risk early in the preoperative process independent of the provider's decision is a part of the process we use to standardize the stratified preoperative evaluation of patients scheduled for ambulatory surgery.
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Observational Study
Evaluation of pre-induction dynamic arterial elastance as an adjustable predictor of post-induction hypotension: A prospective observational study.
Dynamic arterial elastance (Eadyn) has been suggested as a functional measure of arterial load. We aimed to evaluate whether pre-induction Eadyn can predict post-induction hypotension. ⋯ In our study, invasive pre-induction Eadyn during deep breathing -could predict post-induction hypotension. Despite its invasiveness, future studies will be needed to evaluate the usefulness of Eadyn as a predictor of post-induction hypotension because it is an adjustable parameter.
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To systematically evaluate anesthesiology resident and attending perceptions of preoperative planning conversations (POPCs) and to generate understanding for improving the educational and clinical value of this practice. ⋯ Significant discrepancies exist between how anesthesia attendings and residents perceive the purpose of the POPC, with trainees less likely to view the POPC as having clinical value and neither group perceiving the conversation as a very useful educational tool. The results highlight the need to reexamine the value of the daily POPC as a deliberate educational practice to meet expectations of both trainees and attendings.