Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 6 Articles
Background: The American Society of Anesthesiologists Physical Status (ASA-PS) classification is widely used for perioperative communication and research with known variation in agreement amongst assessors. Large language models (LLM) are increasingly considered for uniform decision making due to agreement challenges within clinicians under identical inputs. The study compared four contemporary LLMs against clinicianderived consensus and quantified within-model stability across repeated assessments. Methods: In a cross-sectional vignette study, 228 anesthesiologists from Denmark, England, and India classified 20 standardized perioperative vignettes through online survey. The modal response per vignette was considered as clinician consensus. Four LLMs (ChatGPT-5.2 Plus, Gemini 3 Pro, Perplexity AI Pro, Claude 4 Sonnet) received same set of vignettes through identical prompts. Temporal stability was assessed by repeating each vignette query nine times per model (three-time windows across three nonconsecutive days) in fresh sessions. Primary outcome was exact agreement with clinician consensus. Results: Consensus agreement for modal LLM classifications was 18/20 (90%) for ChatGPT, 17/20 (85%) for Gemini, 17/20 (85%) for Claude, and 15/20 (75%) for Perplexity. Disagreement is clustered in vignettes with weak or split clinician consensus. Stability differed by model: Claude was fully stable across all vignettes (20/20), Gemini 19/20, ChatGPT 18/20, and Perplexity 14/20; instability typically involved adjacentclass shifts. Conclusions: Contemporary LLMs often match clinician modal judgement and are largely temporally stable, with discordance concentrated in clinically ambiguous boundary cases....
Background: Neostigmine is widely used to reverse nondepolarizing neuromuscular blockade in children, but the optimal dose under total intravenous anesthesia is uncertain. Aims: The primary aim was to compare the time to full neuromuscular recovery (TOF ratio of 1.0) following administration of neostigmine at doses of 0, 10, 20, and 30 μg/kg in children at a TOF count of 3. Secondary objectives were full reversal within 10 min and adverse events. Methods: This prospective, randomized, double- blind, parallel- group, superiority trial enrolled 120 children (2–10 years; ASA I–II) undergoing tonsillectomy. Participants received 0, 10, 20, or 30 μg/kg neostigmine at a TOF count of 3 measured by quantitative acceleromyography. The primary outcome was the time from TOF count of 3 to full reversal (TOF ratio = 1.0). Secondary outcomes were the proportion of patients achieving full reversal within 10 min and adverse events. Comparisons among active groups used the Kruskal–Wallis test. Results: A total of 118 patients were analyzed. Median [IQR] time to full reversal was 20.2 [14.8–24.1], 14.0 [10.7–16.8], 11.0 [8.2–15.5], and 11.2 [7.9–14.6] min in the 0, 10, 20, and 30 μg/kg groups, respectively. Reversal was significantly slower in the control group compared with all neostigmine doses. However, there was no statistically significant difference among the active doses (Kruskal–Wallis, p = 0.33). At 10 min, full reversal had occurred in 10.7%, 23.3%, 43.3%, and 33.3% of patients in the respective groups. Adverse events were uncommon, occurring in 10 of 118 patients, and consisted exclusively of transient bradycardia and tachycardia, without differences among groups. Conclusions: At TOF count of 3, neostigmine 10–30 μg/kg shortened reversal compared with no reversal, but doses above 10 μg/kg conferred no additional benefit. Quantitative monitoring remains essential, as fewer than half of patients achieved a TOF ratio of 1.0 within 10 min....
Background and Aims: Patient handover from the operating room to the recovery unit is critical but error‑prone in perioperative care. Despite its importance, structured training in handoff communication is rarely included in anesthesia curricula. This study aimed to design and evaluate an ADDIE‑based educational intervention to improve anesthesia students' handover competencies. Methods: A sequential explanatory mixed‐methods design was employed, with a qualitative phase followed by a quantitative RCT (pre‐test/post‐test control group). Educational needs were explored via semi‐structured interviews with anesthesia students, instructors, and recovery staff, plus clinical observation. Interview data underwent conventional content analysis based on the approach described by Hsieh and Shannon (2005). Based on these findings, a two‐session intervention was developed, incorporating simulation‐based role‐playing, video analysis, and multi‐source feedback. Sixty‐three undergraduate anesthesia students were individually randomized to intervention (n = 32) or control (n = 31) using a random numbers table, with semester as stratification variable. Handover skills were assessed pre‐ and post‐training using a validated 13‐item checklist; data were analyzed with paired/independent t‐tests. Results: The intervention and control groups were comparable at baseline (3.34 vs. 3.03, p = 0.343). Both groups improved, but the intervention showed a significantly greater increase in handoff skills, with mean scores rising from 3.34 ( ± 1.47) to 8.25 ( ± 2.24) (p < 0.001, within‐group Cohen's d = 1.692). The control group's improvement was modest (from 3.03 ± 1.08 to 3.61 ± 0.91). The between‐group comparison confirmed the superiority of the ADDIE‐based intervention (mean difference: 4.623, 95% CI: 3.741–5.505, p < 0.001). Structured theory with active learning effectively translated knowledge into practical competency. Conclusion: The ADDIE‑based intervention significantly enhanced handoff skills, highlighting the value of systematic instructional design in clinical education. These findings support integrating standardized communication training into curricula and warrant future multi‑center studies with long‑term follow‑up....
Regional anesthesia is vital for modern surgical practices, but accessibility to training is often hampered by the high cost of commercial phantom models. This study aimed to develop and evaluate low-cost, realistic phantom alternatives using Ecoflex, borax-containing polyvinyl alcohol (PVA), and plastisol compositions. The models were evaluated under ultrasound for imaging properties, including needle visibility, tissue resistance, cost, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), axial full width at half maximum (FWHM), and compared to a commercial reference (Blue Phantom). Initial qualitative assessments were performed by three experienced evaluators, and inter-observer agreement demonstrated good to excellent reliability. In addition, a long-term usability assessment was conducted more than one year after phantom preparation, involving 20 participants using a structured Likert scale. A statistically significant difference was observed among materials (Friedman test, p < 0.05), with PVA hydrogel containing 20 g borax and the Blue Phantom demonstrating the highest tissue realism scores, without a significant difference between them. The results showed that plastisol softener and PVA (20 g borax) hydrogel provided excellent needle visibility and tissue resistance and achieved an imaging performance comparable to the commercial model. Notably, CNR and SNR values for these materials approached reference levels, while costs ranged from $0.5 to $2.50 per 100 mL, representing a significant reduction compared to $45 per 100 mL for commercial models. In conclusion, this research confirms that affordable materials such as PVA and plastisol can effectively simulate human tissue for ultrasound-guided training. Furthermore, the findings suggest that PVA-based hydrogels may provide sustained usability over time, offering a practical and accessible solution for enhancing clinical skill acquisition in resource-constrained settings....
The rising incidence of hip fractures in aging populations necessitates optimized perioperative management to mitigate complications. This narrative review evaluates the impact of regional anesthesia (RA) and analgesia techniques compared to general anesthesia (GA) on perioperative outcomes in geriatric patients undergoing hip fracture surgery. Current evidence reveals no consistent mortality benefit for RA over GA. Multicenter trials such as REGAIN and RAGA found no significant difference in 30- to 60-day survival. Similarly, spinal anesthesia does not show a clear superior advantage over GA on postoperative delirium (POD) in geriatric hip fracture patients. For pneumonia and other major complications, current evidence remains inconclusive, with more well-designed studies needed in the future. Peripheral nerve blocks (PNBs), including femoral block, fascia iliaca compartment block, and pericapsular nerve group blocks, demonstrate superior perioperative analgesia by reducing opioid consumption and early pain scores. However, evidence on PNBs’ effects on mortality or major complications remains limited. Overall, RA and GA exhibit comparable mortality outcomes, while PNBs enhance pain management but require further high-quality trials to assess long-term benefits. Current data highlight the need for individualized anesthesia strategies and robust RCTs to clarify optimal practices in high-risk geriatric populations....
Introduction: Total intravenous anesthesia (TIVA) in children has gained popularity due to potential advantages, including decreased respiratory adverse events, postoperative nausea and vomiting, and emergence agitation. British Columbia Children's Hospital (BCCH) has a reputation for TIVA use, training, and advocacy, including intravenous induction. Aim: To inform practice change and education by exploring how institutional culture impacts TIVA adoption, particularly regarding intravenous cannulation in awake children. Methods: Current and former BCCH anesthesiologists and trainees were surveyed and interviewed about TIVA practices at BCCH and at their current institutions. The survey covered demographics, practice settings, past and current methods for induction and maintenance of anesthesia, factors contributing to technique selection, TIVA barriers and facilitators, and implementation factors. Semi- structured interviews conducted with a subset of participants were analyzed using deductive and inductive thematic analysis. Results: Twenty- six participants completed the survey: 21 attending physicians, 2 fellows, and 3 residents; 58% with < 10 years' and 23% with > 20 years' anesthesia practice. Most participants (92%) practised in an academic setting, caring for a median [interquartile range] 400 [200–500] children annually. Most (96%) indicated their BCCH experience had changed their practice, with a greater effect on using intravenous anesthesia for maintenance than induction. Changes were influenced by a positive experience (77%), supportive environment (42%), and scientific evidence (42%). Choice of anesthetic technique depended on patient factors (89%), institutional expectations (46%), pharmacology (42%), and patient preference (39%), but not parental preference (15%). Interviews with 11 participants focused on intervention bundles to enable success, expectation- setting, family education, equipment and staff availability, and supportive workflows. Conclusion: Training in a TIVA institution can have a profound effect on using TIVA in children and drive changes in anesthetic practice elsewhere. Introducing TIVA requires a supportive culture, appropriate equipment, and the personalization of approaches, and may benefit from understanding factors in change management....
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