Artificial intelligence and its clinical application in Anesthesiology: a systematic review.

PURPOSE: Application of artificial intelligence (AI) in medicine is quickly expanding. Despite the amount of evidence and promising results, a thorough overview of the current state of AI in clinical practice of anesthesiology is needed. Therefore, our study aims to systematically review the application of AI in this context. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched Medline and Web of Science for articles published up to November 2022 using terms related with AI and clinical practice of anesthesiology. Articles that involved animals, editorials, reviews and sample size lower than 10 patients were excluded. Characteristics and accuracy measures from each study were extracted. RESULTS: A total of 46 articles were included in this review. We have grouped them into 4 categories with regard to their clinical applicability: (1) Depth of Anesthesia Monitoring; (2) Image-guided techniques related to Anesthesia; (3) Prediction of events/risks related to Anesthesia; (4) Drug administration control. Each group was analyzed, and the main findings were summarized. Across all fields, the majority of AI methods tested showed superior performance results compared to traditional methods. CONCLUSION: AI systems are being integrated into anesthesiology clinical practice, enhancing medical professionals' skills of decision-making, diagnostic accuracy, and therapeutic response.

Prevalence of Problematic Use of Opioids in Patients with Chronic Noncancer Pain: A Systematic Review with Meta-analysis.

BACKGROUND AND OBJECTIVE: Opioid prescription for chronic noncancer pain is associated with problematic use. We aimed to review and summarize the evidence on the prevalence of problematic use of opioids in adults with chronic noncancer pain and investigate whether the prevalence rates were changing over time. DATABASES AND DATA TREATMENT: A systematic review of the literature was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the literature in the electronic databases MEDLINE, SCOPUS, and Web of Science and studies with adult participants with chronic noncancer pain using opioids with indication of one or more of the following terms about problematic opioid use: abuse, misuse, addiction, dependence, problematic use, and aberrant behavior/use were eligible for data extraction. Meta-analysis was performed to estimate the pooled prevalence rates using a random-effects model, and subanalysis was conducted. RESULTS: Our search identified a total of 784 potentially relevant studies. After a thorough evaluation, 19 papers, mostly from the United States, were included in our qualitative and quantitative synthesis. The majority of the data came from speciality pain clinics. The estimated prevalence of problematic use of opioids in adults with chronic noncancer pain was 36.3% (95% confidence interval: 27.4 to 45.2%; I2  = 99.64%). Problematic opioid use was mostly identified using the questionnaire method. Thirteen studies (68%) presented a low risk of bias. CONCLUSIONS: Our study presents an alarming estimate regarding the prevalence of problematic use of opioids among patients with noncancer pain. These results deserve special attention from health care professionals and health authorities.

Translation, Cultural Adaptation and Validation of the Current Opioid Misuse Measure for European Portuguese.

INTRODUCTION: Current practice guidelines recommend using Current Opioid Misuse Measure to screen aberrant opioid-related behaviors in chronic pain patients. Our aims were to translate, adapt and validate it to be used in Portuguese chronic pain patients. MATERIAL AND METHODS: Translation and cultural adaptation process followed guidelines and a model of principles for good practice. Adult chronic pain patients on opioid therapy, from one major hospital in Portugal, were invited to complete the translated version. Descriptive statistics, Cronbach's alpha, inter-item, item-total and intra-class correlation coefficients and principal components analysis were applied. RESULTS: Translation process was performed as planned and the validation sample was composed by 98 patients (median age = 62.5 years). Regarding internal consistency, a global Cronbach's alpha of 0.778 was obtained and item-total correlations of all items were above 0.20 with four exceptions. An intra-class correlation coefficient of 0.90 was found between test and retest. Regarding validity, all 17 items presented a content validity index above 0.80. Six principal components were extracted and explained 66.3% of the variance. DISCUSSION: The Portuguese version of Current Opioid Misuse Measure was properly translated, adapted and validated; showing good quality in terms of reliability and validity. This is the first instrument to screen aberrant opioid-related behaviors in Portuguese chronic pain patients. Consequently, it will aid and promote the identification of opioid misuse in these patients. CONCLUSION: The implementation of this questionnaire may reduce the incidence and morbimortality of opioid misuse among chronic pain patients and should improve chronic pain treatment in Portugal.

Introdução: Orientações atuais recomendam a utilização da Escala de Uso Indevido de Opióides para rastrear comportamentos aberrantes, relativos ao uso de opióides em dor crónica. Os objetivos foram a sua tradução, adaptação cultural e validação para a população portuguesa com dor crónica. Material e Métodos: O processo de tradução e adaptação cultural seguiu as recomendações. Adultos com dor crónica medicados com opióides, seguidos num hospital português de grande dimensão, foram convidados a completar a versão traduzida. Recurso a estatística descritiva, alfa de Cronbach, correlações inter-item, item-total, intra-classe, e análise de componentes principais. Resultados: A tradução decorreu conforme planeado e a amostra de validação foi de 98 doentes (mediana de idades = 62,5 anos). Relativamente à consistência interna, alfa Cronbach global = 0,778, correlações item-total dos itens > 0,20 (quatro exceções), e coeficiente de correlação intra-classe = 0,90 (entre teste e reteste). Relativamente à validade, os 17 itens apresentaram um índice de validade de conteúdo > 0,80. Extraíram-se seis componentes principais, que explicaram 66,3% da variância. Discussão: A versão portuguesa da Escala de Uso Indevido de Opióides foi adequadamente traduzida, adaptada e validada; demonstrando boa qualidade relativamente à confiabilidade e validade. Este é o primeiro instrumento para rastrear comportamentos aberrantes, relativos ao uso de opióides em portugueses com dor crónica. Consequentemente, ajudará e promoverá a identificação do uso indevido de opióides nestes doentes. Conclusão: A implementação deste questionário poderá reduzir a incidência e morbimortalidade do uso indevido de opióides em doentes com dor crónica, e deverá melhorar o tratamento da dor crónica em Portugal.

The postoperative venous thromboembolism (TREVO) study - risk and case mortality by surgical specialty. / Estudo TRomboEmbolismo Venoso pós­Operatório (TREVO) ­ risco e mortalidade por especialidade cirúrgica.

INTRODUCTION AND OBJECTIVES: Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. METHODS: We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included. RESULTS: Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery and general surgery (p<0.001). There were 50 cases of pulmonary embolism, 11 of which were fatal. Of the 90 cases, 12.2% occurred under neuraxial anesthesia and 55.1% in patients with American Society of Anesthesiology III physical status. At least 37.7% of patients with events received a prophylactic dose of injectable anticoagulant postoperatively. The overall risk decreased from 2008 to 2012. Venous thromboembolism-associated mortality during hospitalization was 21.1% (95% CI 13.6-30.4). CONCLUSIONS: The incidence of postoperative symptomatic venous thromboembolism was 1.33/1000. Neurosurgery showed the greatest risk. Mortality was 21.1%.

Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity.

Persistent postoperative pain (PPP) has been described as a complication of cardiac surgery (CS). We aimed to study PPP after CS (PPPCS) by conducting a systematic review of the literature regarding its incidence, intensity, location, and the presence of neuropathic pain, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The review comprised 3 phases: a methodological assessment of 6 different databases identifying potential articles and screening for inclusion criteria by 2 independent reviewers; data extraction; and study quality assessment. Meta-analysis was used to estimate the pooled incidence rates using a random effects model. We have identified 442 potentially relevant studies through database searching. A total of 23 studies (involving 11,057 patients) met our inclusion criteria. Persistent postoperative pain affects 37% patients in the first 6 months after CS, and it remains present more than 2 years after CS in 17%. The reported incidence of PPP during the first 6 months after CS increased in recent years. Globally, approximately half of the patients with PPPCS reported moderate to severe pain. Chest is the main location of PPPCS followed by the leg; neuropathic pain is present in the majority of the patients. This is the first systematic review and meta-analysis to provide estimates regarding incidence and intensity of PPPCS, which elucidates its relevance. There is an urgent need for adequate treatment and follow-up in patients with PPPCS.

Quality of recovery after anaesthesia measured with QoR-40: a prospective observational study / Qualidade da recuperação pós-anestesia medida com QoR-40: um estudo observacional prospectivo

Abstract Background: QoR-40, a 40-item questionnaire on quality of recovery from anaesthesia, has been shown to measure health status after surgery. Our aim was to evaluate the incidence of poor quality of recovery in our Post Anaesthesia Care Unit and to compare their QoR-40 scores before surgery and 3 months later. Methods: A prospective observational study was conducted in adult patients consecutively admitted from 18 June to 12 July 2012. The follow-up period was 3 months. We exclude patients submitted to cardiac surgery, neurosurgery, obstetric surgery and with a mini-mental state examination test score lower than 25. The primary endpoint was quality of recovery measured with the validated Portuguese for Portugal version of the QoR-40 before surgery (T0), 24 h after surgery (T1) and 3 months after (T2). Results: A total of 114 patients completed the study. Mean QoR-40 score was 169 and patients with poor quality of recovery were identified if their QoR-40 score was lesser than 142. This occurred in 26 patients (24%). Global median scores for patients with poor quality of recovery were lower at T0 (121 vs. 184, p < 0.001), at T1 (120 vs. 177, p < 0.001) and at T2 (119 vs. 189, p < 0.001). Conclusion: Patients with poor quality of recovery had lower quality of life. This fact may allow earlier and more effective interventions, in order to improve quality of life after surgery. Beside its utility after surgery, QoR-40 may be important prior to surgery to identify patients who will develop a poor quality of recovery.

Resumo Justificativa: QoR-40, um questionário com 40 itens sobre a qualidade de recuperação da anestesia, mostrou medir o estado de saúde após a cirurgia. O nosso objetivo foi avaliar a incidência de má qualidade da recuperação em nossa Sala de Recuperação Pós-Anestesia e comparar os escores do QoR-40 antes e três meses depois da cirurgia. Métodos: Estudo observacional prospectivo, feito com pacientes adultos admitidos consecutivamente de 18 de junho a 12 de julho de 2012. O período de acompanhamento foi de três meses. Excluímos os pacientes submetidos a cirurgia cardíaca, neurocirurgia, cirurgia obstétrica e aqueles com escore inferior a 25 no miniexame do estado mental. O desfecho primário foi a qualidade da recuperação medida com a versão do QoR-40, validada para a versão do português de Portugal, antes da cirurgia (T0), 24 horas após a cirurgia (T1) e três meses após a cirurgia (T2). Resultados: No total, 114 pacientes completaram o estudo. A média dos escores no QoR-40 foi de 169 e os pacientes com má qualidade de recuperação foram identificados se os seus escores no QoR-40 fossem menores do que 142. Isso ocorreu em 26 pacientes (24%). As médias dos escores globais dos pacientes com má qualidade de recuperação foram menores em T0 (121 vs. 184, p < 0,001), T1 (120 vs. 177, p < 0,001) e T2 (119 vs. 189, p < 0,001). Conclusão: Os pacientes com má qualidade de recuperação apresentaram uma pior qualidade de vida. Esse fato pode permitir intervenções precoces e mais eficazes para melhorar a qualidade de vida após a cirurgia. Além de sua utilidade após a cirurgia, o QoR-40 pode ser importante antes da cirurgia para identificar os pacientes que desenvolverão uma má qualidade de recuperação.

Evaluating Persistent Postoperative Pain in One Tertiary Hospital: Incidence, Quality of Life, Associated Factors, and Treatment.

BACKGROUND: Persistent postoperative pain (PPP) is defined as persistent pain after surgery of greater than three months' duration. OBJECTIVES: Identify the incidence of PPP in our hospital and its associated factors; evaluate quality of life (QoL) and treatment of patients. PATIENTS AND METHODS: We conducted an observational prospective study in adults proposed to various types of surgery using the brief pain inventory short form preoperatively (T0), one day after surgery, and three months later (T3). If the patient had pain at T3 and other causes of pain were excluded, they were considered to have PPP, and the McGill Pain Questionnaire Short Form was applied. QoL was measured with the EuroQol 5-dimension questionnaire (EQ-5D). RESULTS: One hundred seventy-five patients completed the study. The incidence of PPP was 28%, and the affected patients presented lower QoL. The majority referred to a moderate to severe level of interference in their general activity. Cholecystectomies were less associated with PPP, and total knee/hip replacements were more associated with it. Preoperative pain, preoperative benzodiazepines or antidepressants, and more severe acute postoperative pain were associated with the development of PPP. Half of the patients with PPP were under treatment, and they refer a mean symptomatic relief of 69%. CONCLUSIONS: This study, apart from attempting to better characterize the problem of PPP, emphasizes the lack of its treatment.

Quality of recovery after anaesthesia measured with QoR-40: a prospective observational study.

BACKGROUND: QoR-40, a 40-item questionnaire on quality of recovery from anaesthesia, has been shown to measure health status after surgery. Our aim was to evaluate the incidence of poor quality of recovery in our Post Anaesthesia Care Unit and to compare their QoR-40 scores before surgery and 3 months later. METHODS: A prospective observational study was conducted in adult patients consecutively admitted from 18 June to 12 July 2012. The follow-up period was 3 months. We exclude patients submitted to cardiac surgery, neurosurgery, obstetric surgery and with a mini-mental state examination test score lower than 25. The primary endpoint was quality of recovery measured with the validated Portuguese for Portugal version of the QoR-40 before surgery (T0), 24h after surgery (T1) and 3 months after (T2). RESULTS: A total of 114 patients completed the study. Mean QoR-40 score was 169 and patients with poor quality of recovery were identified if their QoR-40 score was lesser than 142. This occurred in 26 patients (24%). Global median scores for patients with poor quality of recovery were lower at T0 (121 vs. 184, p<0.001), at T1 (120 vs. 177, p<0.001) and at T2 (119 vs. 189, p<0.001). CONCLUSION: Patients with poor quality of recovery had lower quality of life. This fact may allow earlier and more effective interventions, in order to improve quality of life after surgery. Beside its utility after surgery, QoR-40 may be important prior to surgery to identify patients who will develop a poor quality of recovery.

[Quality of recovery after anaesthesia measured with QoR-40: a prospective observational study]. / Qualidade da recuperação pós-anestesia medida com QoR-40: um estudo observacional prospectivo.

BACKGROUND: QoR-40, a 40-item questionnaire on quality of recovery from anaesthesia, has been shown to measure health status after surgery. Our aim was to evaluate the incidence of poor quality of recovery in our Post Anaesthesia Care Unit and to compare their QoR-40 scores before surgery and 3 months later. METHODS: A prospective observational study was conducted in adult patients consecutively admitted from 18 June to 12 July 2012. The follow-up period was 3 months. We exclude patients submitted to cardiac surgery, neurosurgery, obstetric surgery and with a mini-mental state examination test score lower than 25. The primary endpoint was quality of recovery measured with the validated Portuguese for Portugal version of the QoR-40 before surgery (T0), 24h after surgery (T1) and 3 months after (T2). RESULTS: A total of 114 patients completed the study. Mean QoR-40 score was 169 and patients with poor quality of recovery were identified if their QoR-40 score was lesser than 142. This occurred in 26 patients (24%). Global median scores for patients with poor quality of recovery were lower at T0 (121 vs. 184, p<0.001), at T1 (120 vs. 177, p<0.001) and at T2 (119 vs. 189, p<0.001). CONCLUSION: Patients with poor quality of recovery had lower quality of life. This fact may allow earlier and more effective interventions, in order to improve quality of life after surgery. Beside its utility after surgery, QoR-40 may be important prior to surgery to identify patients who will develop a poor quality of recovery.

Persistent Postoperative Pain after Cardiac Surgery: Incidence, Characterization, Associated Factors and its impact in Quality of Life.

BACKGROUND: Cardiac surgery (CS) ranks among the most frequently performed interventions worldwide and persistent postoperative pain (PPP) has been recognized as a relevant clinical outcome in this context. We aimed to evaluate its incidence, characteristics, associated factors and patient's quality of life (QoL). METHODS: Observational prospective study conducted in patients undergoing CS in a tertiary university hospital. PPP was defined as persistent pain after surgery with higher than 3 months' duration, after excluding other causes of pain. We used a set of questionnaires for data collection: Pain Catastrophizing Scale, Duke Health Profile, Brief Pain Inventory Short Form, McGill Pain Questionnaire Short Form, Douleur Neuropathique en 4 Questions and standardized questions regarding pain periodicity. RESULTS: A total of 288 patients have completed the study and 43% presented PPP assessed at 3 months (PPP3M); out of which 84% were not under any treatment. PPP patients reported significantly lower QoL, and a neuropathic pain (NP) component was present in 50% of them. Younger age, female gender, higher body mass index, catastrophizing, coronary artery bypass graft, osteoarthritis, history of previous surgery (excluding sternotomy) and moderate to severe acute postoperative pain were independent predictors of PPP3M. CONCLUSION: This is the first study comprehensively describing PPP after CS and identifying NP in half of them. Our results support the important role that PPP plays after CS in considering its interference in patients' daily life and their lower QoL, which deserves the attention of health care professionals in order to improve prevention, assessment and treatment of these patients. WHAT DOES THIS STUDY ADD?: This study comprehensively describes persistent postoperative pain (PPP) after cardiac surgery (CS) and identifies neuropathic pain (NP) in half of them. Our results support the important role that PPP plays after CS in considering its interference in patients' daily life and their lower quality of life.