Canadian Journal of Anesthesia-Journal Canadien D Anesthesie最新文献

{"title":"The applications of ChatGPT and other large language models in anesthesiology and critical care: a systematic review.","authors":"Nicolas Daccache, Joe Zako, Louis Morisson, Pascal Laferrière-Langlois","doi":"10.1007/s12630-025-02973-9","DOIUrl":"10.1007/s12630-025-02973-9","url":null,"abstract":"<p><strong>Purpose: </strong>ChatGPT and other large language models (LLMs) have gained immense popularity since their commercial release in 2022, with applications in various sectors including health care. We sought to evaluate their deployment in anesthesiology and critical care in a systematic review. Our aim was to describe the integration of LLMs in the field by showcasing and categorizing their current applications, assessing their performance in patient care, and reviewing application-specific ethical and practical challenges in deployment.</p><p><strong>Methods: </strong>Respecting Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched through PubMed®, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science®, from inception until 1 August 2024. We extracted all papers investigating LLMs in anesthesiology or critical care and reporting results. We segmented the literature into major themes and highlighted key findings and limitations.</p><p><strong>Results: </strong>From 480 retrieved articles, we included 45 papers. The evaluated models (GPT-4, GPT-3.5, Google Bard [now Gemini], LLaMA, and others) showed diverse applications in four segments: intensive care unit, patient education, medical education, and perioperative care. Large language models, especially newer models, are promising in predicting clinical scores, navigating simple clinical scenarios, and managing preoperative anxiety. Their performance remains below the clinician level in predicting outcomes, solving complex clinical scenarios (i.e., airway management), board examinations, and generating patient-directed documents, although newer models performed better than older ones.</p><p><strong>Conclusion: </strong>While LLMs are not yet equipped to fully assist physicians in anesthesiology and critical care, they have significant potential, and their capabilities are rapidly improving. Supervised use for select tasks can streamline patient care. Further trials are warranted as new versions of models become available.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42024567380 ); first submitted 22 July 2024.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"904-922"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional anesthesia use as a bridge to the provision of medical assistance in dying.","authors":"Catherine Moores, Duncan Maguire, Vincent P Fruci, Tim T H Jen","doi":"10.1007/s12630-025-02956-w","DOIUrl":"10.1007/s12630-025-02956-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1021-1022"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brachial plexus block at the level of the humeral head: a proof-of-concept observational cadaver and clinical study.","authors":"Jean-Pierre Lecoq, Annalinda Ciorra, Marie Renard, Alain Carlier, Pierre Bonnet, Jean-François Fils, Vincent Bonhomme, Emmanuel Guntz","doi":"10.1007/s12630-025-02962-y","DOIUrl":"10.1007/s12630-025-02962-y","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1023-1025"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia management for pediatric intestinal transplantation-a single-centre case series of eleven patients.","authors":"Melody Long, Asad Siddiqui, Yaron Avitzur, Dimitri Parra, Blayne Sayed, Anand Ghanekar, Mark Cattral, Naiyi Sun","doi":"10.1007/s12630-025-02976-6","DOIUrl":"10.1007/s12630-025-02976-6","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric intestinal transplantation is the main treatment modality for children with intestinal failure who develop severe complications including intestinal failure-associated liver disease, progressive loss of central venous access, and repeated admissions requiring critical care management. We aimed to describe the perioperative management of patients undergoing intestinal transplantation at a tertiary children's hospital between 2012 and 2023, identifying challenges and potential solutions.</p><p><strong>Methods: </strong>We retrospectively reviewed the anesthetic management of 11 children who underwent intestinal transplantation between January 2012 and August 2023. Information collected included preoperative characteristics, intraoperative management, and postoperative outcomes.</p><p><strong>Results: </strong>The predominant diagnosis of intestinal failure was gastroschisis (5/11, 45%), while progressive liver disease (6/11, 55%) was the main indication for transplantation. In our cohort, five patients underwent isolated intestinal transplantation, four underwent multivisceral transplantation, and two had liver and intestine transplantation. Five patients had postreperfusion syndrome, while eight (73%) patients were hypothermic (temperature [T] < 35 °C). Ten patients required at least one vasopressor/inotrope intraoperatively, with the first-line agent being norepinephrine. Three patients were extubated in the operating room; they had a median intensive care unit stay of three days. To date, the 1-year patient and graft survival rates were 91% (10/11).</p><p><strong>Conclusions: </strong>With careful preoperative planning, judicious fluid management, and anticipation of potential hemodynamic instability, including postreperfusion syndrome, our data show that pediatric intestinal transplantation can be performed safely, with improved long-term outcomes compared with previous reports.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"945-953"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The magnitude and impact of noise on patient care in a tertiary postanesthesia care unit: an observational study and survey of nursing perspectives.","authors":"Ben T Chen, Wendy H C Song, Anthony Chau, Su-Yin MacDonell","doi":"10.1007/s12630-025-02963-x","DOIUrl":"10.1007/s12630-025-02963-x","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1026-1027"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative vision loss and visual disturbances in a Canadian provincial administrative data repository.","authors":"Michael T Paillé, Frank Stockl, Thomas C Mutter","doi":"10.1007/s12630-025-02974-8","DOIUrl":"10.1007/s12630-025-02974-8","url":null,"abstract":"<p><strong>Purpose: </strong>Population-based, health administrative database analyses of postoperative vision loss (POVL) have primarily examined International Classification of Diseases (ICD) diagnosis codes for ischemic optic neuropathy (ION) and retinal artery occlusion (RAO) after cardiac and spine surgery. Other nonspecific diagnosis codes describing significant vision loss have been mostly overlooked. We sought to investigate their contribution to the broader epidemiology of POVL after a variety of surgical procedures.</p><p><strong>Methods: </strong>Using administrative data from Manitoba, Canada, we identified hospital admissions where patients underwent spine, cardiac, and other common inpatient and ambulatory surgeries between 1987 and 2017. To avoid misclassifying pre-existing vision loss as POVL, we excluded admissions where patients had ICD diagnosis codes suggestive of pre-existing vision loss in at least 5 years of preoperative data. Postoperative vision loss outcomes included specific diagnosis codes, such as RAO and ION, and nonspecific diagnosis codes for blindness, visual disturbances, and visual field defects.</p><p><strong>Results: </strong>We excluded 158,730 admissions for suspected pre-existing vision loss, including 345 admissions with POVL diagnosis codes. We included 170 POVL cases in 596,241 admissions. Nonspecific diagnosis codes accounted for 140 (82%) cases and were associated with risk factors previously reported for ION, RAO, and cortical blindness. Overall, 24 (14%) cases were RAOs, and privacy restrictions precluded analysis of the remaining 6 (4%) cases. The incidence of RAO and nonspecific diagnosis codes was highest after cardiac and spine surgery. Still, other types of surgery accounted for 87 (62%) of the nonspecific diagnosis code cases and 11 (46%) of the RAO cases.</p><p><strong>Conclusion: </strong>In surgical patients without a history of vision loss, new diagnosis codes for blindness, visual field defects, and visual disturbances other than ION and RAO may represent an important but overlooked aspect of POVL epidemiology.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"923-933"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure management during cardiac surgery: a survey of Canadian cardiac anesthesiologists, perfusionists, and cardiac surgeons.","authors":"Karen Zhao, Renée Fournier, Kevin Kennedy, Hilary P Grocott, Emilie Belley-Côté, Matthew Cameron, Richard P Whitlock, C Scott Brudney, Allison M Janda, Eric Jacobsohn, C David Mazer, François Lamontagne, Christie Smith, Gordon Guyatt, Jessica Spence","doi":"10.1007/s12630-025-02971-x","DOIUrl":"10.1007/s12630-025-02971-x","url":null,"abstract":"<p><strong>Purpose: </strong>Clinicians presume a relationship between the management of blood pressure during cardiac surgery and postoperative morbidity and mortality. With limited evidence to inform practice, we surveyed Canadian cardiac anesthesiologists, perfusionists, and cardiac surgeons. We sought to solicit information to inform a trial evaluating the blood pressure management approach on outcomes after cardiac surgery.</p><p><strong>Methods: </strong>We iteratively developed a survey assessing the lowest and highest blood pressures respondents would target, the narrowest feasible blood pressure range to achieve, the range of blood pressure observed in clinical practice, and factors influencing targeted blood pressure before, during, and after cardiopulmonary bypass (CPB). We contacted leads from every Canadian hospital providing cardiac surgery to distribute the survey via a computerized link. We used a modified Dillman approach to optimize response rate. Responses were analyzed descriptively.</p><p><strong>Results: </strong>Of 819 clinicians surveyed, 532 (65%) responded. Respondents' lowest pooled mean arterial pressure (MAP) target, presented as mean (standard deviation [SD]), was 59 (6) mm Hg before CPB, 55 (7) mm Hg during CPB, and 60 (5) mm Hg after CPB. Respondents' highest pooled MAP target, presented as mean (SD), was 92 (10) mm Hg before CPB, 84 (7) mm Hg during CPB, and 75 (6) mm Hg after CPB. The narrowest feasible MAP range, presented as mean (SD), all respondents believed could be achieved was 19 (7) mm Hg before CPB, 16 (7) mm Hg during CPB, and 20 (7) mm Hg after CPB.</p><p><strong>Conclusions: </strong>The responses to our survey support the clinical acceptability of a trial examining blood pressure target thresholds at the extreme ends of the range recommended by existing guidelines and the feasibility of maintaining blood pressure within a narrow target range.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"895-903"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure management in cardiac surgery: how low can you go?","authors":"Vanja Ristovic, Louise Y Sun","doi":"10.1007/s12630-025-02972-w","DOIUrl":"10.1007/s12630-025-02972-w","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"877-881"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New evidence amid old assumptions for thromboembolic risk after total knee arthroplasty: a twist in the story.","authors":"Derek Dillane, Colleen Harnett","doi":"10.1007/s12630-025-02958-8","DOIUrl":"10.1007/s12630-025-02958-8","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"871-876"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of perioperative changes in serum primary metabolites in patients after major surgery under general anesthesia: an exploratory secondary analysis of the TAPIR trial.","authors":"Nadine Krieg, Philipp Baumbach, Iuliana-Andreea Ceanga, Anne Standke, Markus H Gräler, Ralf A Claus, Julia Y Nicklas, Martin S Winkler, Bernd Saugel, Sina M Coldewey","doi":"10.1007/s12630-025-02984-6","DOIUrl":"10.1007/s12630-025-02984-6","url":null,"abstract":"<p><strong>Purpose: </strong>Major surgery under general anesthesia substantially alters physiologic homeostasis. Nevertheless, the intricate effects on the metabolome are poorly studied. Metabolic fingerprints may allow the identification of patients at risk for unfavourable outcomes.</p><p><strong>Methods: </strong>We conducted a secondary, exploratory, targeted metabolomic analysis of 177 high-risk patients undergoing major abdominal surgery under general anesthesia enrolled in the Targeting preoperatively Assessed Personal cardiac Index in major abdominal suRgery patients (TAPIR) randomized controlled trial. We analyzed primary serum metabolites using liquid chromatography coupled with triple quadrupole mass spectrometry before surgery (on preoperative day 0) and on postoperative day 3 (POD3). Our primary aim was to investigate postoperative alterations in primary serum metabolites. Secondary objectives included analyses in different subgroups, including patients with postoperative complications (composite of complication, delirium, acute kidney injury, and infection) up to day 30. We applied regression analyses and calculated false discovery rate-adjusted P values to address multiplicity.</p><p><strong>Results: </strong>Of the 37 metabolites analyzed, 20 were different on POD3 after comparison with before surgery (lower: 4-hydroxyproline, alanine, asparagine, citrulline, cystine, dimethylglycine, glutamine, glutamic acid, glycine, guanosine, histidine, niacinamide, serine, uric acid, and xanthine; higher: isoleucine, leucine, methionine, methionine sulfoxide, pyruvic acid; adjusted P values < 0.05). We found no statistically significant preoperative differences between patients with and without postoperative complications (all adjusted P values ≥ 0.05). Postoperatively, patients with (vs without) delirium within thirty days after surgery (n = 13/177) showed lower levels of alanine, asparagine, citrulline, cystine, glutamine, glutamic acid, serine, threonine, and tyrosine after adjusting for preoperative metabolite levels.</p><p><strong>Conclusion: </strong>Major abdominal surgery under general anesthesia was associated with complex changes in primary metabolites. We identified alterations in certain metabolites that were associated with postoperative delirium. Future research may establish metabolic patterns allowing the identification of patients at risk for unfavourable postoperative outcomes.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"954-965"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}