Anesth. Res., Volume 2, Issue 1 (March 2025) – 4 articles

Background/Objectives: The rapid development of Large Language Models (LLMs) presents promising applications in healthcare, including patient education. In anesthesia, where patient anxiety is common due to misunderstandings and fears, LLMs could alleviate perioperative anxiety by providing accessible and accurate information. This study explores the potential of LLMs to enhance patient education on anesthetic and perioperative care, addressing time constraints faced by anesthetists. Methods: Three language models—ChatGPT-4, Claude 3, and Gemini—were evaluated using three common patient prompts. To minimize bias, incognito mode was used. Readability was assessed with the Flesch–Kincaid, Flesch Reading Ease, and Coleman–Liau indices. Response quality was rated for clarity, comprehension, and informativeness using the DISCERN score and Likert Scale. Results: Claude 3 required the highest reading level, delivering detailed responses but lacking citations. ChatGPT-4o offered accessible and concise answers but missed key details. Gemini provided reliable and comprehensive information and emphasized professional guidance but lacked citations. According to DISCERN and Likert scores, Gemini had the highest rank for reliability and patient friendliness. Conclusions: This study found that Gemini provided the most reliable information, followed by Claude 3, although no significant differences were observed. All models showed limitations in bias and lacked sufficient citations. While ChatGPT-4o was the most comprehensible, it lacked clinical depth. Further research is needed to balance simplicity with clinical accuracy, explore Artificial Intelligence (AI)–physician collaboration, and assess AI’s impact on patient safety and medical education. Full article

Background: While multimodal analgesia is the standard of care for postoperative pain relief, opioid medications continue to be a part of the treatment regimen, especially for more invasive surgeries such as spinal fusion, craniofacial reconstruction, laparotomy, and others. In pediatric patients, safe usage, storage, and dosing are especially important, along with clear instructions to caregivers on how to manage their child’s pain. Combination opioids such as hydrocodone with acetaminophen and acetaminophen with codeine are the most commonly prescribed opioid medications for postoperative pain control. However, these combination products can lead to acetaminophen toxicity, limit the ability to prescribe acetaminophen or ibuprofen, and add to caregiver confusion. Administering acetaminophen and ibuprofen individually rather than in combination products allows the maximal dosing of these nonopioid medications. The primary aim of this quality improvement (QI) project was to increase the utilization of single-agent opioids for postoperative pain control, primarily oxycodone, by the various surgical groups here at Cook Children’s Medical Center (CCMC). Methods: The project setting was a tertiary-level children’s hospital with a level 2 trauma center, performing over 20,000 surgeries annually. The opioid stewardship committee (OSC) mapped the steps and overlapping activities in the intervention that led to changes in providers’ prescription practices. A Plan–Do–Study–Act continuous improvement cycle allowed for an assessment and modification of implementation strategies. Statistical control process charts were used to detect the average percentage change in surgical specialties using single-agent opioid therapy. Data were monitored for three periods: one-year pre-intervention, one-year post-intervention, and one-year sustainment periods. Results: There were 4885 (41%) pre-intervention procedures, 3973 (33%) post-intervention procedures, and 3180 (26%) sustainment period procedures that received opioids. During the pre-intervention period, the average proportion of single-agent opioids prescribed was 8%. This average shifted to 89% for the first five months of the post-intervention period, then to 91% for the remainder of the study. Conclusions: The methodical application of process improvement strategies can result in a sustained change from outpatient post-surgical combination opioid prescriptions to single-agent opioid prescriptions in multiple surgical departments. Full article

Background: In Germany, over 16 million pre-anesthesia consultations (PAC) are conducted annually, which is associated with a significant investment of time and high costs. However, some PACs do not lead to surgery, which is inefficient and results in wasted resources. This study evaluates the costs and time loss associated with PACs that did not result in anesthesia-required surgery or diagnostic procedures and identifies the predictors of these cancellations. Methods: A total of 1357 PACs conducted in September 2023 at the University Hospital Aachen were retrospectively analyzed. The study groups included patients whose PACs resulted in anesthesia-required surgery or diagnostic procedures (SURG group) and those whose PACs did not (NoSURG group). The primary outcomes were costs in EUR and the hours lost due to PACs not resulting in anesthesia for patients in the NoSURG group, and the secondary outcomes included the predictors of surgery cancellations, the frequency of missing test results, necessary pre-anesthesia re-consultations due to missing tests, and hospital length of stay for NoSURG patients. Results: In September 2023, 7.3% (99/1357) of PACs did not result in anesthesia-required procedures. ASA scores were higher in the NoSURG group, with almost two-thirds classified as ASA III or higher (p = 0.001). The NoSURG group had more planned postoperative IMC stays (16.2% vs. 9.3%; p = 0.027) and fewer medical report letters available (50.5% vs. 97.1%; p < 0.001). The reasons for surgery cancellation were often undetermined (47.5%). Other reasons included surgeons opting for a conservative approach (19.2%), patient decisions (9.1%), surgery no longer indicated (8.1%), hospital capacity constraints (5.1%), patient transfers (3.0%), and high surgical risk (8.1%). The annual projected cost for the NoSURG group was EUR 29,182, with 888 h of time loss. The median hospital length of stay for the NoSURG group was 5 (2; 15) days. Conclusions: PACs that were carried out but were not followed by anesthesiology services led to substantial costs and time loss. Improving medical report availability and assessing procedure necessity beforehand might help to reduce these expenses and time losses. Full article

Background/Objectives: Hemolysis has been associated with acute kidney injury (AKI) in infants and neonates after surgery involving cardiopulmonary bypass (CPB). Erythrocyte hemolysis and subsequent end-organ injury have been shown to be a complex process involving the liberation of multiple molecules that mediate the loss of nitric oxide and oxidative damage. This study assesses the association of multiple products of erythrocyte hemolysis with the evolution of AKI in neonates and infants undergoing CPB surgery. Methods: Blood and urine samples were collected at multiple time points before and after CPB and stored within an institutional biorepository. Twenty-one patients with AKI were matched with twenty-one non-Aki patients based on demographic and case complexity data. Results: Samples were analyzed for cell-free hemoglobin, heme, non-transferrin-bound iron, haptoglobin, hemopexin, and nitrite/nitrate. NGAL and KIM-1 were measured to index AKI. Cell-free hemoglobin was higher, haptoglobin was lower, and haptoglobin:hemoglobin ratio was lower in AKI compared to non-AKI patients. Conclusions: AKI in neonates and infants after CPB is associated with a pre and postoperative decrease in serum haptoglobin. These results confirm the need for future studies to prevent injury from hemolysis during CPB and potentially identify at-risk patients with decreased haptoglobin levels before surgery if delay is an option. Full article