Anesthesiology and Perioperative Science最新文献

{"title":"A systematic review and meta-analysis on ketamine use and postoperative delirium in older patients undergoing spine or orthopedic surgery","authors":"Andrew Sretavan,&nbsp;Marc Buren,&nbsp;Peggy Tahir,&nbsp;Jacqueline M. Leung","doi":"10.1007/s44254-025-00145-y","DOIUrl":"10.1007/s44254-025-00145-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Postoperative delirium (POD) is common in older adults following major surgery. Ketamine has opioid-sparing properties and potential neuroprotective effects, yet whether intraoperative ketamine reduces the incidence of postoperative delirium remains uncertain. This systematic review aims to determine whether ketamine use is associated with a lower incidence of POD in older patients undergoing spine or orthopedic surgery.</p><h3>Methods</h3><p>We conducted comprehensive searches in PubMed, Web of Science, EMBASE, Cochrane CENTRAL, and CINAHL Complete from inception to June 26, 2025. Both keywords and index terms (Mesh/EMTREE) were used to develop broad and sensitive searches tailored to each database to retrieve all relevant articles. EMBASE results were limited to articles and articles in press. Eligible studies included patients aged ≥ 60 years undergoing surgery with intraoperative ketamine administration and reporting POD as an outcome. Two reviewers independently screened studies, extracted data, assessed risk of bias, and performed quality appraisal using RoB 2 for randomized controlled trials (RCTs) and ROBINS-I for observational studies. Random-effects meta-analyses were performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs).</p><h3>Results</h3><p>We included 24 studies in the final analysis and five specifically studied patients undergoing spine or orthopedic surgery. The effect of ketamine on POD showed an OR of 1.50 (95% CI 0.38–5.91, <i>P</i> = 0.56 random effects model) for the two RCTs. Including the additional three cohort studies was marginally associated with an increase in the occurrence of postoperative delirium, OR 1.30 (95% CI 1.01–1.67), <i>P</i> = 0.0425. However, the imprecision of the studies was deemed to be serious due to small sample sizes, and only two were RCTs.</p><h3>Conclusions</h3><p>This systematic review and meta-analysis did not find a statistically significant association between intraoperative ketamine use and POD in older patients undergoing spine or orthopedic surgery in the RCTs. However, because of the small number of available studies together with imprecision, this conclusion should only be considered as preliminary. Larger, high-quality randomized trials are needed to determine whether ketamine influences POD risk and to assess different dosing strategies for their effects on postoperative cognitive outcomes in older adults.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural sedation and analgesia in the emergency department: a review of current practices and clinical implications","authors":"Burcu Özen Karabulut,&nbsp;Metin Akgün","doi":"10.1007/s44254-025-00129-y","DOIUrl":"10.1007/s44254-025-00129-y","url":null,"abstract":"<div><p>This review provides an evidence-based overview of procedural sedation and analgesia (PSA) practices in emergency department settings, addressing pharmacologic agent selection, monitoring strategies, pediatric- and adult-specific considerations, and current guideline recommendations to support safe and effective PSA across diverse clinical scenarios. Literature published between 2014 and 2024 was reviewed using PubMed, Cochrane Library, Embase, Scopus, and Web of Science, with inclusion limited to English-language, full-text human studies of methodological quality and clinical relevance. Ketamine, propofol, midazolam, and fentanyl remain the most commonly used agents, often administered in combination to balance efficacy and adverse effects, while newer agents such as remimazolam, esketamine, and ciprofol are emerging but lack robust evidence in emergency settings. In pediatric populations, noninvasive administration routes and age-appropriate dosing are emphasized, and adherence to guidelines is consistently associated with improved procedural standardization and patient safety. Point-of-care ultrasound has gained increasing prominence in monitoring strategies, complementing established practices. Overall, when guided by appropriate patient selection, careful pharmacologic planning, and adherence to evidence-based protocols, PSA can be safely and effectively performed in emergency care, and the integration of standardized training, clinical guidelines, and novel monitoring tools will be critical for optimizing outcomes across diverse patient populations. </p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00129-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research progress and future perspective in anaesthesiology","authors":"Junhao Long,&nbsp;Jinpiao Zhu,&nbsp;Daqing Ma","doi":"10.1007/s44254-025-00159-6","DOIUrl":"10.1007/s44254-025-00159-6","url":null,"abstract":"<div><p>Anaesthesiology is evolving from a clinical-based discipline focused primarily on maintaining intraoperative safety into an evidence-based perioperative medicine that emphasizes comprehensive patient care throughout before, during and after surgery journey. This shift has given rise to several important interdisciplinary research directions, which warrant systematic summarisation to better define future perspectives. In this review, we discuss four key intersecting domains: anaesthesia and neuroscience, perioperative organ protection, anaesthesia and cancer, and anaesthesia therapy. Furthermore, based on emerging establishment of perioperative medicine databases that integrate diverse-source data and leverage artificial intelligence for large-scale data analysis, we propose four new perspectives of anaesthesiology including personalized and perioperative management strategy, anaesthetic and organ-protective drugs, anaesthesia techniques and intelligent devices.</p><h3>Graphical Abstract</h3>\u0000<div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00159-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145730255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A practical and explainable machine learning model based on conventional clinical features for predicting mortality in patients with sepsis","authors":"Xintong Huang,&nbsp;Yingxu Chen,&nbsp;Tongda Li,&nbsp;Lisirui Ge,&nbsp;Lu Yang,&nbsp;Tao Peng,&nbsp;Guangxiang Chen,&nbsp;Maohua Wang","doi":"10.1007/s44254-025-00157-8","DOIUrl":"10.1007/s44254-025-00157-8","url":null,"abstract":"<div><h3>Purpose</h3><p>Sepsis is a complex and life-threatening condition that arises from an abnormal and dysregulated host response to an infection. Developing a practical and interpretable machine learning model to predict mortality in patients with sepsis is essential. To address the limitations of existing sepsis mortality prediction models (insufficient validation and limited interpretability), we developed a streamlined extreme gradient boosting (XGBoost) model that predicts mortality risk using only 7 routine clinical features.</p><h3>Methods</h3><p>Medical Information Mart for Intensive Care-IV (MIMIC-IV) data were used to train and internally validate our model. External validation was performed using the eICU-Collaborative Research Database (eICU-CRD). The area under the receiver operating characteristic curve (AUC) was used as the key evaluation index. Differences in model performances were assessed using DeLong's test. The optimal model was simplified using a recursive feature elimination algorithm, and model interpretability was evaluated using SHAP.</p><h3>Results</h3><p>Our 7-feature model demonstrated strong performance across training (AUC 0.920), internal validation (AUC 0.900) and external validation (AUC 0.839) cohorts. The selected features—platelet count (at discharge), leukocyte levels (post-antibiotic therapy and at discharge), BUN (post-antibiotic therapy), anion gap (post-antibiotic therapy and at discharge), and ICU length of stay—are objective (eliminating subjective/recall bias) and readily available in clinical practice. SHAP analysis showed that the prognostic contributions of these variables differed before and after antibiotic treatment.</p><h3>Conclusion</h3><p>The XGBoost model, built on 7 routine and objective clinical features, quantifies inter-feature relationships to provide mortality risk and treatment thresholds, thereby enabling clinicians to formulate evidence-based therapeutic strategies.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00157-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145730326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal nerve fiber layer thinning as a predictor of delirium in medical and surgical patients: a prospective cohort study","authors":"Xiaoxiao Wang,&nbsp;Xinning Mi,&nbsp;Yichen Cui,&nbsp;Jingshu Hong,&nbsp;Zhuzhu Li,&nbsp;Yimei Cai,&nbsp;Xiangyang Guo,&nbsp;Nan Li,&nbsp;Zhengqian Li","doi":"10.1007/s44254-025-00158-7","DOIUrl":"10.1007/s44254-025-00158-7","url":null,"abstract":"<div><h3>Purpose</h3><p>Emerging evidence suggests that retinal changes may indicate brain disorders. However, the association between retinal nerve fiber layer (RNFL) thickness and delirium risk has not been investigated. This study examined whether reduced RNFL thickness could predict an increased risk of delirium.</p><h3>Methods</h3><p>A total of 42,449 participants without a history of delirium were recruited from the UK Biobank. Optical coherence tomography (OCT) was used for RNFL thickness measurement. Cox proportional hazard models were applied to calculate hazard ratios and 95% confidence intervals for incident delirium risk.</p><h3>Results</h3><p>Over a median follow-up of 13.7 years, 1.0% of participants (425) developed delirium. Each 5-μm decrease in RNFL thickness was associated with a 13.6% higher hazard of delirium. The lowest RNFL tertile was linked to a 47.7% higher hazard compared to the highest tertile. A similar correlation was observed for postoperative delirium.</p><h3>Conclusion</h3><p>Reduced RNFL thickness is associated with increased delirium risk, highlighting the potential of OCT-based RNFL measurements as a non-invasive tool to identify potential delirium patients.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00158-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145730108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of synchronized intermittent mandatory versus manual assistance ventilation during anesthetic emergence on postoperative atelectasis in patients undergoing laparoscopic abdominal surgery: a randomized controlled trial","authors":"Fei Fei,&nbsp;Xuefei Li,&nbsp;Yi Xu,&nbsp;Feng Yin,&nbsp;Tingting Zheng,&nbsp;Hai Yu","doi":"10.1007/s44254-025-00155-w","DOIUrl":"10.1007/s44254-025-00155-w","url":null,"abstract":"<div><h3>Background</h3><p>Atelectasis usually leads to gas exchange and respiratory function impairment, which deteriorate the quality of recovery and increasing mortality. Although recent evidence suggested that the ventilation mode during emergence may affect the occurrence of atelectasis, the optimal ventilation mode remains controversial and randomized controlled trial is needed to clarify the issue.</p><h3>Methods</h3><p>In this prospective, randomized, and double-blind controlled trial, adult patients undergoing laparoscopic abdominal surgery at West China Hospital were assigned randomly (1:1:1) into SIMV-PC, SIMV/PSV or intermittent manual assistance ventilation group. The primary outcome was the incidence of atelectasis. The secondary outcomes included the incidence of postoperative hypoxemia, the oxygenation index and a composite of postoperative pulmonary complications (PPCs).</p><h3>Results</h3><p>Following an 8.73% dropout rate, a total of 115 patients undergoing elective laparoscopic abdominal surgery were enrolled in the final analysis. The incidence of atelectasis was lower in the pooled SIMV group compared to that in intermittent manual assistance ventilation group (29.5% <i>vs.</i> 48.6%, 95% CI: 0.38 to 0.98; <i>P</i> = 0.045). Sensitivity analyses confirmed the robustness of this result. There were no statistical differences in the secondary outcomes.</p><h3>Conclusions</h3><p>Among patients undergoing laparoscopic abdominal surgery, the use of SIMV (SIMV-PC or SIMV/PSV) during emergence resulted in a reduced incidence of early postoperative atelectasis compared to intermittent manual assistance ventilation. Future research with a larger sample size is needed.</p><h3>Trial registration</h3><p>ChiCTR2300073366. This study was registered before enrollment (July 7, 2023). Available at: https://www.chictr.org.cn/showproj.html?proj=198051.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00155-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145729625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal links between multisite chronic pain and psychiatric disorders: a bidirectional Mendelian randomization study","authors":"Liling Lin,&nbsp;Jianwei Lin,&nbsp;Ziyang Cui,&nbsp;Zhuochen Chen,&nbsp;Chengli Wang,&nbsp;Minghui Cao","doi":"10.1007/s44254-025-00141-2","DOIUrl":"10.1007/s44254-025-00141-2","url":null,"abstract":"<div><h3>Purpose</h3><p>Many observational studies have revealed intriguing connections between multisite chronic pain (MCP) and psychiatric disorders. Yet, the critical question of causality remains elusive. Our aim was to systematically evaluate the causal relationships between MCP and 11 psychiatric disorder subtypes while identifying potential mediators.</p><h3>Methods</h3><p>We adopted a three-stage two-sample bi-directional Mendelian randomization (MR) analysis to ensure the robustness and reliability of our findings. MCP summary data was sourced from a genome-wide association study with 387,649 individuals in the UK Biobank. The discovery stage used summary statistics mainly from the Psychiatric Genomics Consortium, while validation involved MR analysis with data from the FinnGen consortium. Meta-analysis was conducted to pool MR estimates from the discovery and validation stages.</p><h3>Results</h3><p>Positive causal relationships were found between MCP and 7 psychiatric disorder subtypes, including depression, panic disorder, anxiety disorders, insomnia, attention deficit hyperactivity disorder, post-traumatic stress disorder, and bipolar disorder, with combined odds ratios ranging from 1.361 (<i>P</i> &lt; 0.00001) to 3.322 (<i>P</i> &lt; 0.0045). Reverse MR revealed bidirectional causal associations between depression and MCP, along with anxiety disorders and MCP (<i>P</i> &lt; 0.05). Additionally, causal links were identified between MCP and smoking initiation, physical activity, body mass index, and changes in human blood cells. Multivariable MR analysis indicated these factors may mediate the relationship between MCP and psychiatric disorders.</p><h3>Conclusion</h3><p>Our findings provide novel insights into the involvement of MCP in psychiatric disorders, highlighting potential modifiable risk factors to reduce their incidence.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00141-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145729624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applications and challenges of large language models in anesthesiology: narrative review and future perspectives","authors":"Yiziting Zhu,&nbsp;Xin Shu,&nbsp;Xiang Liu,&nbsp;Yujie Li,&nbsp;Bin Yi,&nbsp;Daqing Ma","doi":"10.1007/s44254-025-00156-9","DOIUrl":"10.1007/s44254-025-00156-9","url":null,"abstract":"<div><p>With the continuous advancement of medical technologies, perioperative anesthesia management decisions are confronted with challenges of complexity and dynamicity, rendering traditional machine learning models insufficient for clinical needs. As one of the breakthrough applications in artificial intelligence, large language models (LLMs) may offer better help for intelligent anesthesia management. LLMs are capable of processing multidimensional and multi-source data, enabling more comprehensive prediction and intervention suggestions, thereby optimizing anesthesia management processes. This review summarizes the current applications of LLMs in anesthesiology and proposes methods for building specialized LLMs to tackle challenges in application. This work albeit mainly in the proposed stage aims to provide references for future development in this field and to promote in-depth research of LLMs in anesthesiology.</p><h3>Graphical Abstract</h3>\u0000<div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00156-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145729745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between frailty and postoperative pulmonary complications in patients undergoing pulmonary resection: a systematic review and meta-analysis","authors":"Jing Tang,&nbsp;Qian Den,&nbsp;Shilian Tan,&nbsp;Man Weng,&nbsp;Jun Li","doi":"10.1007/s44254-025-00154-x","DOIUrl":"10.1007/s44254-025-00154-x","url":null,"abstract":"<div><h3>Purpose</h3><p>Frailty is increasingly recognized as a risk factor for surgical complications; however, its association with postoperative pulmonary complications (PPCs) following pulmonary resection remains controversial. This study aimed to systematically evaluate the association between frailty and PPCs in elderly patients undergoing pulmonary resection.</p><h3>Methods</h3><p>We systematically searched PubMed, Cochrane Library, Embase, CNKI (China National Knowledge Infrastructure), CBM (China Biology Medicine Disc) , Wanfang Database, Cochrane Central Register of Controlled Trials, and Web of Science from inception to April 2024, using the search terms: (frailty OR frail) AND (pneumonectomy OR lobectomy OR lung resection OR lung cancer). Two investigators independently screened literature, extracted data, and assessed risk of bias. Statistical analyses were performed using Review Manager version 5.4.</p><h3>Results</h3><p>Twelve observational studies involving 394,947 patients were included. Frailty was significantly linked to PPCs risk (odds ratio [OR] = 2.96, 95% confidence interval [CI]: 2.15–4.06, <i>I</i>^<i>2</i> = 97%). Subgroup analysis indicated that the mFI-11 scale demonstrated a potentially strong predictive value (OR = 3.47, 95% CI: 2.04–5.92, <i>I</i>^<i>2</i> = 59%), though this requires validation in larger prospective cohorts.</p><h3>Conclusion</h3><p>Frailty is independently associated with an increased risk of PPCs in elderly patients undergoing pulmonary resection.</p><h3>Systematic review registration</h3><p>PROSPERO (Prospective Register of Systematic Reviews), registration ID: CRD42024532270.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00154-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145729684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and design of the Colloids infusion for Optimal outcomes In Non-cardiac surgery (COIN) randomized controlled trial","authors":"Lini Wang,&nbsp;Ziyu Zheng,&nbsp;Baobao Gao,&nbsp;Xue Yang,&nbsp;Junping Chen,&nbsp;Xiaohua Zou,&nbsp;Ke Wei,&nbsp;Zhaoyang Xiao,&nbsp;Erfei Zhang,&nbsp;Yanyuan Sun,&nbsp;Hailong Dong,&nbsp;Chong Lei","doi":"10.1007/s44254-025-00147-w","DOIUrl":"10.1007/s44254-025-00147-w","url":null,"abstract":"<div><h3>Background</h3><p>Post-induction hypotension is a common complications in surgical patients under general anesthesia. Previous evidence indicated preoperative fluid bolus infusion might improve hemodynamic stability after anesthesia induction. But the reported results regarding the postoperative clinical outcomes remains controversary.</p><h3>Methods</h3><p>Colloids infusion for Optimal outcomes In Non-cardiac surgery (COIN) trial is a multicenter, double-blinded, parallel-group, randomized controlled trial being conducted in seven tertiary hospitals in China. The trial will enroll and randomize 2,020 adult participants scheduled to undergo noncardiac surgery under general anesthesia with tracheal intubation. Participants will receive either 5 ml/kg of 6% hydroxyethyl starch 130/0.4 electrolyte solution (colloid group) or balanced multiple electrolyte solution (crystalloid group) prior to anesthesia induction. The primary endpoint is the incidence of postoperative complications within 30 days after surgery, defined as Clavien-Dindo classification Grade I or higher (any deviation from the normal postoperative course, including those requiring pharmacological treatment). The primary analysis will be an unadjusted, modified intention-to-treat comparison between patients randomized to colloids group and crystalloids group using chi-square test. The first patient was enrolled on July 12, 2023, and the trial is expected to be completed in June 2025.</p><h3>Conclusion</h3><p>The study aims to provide evidence-based insights into reducing postoperative complications in non-cardiac surgery patients undergoing general anesthesia, by comparing the effects of preoperative colloid versus crystalloid solution infusion prior to anesthetic induction. Should the findings demonstrate that colloid solution infusion effectively reduces the 30-day postoperative complication rate, this protocol may contribute to an optimized perioperative management strategy and further promote the clinical adoption of standardized preoperative hemodynamic management.</p><h3>Trial registration</h3><p>This study was registered at ClinicalTrials.gov under the identifier NCT05728645 on July 9, 2023, prior to its initiation (http://clinicaltrials.gov).</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00147-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145612317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}