Journal of Clinical Anesthesia最新文献

{"title":"Video laryngoscopy vs. direct laryngoscopy in infants and neonates: A systematic review and meta-analysis","authors":"Issa Salha MD ,&nbsp;Paweł Łajczak ,&nbsp;Yasmin Picanco Silva MD ,&nbsp;Sana Ahmed ,&nbsp;Thaïmye Joseph ,&nbsp;Oguz Kagan Sahin ,&nbsp;Railla Silva ,&nbsp;Rafaela Machado Filardi MD","doi":"10.1016/j.jclinane.2025.112024","DOIUrl":"10.1016/j.jclinane.2025.112024","url":null,"abstract":"<div><h3>Background</h3><div>Endotracheal intubation in infants and neonates is a critical yet challenging procedure with a narrow time window. This meta-analysis aimed to compare video laryngoscopy (VL) to direct laryngoscopy (DL) regarding first-attempt success, time to intubation, and complication rates.</div></div><div><h3>Methods</h3><div>We searched PubMed, Cochrane, and Embase databases and conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published up to June 2024, comparing VL and DL in infants less than one-year-old and neonates (defined as infants 0–28 days old). Primary outcomes included first-attempt success rate, while secondary outcomes were time to intubation (TTI) and complication rates. A subgroup analysis was performed for neonates.</div></div><div><h3>Results</h3><div>In our analysis of 17 RCTs with 1918 participants, VL demonstrated a higher first-attempt success rate compared to DL (87.5 % vs 78 %; OR 2.13; <em>p</em> &lt; 0.001), with similar results in neonates (77.6 % vs 63 %; OR 2.12; <em>p</em> = 0.027). VL also improved the time to best view (MD -2.85; <em>p</em> &lt; 0.01) and showed significantly better POGO scores (MD 16.8; p &lt; 0.01). However, there was no advantage of VL over DL in reducing time to intubation (MD 0.79; <em>p</em> = 0.49). VL reduced complications compared to DL (2.77 % vs 8.44 %; OR 0.33; <em>p</em> = 0.022).</div></div><div><h3>Conclusions</h3><div>This meta-analysis suggests that VL may improve first-attempt success and glottic visualization and may reduce complications compared with DL in infants and neonates. Intubation times appear similar between the two approaches. However, moderate heterogeneity, variability in VL devices, and potential operator dependence indicate that these findings should be interpreted with caution. Further clinical trials are warranted to validate these results and explore the long-term implications of VL on patient outcomes.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112024"},"PeriodicalIF":5.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145155353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a machine learning-based risk prediction model for perioperative neurocognitive disorders","authors":"Hengjun Wan ,&nbsp;Qing Zhong ,&nbsp;Ana Kowark ,&nbsp;Mark Coburn ,&nbsp;Yuling Tang ,&nbsp;Yiyun Li ,&nbsp;Xiaobin Wang ,&nbsp;Qiuran Zheng ,&nbsp;Xiaoxia Duan","doi":"10.1016/j.jclinane.2025.112016","DOIUrl":"10.1016/j.jclinane.2025.112016","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative neurocognitive disorder (PND) is a common complication that significantly increases patient mortality and healthcare burden. Existing predictive models lack standardisation and personalisation, especially for elderly patients undergoing non-cardiac elective surgery.</div></div><div><h3>Methods</h3><div>This study first identified 13 key feature variables through LASSO regression and then constructed ten machine learning prediction models based on this subset of variables. Model performance was validated via ROC/AUC and decision curve analysis. SHAP interpreted the optimal model, enabling development of a clinical risk assessment tool. Kaplan-Meier analysis examined the association between risk factors and PND onset timing.</div></div><div><h3>Results</h3><div>The incidence of PND was 12.5 % (255/2042). The AUC values across the ten machine learning models ranged from 0.615 to 0.877. Among these, the neural network model demonstrated the optimal predictive performance (AUC = 0.877, 95 % CI: 0.839–0.916). SHAP analysis identified hyperlipidaemia (highest SHAP value), smoking, ASA classification III, and low education level as key risk factors. Survival analysis showed that smoking, ASA classification III, and hypertension were associated with earlier onset of PND (log-rank test, <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>This study systematically identified core risk factors for PND in non-cardiac surgical patients using machine learning, and developed both logistic regression-based nomograms and online tools that prioritize interpretability and practicality to support clinical decision-making. The primary modifiable factors include hyperlipidaemia, smoking, and ASA classification. Survival analysis revealed that smokers and hypertensive patients experienced earlier onset of perioperative neurocognitive disorder (PND). However, multicentre validation is warranted, alongside the development of individualised strategies informed by risk stratification.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112016"},"PeriodicalIF":5.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-inflammatory and anti-nociceptive effects of individualized blood pressure strategy based on low-dose noradrenaline infusion in elderly patients following major surgery: A randomized, controlled study","authors":"Zheng Fang ,&nbsp;Yu-jie Wang ,&nbsp;Xiao-he Zhu ,&nbsp;Jia-hui Zheng ,&nbsp;Wei Liu ,&nbsp;Erwei Gu ,&nbsp;Xin-qi Cheng","doi":"10.1016/j.jclinane.2025.111978","DOIUrl":"10.1016/j.jclinane.2025.111978","url":null,"abstract":"<div><h3>Study objective</h3><div>To determine whether an individualized blood pressure strategy based on low-dose noradrenaline infusion could reduce cytokines/stress level, thus reducing the acute kidney injury (AKI) complication.</div></div><div><h3>Design</h3><div>A prospective, randomized, controlled trial.</div></div><div><h3>Setting</h3><div>The study was performed in First Affiliated Hospital of Anhui Medical University, China, from December 2021 to July 2023.</div></div><div><h3>Patients</h3><div>108 patients older than 60 years with ASA class II-III and scheduled to hepatobiliary and pancreatic surgery were enrolled.</div></div><div><h3>Intervention</h3><div>Patients were randomly assigned in a 1:1 ratio to either a standard or individualized treatment group. Individualized management strategy aimed at achieving a mean arterial pressure (MAP) within 20 % of the reference value or standard management strategy of treating MAP less than 65 mmHg.</div></div><div><h3>Measurements</h3><div>The primary outcome was tumor necrosis factor-α (TNF-α) at 24 h after surgery. The secondary outcomes included other inflammatory cytokine IL-6 and IL-10 levels and the incidence of postoperative AKI within 7-day after surgery.</div></div><div><h3>Main results</h3><div>100 patients completed the trial and were included in the modified intention-to-treat analysis. The primary outcome TNF-α at 24 h was increased to 16.65 (7.36) pg/ml assigned to the individualized treatment strategy vs 21.23 (7.70) pg/ml in standard treatment group (difference −4.58, 95 %CI −7.56 to −1.58, <em>P</em> = 0.003). A relatively mild increase from baseline were found after surgery in IL-6 and cortisol level except for IL-10. 3 patients (6 %) in the individualized treatment group and 10 (20 %) in the standard treatment group had AKI (Relative Risk 3.33; 95 % CI, 0.95 to 11.39; <em>P</em> = 0.037).</div></div><div><h3>Conclusion</h3><div>Among elderly patients undergoing major surgery, an individualized mean arterial pressure strategy management based on low-dose norepinephrine reduced surgical stress responses and attenuated the release of proinflammatory cytokines TNF-α and IL-6. It was also associated with a lower risk of AKI.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 111978"},"PeriodicalIF":5.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to comment on \"The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery\".","authors":"Lis S M Hoeijmakers, Heleen Driessens, Marcel den Dulk, Steven W M Olde Damink, Joost M Klaase, Bart C Bongers","doi":"10.1016/j.jclinane.2025.112007","DOIUrl":"https://doi.org/10.1016/j.jclinane.2025.112007","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"112007"},"PeriodicalIF":5.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing geriatric syndromes in perioperative care - implications for anesthesia practice: A narrative review","authors":"Ricky Ma ,&nbsp;Jacqueline M. Leung","doi":"10.1016/j.jclinane.2025.112023","DOIUrl":"10.1016/j.jclinane.2025.112023","url":null,"abstract":"<div><div>As the aging population grows, anesthesiologists increasingly care for older surgical patients with geriatric syndromes. This paper reviews key geriatric syndromes, particularly frailty and postoperative delirium, and highlights their implications for anesthesia practice with evidence-based management strategies. Frailty, a predictor of poor surgical outcomes, is often underrecognized preoperatively. Screening tools such as the Fried Frailty Phenotype and Hospital Frailty Risk Score can help identify at-risk patients. Prehabilitation, including exercise, nutritional optimization, and multimodal pain management, may improve surgical recovery. For postoperative delirium, prevention is the most important intervention. Medication reconciliation and multimodal nonpharmacologic approaches, such as restoring sensory aids, optimizing sleep hygiene, and early reorientation, should be prioritized. Other strategies include multimodal analgesia with the minimization of opiates and avoiding deliriogenic medications. Delirium screening using the Confusion Assessment Method or Nurses' Delirium Screening Checklist enables early detection and intervention. Pharmacologic treatment of delirium should be limited to severe agitation, with haloperidol or dexmedetomidine used cautiously. By recognizing frailty and postoperative delirium as geriatric syndromes with potentially modifiable risk factors, anesthesiologists can implement targeted perioperative strategies to improve functional recovery and surgical outcomes in older adults.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112023"},"PeriodicalIF":5.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination of shorter and longer-acting LA vs. longer-acting LA for brachial plexus block: Systematic review and meta-analysis of randomized clinical trials","authors":"Adeeb Oweidat MD, DESAIC, EDRA ,&nbsp;Carla R. Hightower MD, MBA ,&nbsp;Vishal Uppal FRCA ,&nbsp;Hari Kalagara MD ,&nbsp;Nada Sadek MD ,&nbsp;Melinda S. Seering MD ,&nbsp;Chris Childs MS ,&nbsp;Rakesh V. Sondekoppam MBBS, MD","doi":"10.1016/j.jclinane.2025.112017","DOIUrl":"10.1016/j.jclinane.2025.112017","url":null,"abstract":"<div><h3>Background</h3><div>Combining shorter-acting local anesthetics (LA) with longer-acting ones should theoretically ensure a quick-onset block without compromising on the duration of blockade. We wanted to perform a review of literature evaluating combination of shorter-acting and longer-acting LA in comparison to long-acting LA alone when used for brachial plexus blocks in terms of block characteristics and efficacy.</div></div><div><h3>Methods</h3><div>Primary literature searches were performed in PubMed, Embase, and the Cochrane databases from their inception through October 26, 2023. Randomized clinical trials (RCTs) utilizing any combination of mixtures of a shorter and longer-acting LA (combination LA) compared to any single long-acting LA for brachial plexus block in adults were selected. The primary outcomes of interest were sensory and motor block onset times while secondary outcomes included duration of blockade, duration of analgesia and, the need for conversion to general anesthesia (GA).</div></div><div><h3>Results</h3><div>A total of 4209 primary references were reviewed and after exclusions, 11 RCTs were included for data extraction. Pooled data showed that compared to long-acting LA, combination of LAs did not reduce the sensory onset time [MD (95 % CI) -0.44 min (−0.89; 0.02)] nor the motor onset [MD (95 % CI): 0.01 (−1.30 to 1.32)]. The combination group showed a shorter duration of sensory and motor blockade without differences in other secondary outcomes.</div></div><div><h3>Conclusion</h3><div>Our meta-analysis of RCTs indicate that combination of shorter and long acting LAs did not provide benefit in terms of onset time while leading to notably shorter durations of sensory and motor blockade compared to longer acting LA alone when used in brachial plexus blocks.</div><div>PROSPERO registration no.: CRD42023476579.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112017"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"United States' anesthesia workdays in 2022–2023 – Implications for national workforce assessments","authors":"Franklin Dexter MD PhD FASA ,&nbsp;Richard H. Epstein MD FASA ,&nbsp;Richard P. Dutton MD MBA","doi":"10.1016/j.jclinane.2025.111988","DOIUrl":"10.1016/j.jclinane.2025.111988","url":null,"abstract":"<div><h3>Background</h3><div>Over the decade from 2013 to 2023, the percentage increase in the number of anesthesia clinicians in the United States increased more than the percentage increase in the yearly number of cases involving an anesthesia clinician. A potential explanation is that the expansion of ambulatory surgery has increased anesthetizing locations on weekday mornings, thereby decreasing overall anesthetic hours per clinician. We tested this hypothesis using 2022–2023 data from the American Society of Anesthesiologist's National Anesthesia Clinical Outcomes Registry. We performed analyses comparable to those from our earlier studies using 2013 NACOR data.</div></div><div><h3>Methods</h3><div>We studied <em>N</em> = 13,901,414 anesthetics, excluding labor epidurals. Cases' start and end dates and times were used to create categories, including regular workdays (Mondays – Fridays, excluding US federal holidays) and weekends (Saturdays – Sundays). Proportions of cases were estimated along with standard errors calculated among the 26 four-week periods. A similarity index compared pairwise, between regular workdays and weekends, the relative proportions of different anesthesia Current Procedural Terminology procedure codes.</div></div><div><h3>Results</h3><div>Regular workdays accounted for 95.5 % of the total anesthetic minutes. Among regular workdays, the 8-h period of 7:30 AM to 3:29 PM had 82.9 % (0.1 %) of anesthesia minutes, significantly &gt;0.8 (i.e., ⅘, <em>P</em> &lt; .0001). There were 61.2 % (0.1 %) of all anesthetic minutes completed on regular workdays and before 1:00 PM, significantly &gt;53.0 % (<em>P</em> &lt; .0001), the percentage from 2013. There were 79.2 % (0.1 %) of all anesthetic minutes on regular workdays 7:30 AM to 3:29 PM, significantly &gt;70.3 % (<em>P</em> &lt; .0001), from 2013. At least ⅔^rd of anesthetic minutes, 67.9 % (0.1 %) were covered by the 6.5 h, 7:30 AM to 1:59 PM. More than half (<em>P</em> &lt; .0001) of the minutes were mornings: 51.6 % (0.1 %). There were 4.1 % (0.1 %) of case minutes on weekends, &lt;5.2 % (P &lt; .0001), the observed percentage in 2013. There was moderate similarity (0.511 [0.002]) between surgical procedure categories on regular workdays 7:30 AM to 3:29 PM and weekends, much &lt;0.8, the value expected if experience with the types of procedures performed on regular workdays matched those on weekends, and &lt; 0.55 (<em>P</em> &lt; .0001), the estimate from 2013.</div></div><div><h3>Conclusions</h3><div>Nationwide, anesthesia times on regular workdays sum to substantially less than 8 h and even less than in 2013. Demand for daily numbers of clinicians at the start of the regular workdays probably is a large contributor to perceived workforce shortages and ongoing institutional support. The small but significant changes for weekends suggest an increased rationale for the development of acute care anesthesiology teams.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 111988"},"PeriodicalIF":5.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging data-driven machine learning: From explainable risk prediction to hierarchical clustering-based subtypes of postoperative delirium in a prospective non-cardiac surgery cohort","authors":"Jin-yun Shi ,&nbsp;Da-peng Gao ,&nbsp;Rong Chen ,&nbsp;Xiao-yi Hu ,&nbsp;Lan-yue Zhu ,&nbsp;Yue Zhang ,&nbsp;Qing Li ,&nbsp;Qing-hong Mao ,&nbsp;Mu-huo Ji ,&nbsp;Di Fan ,&nbsp;Qing-ren Liu","doi":"10.1016/j.jclinane.2025.112006","DOIUrl":"10.1016/j.jclinane.2025.112006","url":null,"abstract":"<div><h3>Study objective</h3><div>To leverage perioperative indicators in developing an explainable machine learning (ML) model for postoperative delirium (POD) prediction, discover distinct data-driven POD subtypes through hierarchical clustering analysis, and enhance personalized risk stratification to inform targeted clinical interventions.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of several prospective observational studies, including 1106 patients who had non-cardiac surgery. Univariate analysis and the least absolute shrinkage and selection operator (LASSO) regression was used to screen essential features associated with POD. We compared six algorithms: adaptive boosting with classification trees, random forest (RF), neural networks, support vector machines, extreme gradient boosting with classification trees and logistic regression. SHapley Additive exPlanations (SHAP). was used to interpret the best one and to externally validate it in another large tertiary hospital. Among patients who developed POD, we conducted hierarchical clustering analysis on the risk factors (identified through univariate screening in the prediction model) to delineate distinct subtypes. We then compared the length of postoperative hospital stay and mortality rates (at 1, 3, 6, and 12 months postoperatively) between the identified clusters.</div></div><div><h3>Main results</h3><div>We identified 14 POD risk factors to develop ML models. The RF model performed best among the six ML models (area under the curve [AUC] of 0.85, 95 % confidence interval [CI], 0.78–0.91). SHAP analysis highlighted surgery duration, preoperative mini-mental state examination score, and Edmonton Frail Scale as the top predictors of POD. Hierarchical clustering identified three distinct POD subtypes: Subtype 1 (high-risk profile with significant comorbidity and inflammatory dysregulation, longest hospitalization: 21.5 days ([interquartile range (IQR) 19–28]; <em>p</em> &lt; 0.001), Subtype 2 (resilient majority with optimal survival; Log-rank <em>p</em> &lt; 0.001), and Subtype 3 (advanced age, frailty and low cognitive reserve, shortest hospitalization: 5 days [IQR 4–8]). Kaplan-Meier analysis showed significant 12-month survival differences among the subtypes (Subtype 2 &gt; Subtype 3 &gt; Subtype 1; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Our study validated the utility of ML models, particularly RF, in predicting POD and identified three novel data-driven subtypes with distinct clinical characteristics.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112006"},"PeriodicalIF":5.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of machine learning predictive models for gastric volume based on ultrasonography: A multicentre study","authors":"Jie Liu ,&nbsp;Shiqi Li ,&nbsp;Minhui Li ,&nbsp;Guifei Li ,&nbsp;Niannian Huang ,&nbsp;Bin Shu ,&nbsp;Jie Chen ,&nbsp;Tao Zhu ,&nbsp;He Huang ,&nbsp;Guangyou Duan","doi":"10.1016/j.jclinane.2025.112010","DOIUrl":"10.1016/j.jclinane.2025.112010","url":null,"abstract":"<div><h3>Study objective</h3><div>Aspiration of gastric contents is a serious complication associated with anaesthesia. Accurate prediction of gastric volume may assist in risk stratification and help prevent aspiration. This study aimed to develop and validate machine learning models to predict gastric volume based on ultrasound and clinical features.</div></div><div><h3>Methods</h3><div>This cross-sectional multicentre study was conducted at two hospitals and included adult patients undergoing gastroscopy under intravenous anaesthesia. Patients from Centre 1 were prospectively enrolled and randomly divided into a training set (Cohort A, <em>n</em> = 415) and an internal validation set (Cohort B, <em>n</em> = 179), while patients from Centre 2 were used as an external validation set (Cohort C, <em>n</em> = 199). The primary outcome was gastric volume, which was measured by endoscopic aspiration immediately following ultrasonographic examination. Least absolute shrinkage and selection operator (LASSO) regression was used for feature selection, and eight machine learning models were developed and evaluated using Bland-Altman analysis. The models' ability to predict medium-to-high and high gastric volumes was assessed. The top-performing models were externally validated, and their predictive performance was compared with the traditional Perlas model.</div></div><div><h3>Main results</h3><div>Among the 793 enrolled patients, the number and proportion of patients with high gastric volume were as follows: 23 (5.5 %) in the development cohort, 10 (5.6 %) in the internal validation cohort, and 3 (1.5 %) in the external validation cohort. Eight models were developed using age, cross-sectional area of gastric antrum in right lateral decubitus (RLD-CSA) position, and Perlas grade, with these variables selected through LASSO regression. In internal validation, Bland-Altman analysis showed that the Perlas model overestimated gastric volume (mean bias 23.5 mL), while the new models provided accurate estimates (mean bias −0.1 to 2.0 mL). The models significantly improved prediction of medium-high gastric volume (area under the curve [AUC]: 0.74–0.77 vs. 0.63) and high gastric volume (AUC: 0.85–0.94 vs. 0.74). The best-performing adaptive boosting and linear regression models underwent externally validation, with AUCs of 0.81 (95 % confidence interval [CI], 0.74–0.89) and 0.80 (95 %CI, 0.72–0.89) for medium-high and 0.96 (95 %CI, 0.91–1) and 0.96 (95 %CI, 0.89–1) for high gastric volume.</div></div><div><h3>Conclusions</h3><div>We propose a novel machine learning-based predictive model that outperforms Perlas model by incorporating the key features of age, RLD-CSA, and Perlas grade, enabling accurate prediction of gastric volume.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112010"},"PeriodicalIF":5.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tissue perfusion as the ultimate target of hemodynamic interventions in the perioperative period","authors":"Zbigniew Putowski ,&nbsp;Jan Bakker ,&nbsp;Eduardo Kattan ,&nbsp;Glenn Hernández ,&nbsp;Hafid Ait-Oufella ,&nbsp;Wojciech Szczeklik ,&nbsp;Philippe Guerci","doi":"10.1016/j.jclinane.2025.112009","DOIUrl":"10.1016/j.jclinane.2025.112009","url":null,"abstract":"<div><div>This point-of-view article examines the complex relationship between global hemodynamic parameters and tissue perfusion, emphasizing the limitations of using macrohemodynamic metrics as proxies for tissue-level oxygen delivery. Key topics of the paper include the physiological determinants of tissue perfusion, the influence of anesthesia on perfusion dynamics, and the role of hemodynamic interventions in optimizing perfusion. Furthermore, we explore the application of tissue perfusion monitoring in the perioperative setting, highlighting its potential to guide individualized therapies. By addressing these interconnected factors, we advocate for further research to evaluate whether adding perfusion-guided strategies to current protocols can enhance patient outcomes.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112009"},"PeriodicalIF":5.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}