Journal of Clinical Anesthesia最新文献

{"title":"Improving definitions and innovations for identification and prevention of postoperative opioid-induced respiratory depression (OIRD): Proceedings of the International Consensus Conference","authors":"Richard D. Urman , Andreas H. Taenzer , Albert Dahan , Alparslan Turan , Basem B. Abdelmalak , Bernd Saugel , Bhargavi Gali , Robert H. Dworkin , Faisal N. Masud , Frances Chung , Ken B. Johnson , Piyush Mathur , Michael Wong , Rutger van der Schrier , Sabry Ayad , Toby N. Weingarten , Tong Joo Gan (TJ) , Ashish K. Khanna","doi":"10.1016/j.jclinane.2026.112133","DOIUrl":"10.1016/j.jclinane.2026.112133","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112133"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023980","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":"Intravenous dexmedetomidine and its effects on remifentanil-induced hyperalgesia and opioid consumption: A systematic review and meta-analysis of randomized controlled trials","authors":"Narinder P. Singh MD ,&nbsp;Naveed T. Siddiqui MD ,&nbsp;James Khan FRCPC ,&nbsp;Jeetinder K. Makkar MD ,&nbsp;Preet M. Singh MD ,&nbsp;Cristian Arzola MD","doi":"10.1016/j.jclinane.2026.112138","DOIUrl":"10.1016/j.jclinane.2026.112138","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the efficacy of dexmedetomidine in reducing remifentanil-induced hyperalgesia (RIH) and its potential implications for acute opioid tolerance (AOT) in the adult surgical population.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Setting</h3><div>Perioperative setting.</div></div><div><h3>Patients</h3><div>Thirteen randomized controlled trials (RCTs) including 803 patients.</div></div><div><h3>Interventions</h3><div>Intravenous dexmedetomidine.</div></div><div><h3>Measurements</h3><div>A comprehensive systematic search of PubMed, Embase, and Scopus was performed from their inception through September 2024 to identify RCTs assessing the effectiveness of dexmedetomidine in preventing RIH or AOT in the adult surgical population. Outcomes included time to first rescue analgesia, hyperalgesia incidence, opioid consumption, pain scores, and dexmedetomidine-related adverse events.</div></div><div><h3>Main results</h3><div>Dexmedetomidine significantly prolonged the time to first rescue analgesia (mean difference [MD] 46.08 min, 95% CI 30.52 to 61.65, <em>p</em> &lt; 0.00001) and reduced opioid consumption in the postoperative anesthesia care unit (PACU) and at 24 h postoperatively. Pain scores in PACU and up to 24 h were significantly lower with dexmedetomidine. Dexmedetomidine also exhibited a moderate protective effect against primary hyperalgesia but was associated with a greater incidence of intraoperative bradycardia.</div></div><div><h3>Conclusions</h3><div>Dexmedetomidine may mitigate RIH and, indirectly, aspects of AOT as suggested through surrogate outcomes such as opioid consumption and pain scores. However, significant heterogeneity limits certainty. While dexmedetomidine appears promising as an adjunct to remifentanil, careful monitoring for bradycardia is warranted. Further research should define optimal dosing strategies and clarify its role in preventing AOT.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112138"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074536","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":"Impact of preoperative sleep disturbance on perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery: A multicenter prospective cohort study","authors":"Chao Chen ,&nbsp;Shengfeng Yang ,&nbsp;Yewei Shi ,&nbsp;Zhenyan Zhu ,&nbsp;Xinglong Xiong ,&nbsp;Ling Huang ,&nbsp;Jun Lu ,&nbsp;Guangling Tang ,&nbsp;Xianzhou Gu ,&nbsp;Guangdi Zhang ,&nbsp;Yu Wan ,&nbsp;Ruixue Zhai ,&nbsp;Sijie Tang ,&nbsp;Yuanyu Feng ,&nbsp;Yusu Wang ,&nbsp;Jielei Pan ,&nbsp;Jing Shi","doi":"10.1016/j.jclinane.2026.112123","DOIUrl":"10.1016/j.jclinane.2026.112123","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative neurocognitive disorders (PND) significantly affect recovery in older adult surgical patients. However, whether untreated preoperative sleep disturbance (SD) independently contributes to postoperative cognitive dysfunction (POCD) remains unclear.</div></div><div><h3>Methods</h3><div>This multicenter prospective cohort study involving 535 patients aged ≥60 years undergoing major non-cardiac surgery (≥2 h) was conducted between June 30, 2024 and May 31, 2025. Patients were stratified by Pittsburgh Sleep Quality Index (PSQI): SD (PSQI&gt;7, <em>n</em> = 288) or non-SD (PSQI≤7, <em>n</em> = 247). The primary outcome was POCD assessed on postoperative days 7, 30, 90, and 180. Secondary outcomes included postoperative delirium (days 1–3), 15-item quality of recovery (QoR-15) scores, and insomnia severity (days 30, 90, and 180). Generalized estimating equations identified independent predictors of POCD.</div></div><div><h3>Results</h3><div>Compared with non-SD patients, SD patients showed significantly increased POCD risk on postoperative day 7 (41.7 % vs. 27.1 %; RR = 1.44, 95 %CI 1.16–1.79; <em>P</em> &lt; 0.001), day 30 (36.1 % vs. 18.2 %; RR = 1.73, 95 %CI 1.33–2.25; <em>P</em> &lt; 0.001), day 90 (25.7 % vs. 13.0 %; RR = 1.66, 95 %CI 1.22–2.25; <em>P</em> &lt; 0.001), and day 180 (19.4 % vs. 8.9 %; RR = 1.75, 95 %CI 1.21–2.52; <em>P</em> &lt; 0.001). Preoperative SD was associated with increased delirium risk (29.9 % vs. 18.6 %; RR = 1.43, <em>P</em> = 0.006), poorer QoR-15 scores (difference = 8, <em>P</em> &lt; 0.001), and persistent insomnia (34.7 % vs. 13.8 % at day 180, <em>P</em> &lt; 0.001). PSQI≥10 optimally predicted POCD risk (sensitivity 71.8 %, specificity 69.4 %).</div></div><div><h3>Conclusions</h3><div>Untreated preoperative SD independently predicts both early delirium and POCD after major non-cardiac surgery. A PSQI≥10 effectively identifies high-risk older adult patients, emphasizing preoperative sleep optimization as a potential strategy to mitigate postoperative cognitive impairment.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112123"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903816","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":"Impact of high-intensity work on the physical and mental health of anesthesiologists and intervention strategies","authors":"Wenjie Cheng","doi":"10.1016/j.jclinane.2026.112153","DOIUrl":"10.1016/j.jclinane.2026.112153","url":null,"abstract":"<div><div>With the ongoing transformation of the healthcare landscape, anesthesiologists are experiencing increasing occupational stress, which profoundly affects their physical and mental health. A high-intensity work environment adversely affects the physiological health of anesthesiologists, leading to issues such as cardiovascular diseases and sleep disorders. Furthermore, it also leads to an increased risk of mental health problems such as anxiety, depression, and burnout. This article aims to review the current state of research in this field and analyze the characteristics of anesthesiologists' work environments and the sources of stress they bring. It also explores the specific mechanisms by which high-intensity work negatively impacts physical and mental health, while considering the moderating effects of individual and work environment factors. Based on existing research, this article proposes targeted intervention strategies to improve anesthesiologists' physical and mental health. Finally, the limitations of the current research are summarized. Future research directions are proposed to provide references for further exploration in related fields.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112153"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213373","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":"From fast track to enhanced recovery after Cardiac surgery: 15 years of experience with the Leipzig concept in a specialized post-anesthesia care unit","authors":"Waseem Zakhary ,&nbsp;Anna Flo Forner ,&nbsp;David Holzhey ,&nbsp;Michael A. Borger ,&nbsp;Wolfgang Otto ,&nbsp;Massimiliano Meineri ,&nbsp;Joerg Karl Ender","doi":"10.1016/j.jclinane.2026.112137","DOIUrl":"10.1016/j.jclinane.2026.112137","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Cardiac Surgery (ERACS) has become the standard of care for selected patients. This study evaluated the evolution of the Leipzig concept in a specialized postanaesthesia care unit (PACU) over 15 years, with a focus on temporal trends and clinical outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on patients admitted to PACU after cardiac surgery at the Heart Center Leipzig between November 2005 and December 2020. Postoperative outcomes, including postprocedural complications, hospital length of stay, delirium, and mortality, were recorded. The outcomes were analyzed via multivariable models, and the adjusted results are reported.</div></div><div><h3>Results</h3><div>Among 56,371 cardiac surgery patients, 42% (<em>n</em> = 23,724) were admitted to the PACU and managed according to the ERACS protocol. After excluding incomplete datasets, 20,773 patients were analyzed. Utilization increased from 19% in 2006 to 60% in 2020. Despite a rising proportion of moderate- and high-complexity surgeries, in-hospital mortality has remained stable. Improved adherence to the ERACS components, including the integration of a delirium prevention bundle, was associated with significant reductions in postoperative delirium (<em>p</em> = 0.02) and in-hospital mortality (<em>p</em> = 0.007). Patients treated with sufentanil exhibited significantly lower in-hospital mortality than did those receiving remifentanil (<em>p</em> = 0.005). Subgroup analyses revealed higher in-hospital mortality in patients with EuroSCORE II ≥6%, complex procedures, and age ≥ 75 years (<em>p</em> &lt; 0.001, <em>p</em> = 0.04, and p &lt; 0.001, respectively).</div></div><div><h3>Conclusions</h3><div>This study presents the largest collection of consecutive ERACS patients ever collected and demonstrates the safety and efficacy of ERACS management with a specialized PACU, highlighting the benefits of continuous protocol optimization.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112137"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124986","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":"Effect of recruitment maneuver strategy on early postoperative atelectasis among intermediate- to high-risk patients undergoing abdominal surgery: A multicenter, 2 × 2 factorial, randomized clinical trial","authors":"Yi Xu ,&nbsp;Xue-Fei. Li ,&nbsp;Xiao-Jun Liao ,&nbsp;Ting-Ting Zheng ,&nbsp;Fei Fei ,&nbsp;Hong-Wei Zhang ,&nbsp;Xie Wang ,&nbsp;Gong-Wei Zhang ,&nbsp;Qian-Su Luo ,&nbsp;Hai Yu","doi":"10.1016/j.jclinane.2026.112159","DOIUrl":"10.1016/j.jclinane.2026.112159","url":null,"abstract":"<div><h3>Study objective</h3><div>Recruitment maneuver is pivotal for reducing the development of atelectasis but the optimal strategy is far from being established. This study hypothesized that the recruitment maneuver under ultrasound guidance compared with conventional technique, and that stepwise lung inflation compared with sustained inflation would reduce early postoperative atelectasis among intermediate- to high-risk patients undergoing abdominal surgery.</div></div><div><h3>Design</h3><div>A multicenter, 2 × 2 factorial, randomized clinical trial.</div></div><div><h3>Setting</h3><div>Six tertiary hospitals in China.</div></div><div><h3>Patients</h3><div>Adult patients who had an intermediate to high risk of pulmonary complications scheduled for abdominal surgery with an anticipated duration of 2 h or longer.</div></div><div><h3>Interventions</h3><div>Using a factorial design, patients receiving recruitment maneuver at end of surgery were allocated to ultrasound guidance or conventional technique without ultrasound guidance, combined with one of two lung inflation patterns (stepwise or sustained). All patients received lung-protective ventilation.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of early postoperative atelectasis, as assessed with lung ultrasound at 30 min after tracheal extubation.</div></div><div><h3>Main results</h3><div>Between April 2024 and October 2024, 353 patients were enrolled and randomly assigned. The ultrasound guidance group had a significantly lower incidence of early postoperative atelectasis compared with conventional technique group (75 [41.9%] vs 107 [61.5%]; RR 0.67 [95% CI 0.53 to 0.83]; <em>P</em> &lt; 0.001). There were significant differences favoring ultrasound guidance versus conventional technique for 5 prespecified secondary outcomes: early postoperative lung ultrasound score (median difference − 1 [95% CI −2 to 0]), incidence of hypoxemia (RR, 0.72; 95% CI, 0.58 to 0.88), oxygenation index (median difference 21.7 mmHg [95% CI 0.5 to 42.1]), incidence of pulmonary complications within 7 days postoperatively (RR 0.78 [95% CI 0.63 to 0.97]), and hospitalization cost (median difference − 3586 yuan [95% CI −7084 to −313]). For stepwise versus sustained inflation, there were no significant differences in primary and secondary outcomes.</div></div><div><h3>Conclusions</h3><div>Among intermediate- to high-risk patients undergoing abdominal surgery, recruitment maneuver under ultrasound guidance significantly reduced early postoperative atelectasis versus conventional technique, while both stepwise and sustained lung inflation can be used alternatively for achieving a recruitment maneuver.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112159"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271164","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":"The role of intraoperative real-time nociceptive monitoring in individualised anaesthesia and analgesia and where to head next; A narrative review","authors":"Krister Mogianos M.D,&nbsp;Anna K.M. Persson M.D, PhD","doi":"10.1016/j.jclinane.2026.112162","DOIUrl":"10.1016/j.jclinane.2026.112162","url":null,"abstract":"<div><div>Acute postoperative pain remains common despite advances in surgical techniques and enhanced recovery protocols, suggesting that patient-specific factors and individualised approaches may be key to improving outcomes. Real-time intraoperative nociceptive monitoring has emerged as a potential tool to guide analgesia and predict postoperative pain bur their role in an individualised anaesthesia framework is unclear. This narrative review qualitatively evaluates the evidence for various intraoperative nociception monitors within the conceptual framework of individualised anaesthesia and analgesia, aiming to identify promising methods and highlight knowledge gaps. Literature on real-time nociception monitoring devices, including Analgesia Nociception Index, Surgical Pleth Index, Nociception Level Index, pupillometry, skin conductance, processed EEG and Quantum Nociception Index was reviewed for physiologic rationale, intraoperative performance, and predictive validity for intraoperative opioid consumption, postoperative pain intensity and postoperative opioid consumption. All monitors are based on physiologically plausible surrogates of nociception, primarily autonomic or neurophysiologic responses. Evidence suggests these devices can influence intraoperative opioid titration, but their predictive accuracy for postoperative pain is modest and inconsistent. Confounders such as anaesthetic depth, vasoactive drugs, and patient variability limit specificity. Pooled data and randomised trials show small or no clinically meaningful improvements in postoperative outcomes. Multimodal approaches and integration with anaesthesia depth monitoring may enhance utility, but robust, procedure-specific protocols are lacking. Current real-time nociception monitors should be considered adjuncts rather than standalone tools. Their role in individualised anaesthesia remains theoretical until validated algorithms and high-quality trials demonstrate not only guidance in intraoperative opioid administration but also improvement in recovery and reduction of postoperative pain.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112162"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271167","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":"Analgesic efficacy of the subtransverse process interligamentary plane block in thoracic surgery: A randomized, controlled, non-inferiority trial","authors":"Wei Wu MD ,&nbsp;Yang Liu MM ,&nbsp;Meiyun Liu MD ,&nbsp;Jingjing Wu MD ,&nbsp;Wenxin He PhD ,&nbsp;Hong Shi PhD","doi":"10.1016/j.jclinane.2026.112149","DOIUrl":"10.1016/j.jclinane.2026.112149","url":null,"abstract":"<div><h3>Background</h3><div>Clinical evidence on the analgesic efficacy of the subtransverse process interligamentary plane (STIL) block after thoracic surgery remains limited. This study aimed to compare the postoperative analgesic efficacy of the STIL block versus the thoracic paravertebral block (TPVB) in thoracic surgery.</div></div><div><h3>Methods</h3><div>This randomized, non-inferiority trial enrolled patients undergoing video-assisted thoracoscopic surgery at a large academic medical center in China. Patients were randomly assigned (1:1) to receive either the STIL block or TPVB. Both groups received a single-shot injection of 15 mL of 1% ropivacaine mixed with 2% lidocaine. The primary outcome was pain intensity during deep inspiration within 48 h postoperatively, assessed by the area under the curve (AUC) of the numeric rating scale. A non-inferiority margin of 34 was predefined, and analyses were performed in both intention-to-treat and per-protocol populations.</div></div><div><h3>Results</h3><div>From February 1, 2023, to December 30, 2024, 114 eligible patients (median age 58 years [IQR 49–61]; 54.0% female) were enrolled and randomly assigned to receive either the STIL block (<em>n</em> = 57) or the TPVB (n = 57). Nine patients were excluded after randomisation, resulting in 105 patients included in the per-protocol analysis. In the per-protocol population, the 48-h postoperative pain AUC during deep inspiration was 196.04 ± 2.50 for the STIL group and 187.49 ± 4.13 for the TPVB group (mean difference = 8.59; 95% CI, −0.94 to 18.14). In the intention-to-treat population, the values were 195.24 ± 2.49 and 186.44 ± 4.03, respectively (mean difference = 9.12; 95% CI, −0.39 to 18.63), both within the predefined noninferiority margin. No serious adverse events were observed in either group.</div></div><div><h3>Conclusions</h3><div>This randomized clinical trial demonstrates that, in the studied population, the subtransverse process interligamentary plane block was non-inferior to the thoracic paravertebral block for postoperative pain control after thoracic surgery, providing an effective alternative for analgesia.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112149"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207073","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":"Generative AI in preanesthetic consultations: Effects on efficiency, documentation workload, quality, and physician–patient interaction: A simulation trial","authors":"Arend Rahrisch MD ,&nbsp;Julia Braun PhD ,&nbsp;Michael T. Ganter MD, PhD ,&nbsp;Tadzio R. Roche MD ,&nbsp;Donat R. Spahn MD ,&nbsp;David W. Tscholl MD ,&nbsp;Alexander Kaserer","doi":"10.1016/j.jclinane.2026.112163","DOIUrl":"10.1016/j.jclinane.2026.112163","url":null,"abstract":"<div><h3>Background</h3><div>Clinicians spend over 30% of their workday on electronic health records, reducing patient interaction and contributing to burnout. Preanesthetic consultations demand particularly detailed documentation, making them ideal for generative artificial intelligence (AI)-driven support.</div></div><div><h3>Objective</h3><div>This randomized simulation study evaluated a generative AI application based on a large language model (LLM) designed to automate documentation during preanesthetic consultations. We assessed its effects on consultation efficiency, clinician workload, physician–patient interaction, documentation quality, and user experience.</div></div><div><h3>Methods</h3><div>Thirty anesthesiologists at University Hospital Zurich each conducted two standardized consultations with the same simulated patient, once using the AI tool <em>Isaac</em> (Saipient AG, Zurich) and once with conventional manual documentation. Case order was randomized. The primary outcome was consultation duration. Secondary outcomes included visual attention (eye-tracking), human-computer interaction metrics, subjective workload (NASA-TLX), documentation quality (PDQI-9), self-assessed consultation quality, and workflow preferences.</div></div><div><h3>Results</h3><div>AI-assisted documentation reduced consultation duration by an average of 252 s (−18%, <em>p</em> &lt; 0.0001), screen fixation (−78%, <em>p</em> = 0.0002), refixations (−73%, p &lt; 0.0001), keyboard input (−87%, p &lt; 0.0001), and mouse clicks (−19%, <em>p</em> = 0.01). Clinicians reported a trend toward lower workload (−16%, <em>p</em> = 0.07) and better patient engagement (median rating 87 vs. 69). However, external raters judged documentation quality to be higher for manual reports (+4 PDQI-9 points; <em>p</em> = 0.004), and clinicians expressed less confidence in AI-generated formatting. Still, 60% preferred AI assistance overall.</div></div><div><h3>Conclusions</h3><div>LLM-based generative AI-supported documentation significantly improved efficiency and user experience in simulated preanesthetic consultations. While real-world use will require physicians to review and approve AI-generated drafts to ensure documentation quality, the structured outputs may still help reduce typing effort and screen interaction time, although the overall time savings may be smaller in clinical practice due to this additional review step.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112163"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258271","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":"Beyond systemic frailty: Identifying the “Achilles' heel” in surgical patients","authors":"Zhilin Liu ,&nbsp;Zhongwei Yang ,&nbsp;Rui Dong","doi":"10.1016/j.jclinane.2026.112150","DOIUrl":"10.1016/j.jclinane.2026.112150","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112150"},"PeriodicalIF":5.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213392","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}