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

{"title":"Large language models in perioperative medicine-applications and future prospects: a narrative review.","authors":"Arnaud Romeo Mbadjeu Hondjeu, Zi Ying Zhao, Luka Newton, Anass Ajenkar, Emily Hladkowicz, Karim Ladha, Duminda N Wijeysundera, Daniel I McIsaac","doi":"10.1007/s12630-025-02980-w","DOIUrl":"10.1007/s12630-025-02980-w","url":null,"abstract":"<p><strong>Purpose: </strong>Large language models (LLMs) are a subset of artificial intelligence (AI) and linguistics designed to help computers understand and analyze human language. Clinical applications of LLMs have recently been recognised for their potential enhanced analytic capacity. Availability and performance of LLMs are expected to increase substantially over time with a significant impact on patient care and health care provider workflow. Despite increasing recognition of LLMs, insights on the utilities, associated benefits and limitations are scarce among perioperative clinicians. In this narrative review, we delve into the functionalities and prospects of existing LLMs and their clinical application in perioperative medicine. Furthermore, we summarize challenges and constraints that must be addressed to fully realize the potential of LLMs.</p><p><strong>Source: </strong>We searched MEDLINE, Google Scholar, and PubMed® databases for articles referencing LLMs in perioperative care.</p><p><strong>Principal findings: </strong>We found that in the perioperative setting (from surgical diagnosis to discharge postoperatively), LLMs have the potential to improve the efficiency and accuracy of health care delivery by extracting and summarizing clinical data, making recommendations on the basis of these findings, as well as addressing patient queries. Moreover, LLMs can be used for clinical decision-making support, surveillance tools, predictive modelling, and enhancement of medical research and education.</p><p><strong>Conclusions: </strong>The integration of LLMs into perioperative medicine presents a significant opportunity to enhance patient care, clinical decision-making, and operational efficiency. These models can streamline processes, provide personalized patient education, and offer robust decision support. Nevertheless, their clinical implementation requires addressing several key challenges, including managing hallucinations, ensuring data security, and mitigating inherent biases. If these challenges are met, LLMs can revolutionize perioperative practice, improving both patient outcomes and clinician workflow.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"1000-1014"},"PeriodicalIF":3.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resourcefulness in anesthesia: overcoming absurd limitations in pediatric induction in sub-Saharan Africa.","authors":"Amina Omari, Sheidai Salim, Simon Ponthus, Lionel Dumont","doi":"10.1007/s12630-025-02968-6","DOIUrl":"https://doi.org/10.1007/s12630-025-02968-6","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175920","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":"A cross-sectional study of diversity in regional anesthesia and acute pain medicine fellowships.","authors":"Uchenna O Umeh, Mandip S Kalsi, Maya Tailor, Haoyan Zhong, Shivani Mehta, Niyant Jain, Poonam Pai, Bridget Pulos, Rodney Gabriel, Raymond S Joseph, Justas Lauzadis, Mary J Hargett, Meg A Rosenblatt","doi":"10.1007/s12630-025-02947-x","DOIUrl":"10.1007/s12630-025-02947-x","url":null,"abstract":"<p><strong>Purpose: </strong>The number of underrepresented in medicine (URiM) physicians is disproportionately low compared with the general population. Patient-physician racial concordance may increase patient satisfaction and therapeutic adherence. In this study, we evaluated diversity within 2023-2024 regional anesthesia and acute pain medicine (RA/APM) fellowship programs and discuss methods to increase diversity and inclusion.</p><p><strong>Methods: </strong>The Hospital for Special Surgery Institutional Review Board (IRB no. 2023-1862) approved this cross-sectional survey study. We distributed a questionnaire to RA/APM fellowship directors (FDs) on 2 October 2023 and present responses as counts and percentages or medians and interquartile ranges.</p><p><strong>Results: </strong>We sent questionnaires to 84 FDs with 44 responses (52%)-39 from the USA and five from Canada. Overall, 4/44 (9%) FDs identified as URiM. Many FDs reported no URiM (57%) or lesbian, gay, bisexual, transgender, queer, intersex, asexual, or other (LGBTQIA +) fellows (50%). We observed no differences regarding gender identity, with 46% cisgender female FDs and 46% female fellows reported. While 35 (80%) FDs considered themselves successful at having a diverse program, 27 (61%) reported no outreach programs targeted to underrepresented groups. Thirty-two (73%) programs reported Accreditation Council for Graduate Medical Education accreditation and 33 (75%) reported participation in the 2023 San Francisco Residency and Fellowship Match.</p><p><strong>Conclusions: </strong>Organizational diversity offers several advantages; however, there is a discrepancy between the diversity of RA/APM FDs and fellows compared with the general US and Canadian population. Methods to further increase URiM representation at the trainee and FD levels should be further explored.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"801-810"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011493","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":"Point-of-care ultrasound-guided fluid management to prevent hypotension after induction of general anesthesia-a conundrum to conquer!","authors":"Anisha Pauline Paul, Aruna Parameswari, Priadharsan Pavazhakannan, Mahalakshmi Sankar, Jabeena Salim","doi":"10.1007/s12630-025-02954-y","DOIUrl":"10.1007/s12630-025-02954-y","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"865-866"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055019","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":"Metrics to assess the quality of anesthesia, perioperative care, and acute pain management in Canada: a scoping review.","authors":"Janny X C Ke, Kathryn Sparrow, Mindy A Smith, Kang Mu Yoo, May-Sann Yee, Louise Y Sun, W Scott Beattie, Edlyn Lim, Matthias Görges","doi":"10.1007/s12630-025-02943-1","DOIUrl":"10.1007/s12630-025-02943-1","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this scoping review was to consolidate a list of metrics that can be used to measure quality in anesthesiology, perioperative medicine, and acute pain management in Canada.</p><p><strong>Methods: </strong>We included English-language full-text articles involving metrics (including patient-reported outcome and patient-reported experience measures, quality and safety indicators, and practice standards) for adults aged 18 yr and older undergoing inpatient non-cardiac surgery requiring an anesthesiologist. We searched MEDLINE®, Embase, CINAHL, Web of Science™, the Cochrane Database of Systematic Reviews, and grey literature to find articles on the topic from January 2015 to March 2022. In addition, we contacted 64 Canadian hospitals for existing anesthesia quality assurance and improvement metrics; they responded from June to October 2022. Two independent reviewers performed screening and data extraction. We grouped and condensed similar candidate metrics using thematic analysis.</p><p><strong>Results: </strong>We assessed 4,493 publications, of which 63 met the inclusion criteria. We extracted 662 candidate metrics and consolidated them into 94 distinct metrics. Metrics reflected themes of perioperative management (n = 47), safety and standards (n = 23), patient-centredness (n = 11), intraoperative anesthetic care (n = 5), perioperative team leadership (n = 4), and efficiency (n = 4). Metrics spanned all quality-of-care categories (process, outcome, and structure) and perioperative phases but were limited by poor supporting evidence.</p><p><strong>Conclusions: </strong>We consolidated a list of 94 metrics that can be used to evaluate the quality of anesthesia care. Further work will require verification of feasibility and validity prior to adoption, with operationalization of these metrics into practical indicators that are measurable and comparable.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"822-854"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112899","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":"Concerns with inflation line position in preformed nasal endotracheal tubes-proximal or distal?","authors":"Banupriya Ravichandrane, Janani Vijayasundaram, Santhosh Arulprakasam, Priya Rudingwa","doi":"10.1007/s12630-025-02953-z","DOIUrl":"10.1007/s12630-025-02953-z","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"860-861"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062585","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":"A standardized set of metrics to assess the quality of anesthesia, perioperative care, and acute pain management in Canada: a multidisciplinary modified Delphi study.","authors":"Janny X C Ke, Mindy A Smith, Kathryn Sparrow, Nicholas West, May-Sann Yee, Kang Mu Yoo, Louise Y Sun, W Scott Beattie, Matthias Görges","doi":"10.1007/s12630-025-02951-1","DOIUrl":"10.1007/s12630-025-02951-1","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to develop a consensus list of metrics to measure the quality of care in anesthesia, perioperative care, and acute pain management in Canada.</p><p><strong>Methods: </strong>We sought to conduct a modified Delphi study involving a multidisciplinary panel of perioperative health care professionals (anesthesiologists, surgeons, nurses, internal medicine and family medicine physicians, and hospital administrators), patients, and caregivers. Participants reviewed a candidate list of metrics synthesized from a previous scoping review and performed three rounds of independent iterative scoring and feedback to achieve consensus. In round 3, we asked participants to identify priority metrics to include in a list of core metrics, and we also asked health care professionals to assess the feasibility of implementing each metric.</p><p><strong>Results: </strong>There were 80 participants (49 health care professionals, 22 patients, and 9 caregivers) who completed at least one round of voting, with 56 completing all three rounds. The panel achieved consensus on 87 metrics, of which they deemed 33 to be priority core metrics. The health care professional and patient/caregiver subgroups differed in prioritizing core metrics. Most participants voted airway complications, no residual neuromuscular blockade, difficult airway documentation, complication or critical incident reporting, and complications from pain management the highest priority metrics. Most health care professional participants considered the core metrics to be already measured, currently feasible, or likely feasible by 2025.</p><p><strong>Conclusions: </strong>A multidisciplinary panel developed a list of metrics for measuring the quality of anesthesiology care in Canada. Many metrics require further refinement and validation, and future research is required to guide the measurement techniques and implementation approaches.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"698-720"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112858","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":"Prevention of hypotension after neuraxial anesthesia in nonobstetric surgery: a systematic review.","authors":"Sandra Lee, Nehal Islam, Karim S Ladha, Mark C Bicket, Duminda N Wijeysundera","doi":"10.1007/s12630-025-02925-3","DOIUrl":"10.1007/s12630-025-02925-3","url":null,"abstract":"<p><strong>Purpose: </strong>Hypotension occurs frequently during neuraxial anesthesia and is associated with increased risks of perioperative complications. We sought to conduct a systematic review and meta-analysis of randomized controlled trials that evaluated interventions intended to mitigate exposure to intraoperative hypotension and prevent complications following the administration of neuraxial anesthesia for major nonobstetric noncardiac surgery.</p><p><strong>Source: </strong>We searched MEDLINE, Embase, PubMed®, and the Cochrane Controlled Register of Trials (database inception to 2 August 2023) for randomized controlled trials (RCTs) that evaluated interventions intended to reduce hypotension during neuraxial anesthesia in major noncardiac nonobstetric surgery, without any restrictions on the comparator type. The outcomes of interest were any measure of intraoperative hypotension (e.g., incidence, duration) and postoperative complications.</p><p><strong>Principal findings: </strong>Among 33 included RCTs (n = 3,880) evaluating six classes of interventions, interventions that reduced the risk of hypotension included colloid preload (vs crystalloid, risk ratio [RR], 0.48; 95% confidence interval [CI], 0.30 to 0.80; P = 0.004; I² = 12%; very-low-certainty evidence) and prophylactic ondansetron (vs placebo; RR, 0.64; 95% CI, 0.53 to 0.78; P < 0.001; I² = 39%; moderate-certainty evidence). Prophylactic ephedrine was also associated with reduced time spent in hypotension. Nevertheless, crystalloid preloading did not reduce risks of hypotensive events compared with no preload (RR, 1.36; 95% CI, 0.96 to 1.92; P = 0.09; I² = 0%; very-low-certainty evidence). There were no compelling data showing that these interventions reduced the risks of complications.</p><p><strong>Conclusions: </strong>Several interventions hold promise for mitigating exposure to hypotension following neuraxial anesthesia, albeit supported by very-low to moderate-certainty evidence. It remains unclear whether these interventions reduce the risks of postoperative complications.</p><p><strong>Study registration: </strong>PROSPERO ( CRD42022336197 ); first submitted 29 May 2022.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"721-737"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053898","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":"Finding meaning in measurement: time to make the national conversation around quality of care in anesthesiology louder.","authors":"Maha Al Mandhari, Tariq Esmail, Justyna Bartoszko","doi":"10.1007/s12630-025-02944-0","DOIUrl":"10.1007/s12630-025-02944-0","url":null,"abstract":"","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"683-693"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112865","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":"Effects of breathing circuit insulation on inspired gas conditioning and water vapour condensation: an in vitro study.","authors":"Thi Nguyen-Minh, Christian Hönemann, Alexander Zarbock, Marie-Luise Rübsam","doi":"10.1007/s12630-025-02959-7","DOIUrl":"10.1007/s12630-025-02959-7","url":null,"abstract":"<p><strong>Purpose: </strong>During general anesthesia, physiologic conditioning of inspired gases is bypassed. Mechanical ventilation with dry and cold gas from the central gas supply may lead to dehydration of the mucus membranes, cilia dysfunction, retention of secretions, and atelectasis. The use of metabolic fresh gas flow improves the conditioning of inspiratory gases but increases water vapour condensation within the breathing system. We sought to investigate the effects of breathing circuit insulation on the conditioning of inspired gases and the condensation of water vapour.</p><p><strong>Methods: </strong>In this in vitro study, we used a mechanical nonheated, nonhumidified lung model with carbon dioxide (CO₂) insufflation. We tested foam, cotton, and polyester insulation (FOI, COI, and PEI) against control (noninsulated regular tubing). We measured temperature, absolute humidity (AH), and water vapour condensation after 120 min. We performed 8 measurements per group (total N = 32) and adjusted P values and confidence intervals (CIs) for multiple testing using Bonferroni-Holm adjustment.</p><p><strong>Results: </strong>Regarding mean AH, FOI performed better than control. The mean (standard deviation [SD]) differences in AH between control and insulation were -0.63 (0.52) g·m^-3 H₂O for PEI (adjusted 95% CI, -1.42 to 0.17; P = 0.26), -0.63 (0.74) g·m^-3 H₂O for COI (adjusted 95% CI, -1.42 to 0.17; P = 0.26), and -1.13 (0.35) g·m^-3 H₂O for FOI (adjusted 95% CI, -1.92 to -0.33; P < 0.001). The mean temperature was higher in insulated circuits. The mean (SD) difference compared to control was 0.42 (0.28) °C for PEI (adjusted 95% CI, 0.05 to 0.79; P = 0.002), 0.62 (0.26) °C for COI (adjusted 95% CI, 0.25 to 0.99; P < 0.001), and -1.07 (0.14) °C for FOI (adjusted 95% CI, 0.70 to 1.44; P < 0.001). Condensation of water vapour was lower in insulated breathing circuits compared with control.</p><p><strong>Conclusion: </strong>Foam-based insulation was the most effective form of insulation of the breathing circuit to increase temperature and AH of inspired gases and to reduce water vapour condensation. Overall, the results of this in vitro study support the principle of breathing circuit insulation as a method for inspired gas conditioning during the use of metabolic flow anesthesia.</p>","PeriodicalId":56145,"journal":{"name":"Canadian Journal of Anesthesia-Journal Canadien D Anesthesie","volume":" ","pages":"780-790"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}