Comparison of Conventional Anesthesia Nurse Education and an Artificial Intelligence Chatbot (ChatGPT) Intervention on Preoperative Anxiety: A Randomized Controlled Trial.

PURPOSE: This study aimed to evaluate the effects of an artificial intelligence (AI) chatbot (ChatGPT-3.5, OpenAI) on preoperative anxiety reduction and patient satisfaction in adult patients undergoing surgery under general anesthesia. DESIGN: The study used a single-blind, randomized controlled trial design. METHODS: In this study, 100 adult patients were enrolled and divided into two groups: 50 in the control group, in which patients received standard preoperative information from anesthesia nurses, and 50 in the intervention group, in which patients interacted with ChatGPT. The primary outcome, preoperative anxiety reduction, was measured using the Japanese State-Trait Anxiety Inventory (STAI) self-report questionnaire. The secondary endpoints included participant satisfaction (Q1), comprehension of the treatment process (Q2), and the perception of the AI chatbot's responses as more relevant than those of the nurses (Q3). FINDINGS: Of the 85 participants who completed the study, the STAI scores in the control group remained stable, whereas those in the intervention group decreased. The mixed-effects model showed significant effects of time and group-time interaction on the STAI scores; however, no main group effect was observed. The secondary endpoints revealed mixed results; some patients found that the chatbot's responses were more relevant, whereas others were dissatisfied or experienced difficulties. CONCLUSIONS: The ChatGPT intervention significantly reduced preoperative anxiety compared with the control group; however, no overall difference in the STAI scores was observed. The mixed secondary endpoint results highlight the need for refining chatbot algorithms and knowledge bases to improve performance and satisfaction. AI chatbots should complement, rather than replace, human health care providers. Seamless integration and effective communication among AI chatbots, patients, and health care providers are essential for optimizing patient outcomes.

Association between postoperative changes in the gut microbiota and pseudopsia after cardiac surgery: prospective observational study.

BACKGROUND: Delirium after cardiac surgery affects mortality, but the mechanism remains unclear. Previous studies have reported gut microbiota are associated with brain activity. Systemic inflammation and antibiotics can damage the gut microbiota after cardiac surgery. We aimed to investigate changes in the gut microbiota and the association between the gut microbiota and delirium after cardiac surgery. METHODS: Twenty-one patients who underwent cardiac surgery were enrolled. Microbiota counts and fecal organic acid concentrations were measured in fecal samples harvested before surgery, just after surgery, and before discharge. To quantify the microbiota, we extracted total RNA fractions and examined gut microbiota composition using 16S and 23S rRNA-targeted quantitative-reverse Transcription-PCR. Postoperative delirium, insomnia, and pseudopsia were assessed for 1 week. Postoperative total bacterial counts changed significantly from 10.2 ± 0.2 log10 cells/g of feces to 9.8 ± 0.5 in the first postoperative samples (p = 0.003) and 10.0 ± 0.4 in the samples before discharge (p = 0.039). Fecal pH was 6.9 ± 0.6 before surgery and 7.4 ± 0.7 in the first postoperative samples (p = 0.001). Postoperative Staphylococcus and Pseudomonas counts were significantly higher in patients with postoperative pseudopsia than in patients without pseudopsia (3.2 ± 1.3 vs. 5.4 ± 0.9; p = 0.012 and 1.7 ± 0.8 vs. 4.6 ± 2.7; p = 0.001). CONCLUSIONS: Total bacterial counts were significantly lower after surgery and until discharge. Fecal pH was significantly higher than preoperative levels. Staphylococcus and Pseudomonas counts were significantly higher in patients with postoperative pseudopsia.

Comparison of direct intra-arterial pressure and ClearSight finger cuff arterial pressure measurements in elderly patients undergoing transcatheter aortic valve replacement.

OBJECTIVE: This study aimed to assess the agreement between direct intra-arterial pressure and ClearSight finger cuff arterial pressure measurements in elderly patients undergoing transcatheter aortic valve replacement (TAVR). METHODS: A prospective observational study was conducted at Hitachi General Hospital, Japan, involving 30 patients aged 65 years and older who underwent TAVR under general anesthesia. Intra-arterial pressure and finger cuff arterial pressure measurements were recorded for 30 min after valve deployment. Bland-Altman analysis, four-quadrant plot analysis, and error grid analysis were used to assess the concordance between the two methods. Multiple regression analysis was performed to explore potential confounding factors affecting the agreement. RESULTS: The bias and precision of ClearSight measurements were -4.88 ±â€…15.46 (mmHg) for SBP, 4.73 ±â€…8.95 (mmHg) for mean, and 9.53 ±â€…9.01 (mmHg) for DBP. The Bland-Altman analysis demonstrated acceptable agreement between intra-arterial pressure and finger cuff arterial pressure measurements. The four-quadrant plot analysis showed good trend-tracking ability, and the error grid analysis revealed that most of the observed values fell into the no-risk category. The mean BP match ratio and SBP match ratio were influenced by several factors such as age, BSA, ejection fraction, valve size, and gender. CONCLUSION: The ClearSight finger cuff arterial pressure measurement showed good agreement with direct intra-arterial pressure in elderly patients undergoing TAVR. However, factors such as age, BSA, ejection fraction, valve size, and gender may influence the agreement between the two methods.

Noninvasive cardiac output measurements are inaccurate in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation.

BACKGROUND: Noninvasive cardiac output (CO) measured using ClearSight™ eliminates the need for intra-arterial catheter insertion. The purpose of this study was to examine the accuracy of non-invasive CO measurement in patients with severe aortic valve stenosis (AS). METHODS: Twenty-eight patients undergoing elective transcatheter aortic valve implantation were prospectively enrolled in this study. The CO was simultaneously measured twice before and twice after valve deployment (total of four times) per patient, and the CO was compared between the ClearSight (COClearSight) system and the pulmonary artery catheter (PAC) thermodilution (COTD) method as a reference. The Bland-Altman analysis was used to compare the percentage errors between the methods. RESULTS: A total of 112 paired data points were obtained. The percentage error between the COClearSight and COTD was 43.1%. The paired datasets were divided into the following groups according to the systemic vascular resistance index (SVRI): low (< 1,200 dyne s/cm5/m2) and normal (1,200-2,500 dyne s/cm5/m2). The percentage errors were 44.9% and 49.4%, respectively. The discrepancy of CO between COClearSight and COTD was not significantly correlated with SVRI (r = -0.06, P < 0.001). The polar plot analysis showed the trending ability of the COClearSight after artificial valve deployment was 51.1% which below the acceptable cut-off (92%). CONCLUSIONS: The accuracy and the trending ability of the ClearSight CO measurements were not acceptable in patients with severe AS. Therefore, the ClearSight system is not interchangeable with the PAC thermodilution for determining CO in this population.

Transesophageal echocardiography in robot-assisted mitral valve repair for Barlow's disease: usefulness for predicting artificial ring size and artificial chordae length using the loop technique.

BACKGROUND: There is no fully recommended methodology for surgery for Barlow's disease. Various methods have been proposed. The aim of this study was to investigate the effectiveness of transesophageal echocardiography (TEE) measurements for selecting the optimal annuloplasty ring size and determining the length of artificial chordae in patients with Barlow's disease who underwent robot-assisted mitral valvuloplasty (R-MVP). METHODS: Ten patients were included. Before R-MVP, the anesthesiologist used TEE to predict the optimal annuloplasty ring size and artificial chordae lengths that would reduce mitral regurgitation. The anesthesiolosist's predict ring size was not presented to the surgeon intraoperatively. RESULTS: In 70% (7/10) of cases, the surgeon performed mitral valve repair in full match with the anesthesiologist's repair plan. Mitral regurgitation was controlled in 85% (6/7) of cases. In three cases, the predict annuloplasty ring size and artificial chordae length were not match between anesthesiologist and surgeon. After the operation, 90% (9/10) of patients had no residual mitral regurgitation. CONCLUSIONS: Anesthesiologist's TEE measurements were useful for selecting the optimal annuloplasty ring size and artificial chordae length during R-MVP. TEE can play an important role in robot-assisted, minimally invasive cardiac surgery for mitral regurgitation with extensive and complex prolapse, such as in Barlow's disease.