The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials.

BACKGROUND: This meta-analysis aims to evaluate the effects of ketamine in critically ill intensive care unit (ICU) patients. METHODS: We searched for randomized controlled trials (RCTs) in PubMed, Scopus, and the Cochrane Library; the search was performed initially in January but was repeated in December of 2023. We focused on ICU patients of any age. We included studies that compared ketamine with other traditional agents used in the ICU. We synthesized evidence using RevMan v5.4 and presented the results as forest plots. We also used trial sequential analysis (TSA) software v. 0.9.5.10 Beta and presented results as TSA plots. For synthesizing results, we used a random-effects model and reported differences in outcomes of two groups in terms of mean difference (MD), standardized MD, and risk ratio with 95% confidence interval. We assessed the risk of bias using the Cochrane RoB tool for RCTs. Our outcomes were mortality, pain, opioid and midazolam requirements, delirium rates, and ICU length of stay. RESULTS: Twelve RCTs involving 805 ICU patients (ketamine group, n=398; control group, n=407) were included in the meta-analysis. The ketamine group was not superior to the control group in terms of mortality (in five studies with 318 patients), pain (two studies with 129 patients), mean and cumulative opioid consumption (six studies with 494 patients), midazolam consumption (six studies with 304 patients), and ICU length of stay (three studies with 270 patients). However, the model favored the ketamine group over the control group in delirium rate (four studies with 358 patients). This result is significant in terms of conventional boundaries (alpha=5%) but is not robust in sequential analysis. The applicability of the findings is limited by the small number of patients pooled for each outcome. CONCLUSIONS: Our meta-analysis did not demonstrate differences between ketamine and control groups regarding any outcome except delirium rate, where the model favored the ketamine group over the control group. However, this result is not robust as sensitivity analysis and trial sequential analysis suggest that more RCTs should be conducted in the future.

The Impact of Transcutaneous Electrical Nerve Stimulation (TENS) on Acute Pain and Other Postoperative Outcomes: A Systematic Review with Meta-Analysis.

This study aimed to investigate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) in postoperative acute pain control. PubMed, Scopus, and Cochrane Library were searched on 1-8 December 2022, for randomized controlled trials on the analgesic effects of TENS. The outcomes were pain intensity and opioid use (primary), and postoperative (PO) adverse events, blood pressure, and the duration of hospital stay (secondary); PROSPERO CRD42022333335. A total of 40 articles were included in the meta-analysis. Pain intensity at rest and during coughing for all types of surgeries combined was lower in the TENS group (standardized mean difference (SMD) = -0.51 [-0.61, -0.41], p < 0.00001, 29 studies, and -1.28 [-2.46, -0.09], p-value = 0.03, six studies, respectively). There was a statistically significant decrease in morphine requirements, as well as in the incidence of postoperative nausea and vomiting, dizziness, and pruritus. There was no difference between the groups in postoperative pain intensity during walking, in blood pressure, and only a borderline difference in the length of hospital stay. The subgroup analysis by surgery type did not show significant differences between the groups in pain severity at rest. Thus, TENS has a potential for pain control and postoperative recovery outcomes.

Machine and deep learning methods for clinical outcome prediction based on physiological data of COVID-19 patients: a scoping review.

INTRODUCTION: Since the beginning of the COVID-19 pandemic, numerous machine and deep learning (MDL) methods have been proposed in the literature to analyze patient physiological data. The objective of this review is to summarize various aspects of these methods and assess their practical utility for predicting various clinical outcomes. METHODS: We searched PubMed, Scopus, and Cochrane Library, screened and selected the studies matching the inclusion criteria. The clinical analysis focused on the characteristics of the patient cohorts in the studies included in this review, the specific tasks in the context of the COVID-19 pandemic that machine and deep learning methods were used for, and their practical limitations. The technical analysis focused on the details of specific MDL methods and their performance. RESULTS: Analysis of the 48 selected studies revealed that the majority (∼54 %) of them examined the application of MDL methods for the prediction of survival/mortality-related patient outcomes, while a smaller fraction (∼13 %) of studies also examined applications to the prediction of patients' physiological outcomes and hospital resource utilization. 21 % of the studies examined the application of MDL methods to multiple clinical tasks. Machine and deep learning methods have been shown to be effective at predicting several outcomes of COVID-19 patients, such as disease severity, complications, intensive care unit (ICU) transfer, and mortality. MDL methods also achieved high accuracy in predicting the required number of ICU beds and ventilators. CONCLUSION: Machine and deep learning methods have been shown to be valuable tools for predicting disease severity, organ dysfunction and failure, patient outcomes, and hospital resource utilization during the COVID-19 pandemic. The discovered knowledge and our conclusions and recommendations can also be useful to healthcare professionals and artificial intelligence researchers in managing future pandemics.

The Prevalence of Pain in Chronic Diseases: An Umbrella Review of Systematic Reviews.

Since pain is common in many diseases, it is important to summarize the precise prevalence data on pain and high-impact pain, which frequently worsens the quality of life and work activities. This umbrella review aims to estimate the prevalence of pain among patients with different chronic diseases/conditions. We followed the PRISMA guidelines. We identified the following areas addressing the prevalence of pain: (1) pain in cancer patients; (2) neurodegenerative diseases; (3) chronic heart failure; (4) chronic obstructive pulmonary disease; (5) chronic kidney diseases; (6) liver diseases and failure; (7) nursing home seniors; and (8) postamputation (phantom) pain. We included systematic reviews and meta-analyses that reported pain in patients from the mentioned populations. The prevalence of pain in chronic diseases is high, in some cases even higher than the cardinal symptoms of these diseases/conditions. Most patients who suffer from any of these diseases/conditions can develop chronic pain at later stages. Pain in chronic diseases does not receive enough attention and is not properly managed. Future studies are warranted to establish a more precise prevalence of chronic pain and develop better methods of pain screening, detection, and management.

The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Surgical interventions in hip fracture have been associated with multiple adverse events, including perioperative hypotension and mortality, making the choice of the anesthetic method for this procedure crucial. There is still no consensus on whether regional (RA) or general (GA) anesthesia should be used to maintain hemodynamic stability and more favorable outcomes. Therefore, this meta-analysis examines the differences between RA and GA groups in the incidence of mortality, intraoperative hypotension, and other intra- and postoperative complications. The comparison is essential given the rising global prevalence of hip fractures and the need to optimize anesthesia strategies for improved patient outcomes, particularly in an aging population. We followed PRISMA guidelines (PROSPERO #CRD42022320413). We conducted the search for studies published in English before March 2022 in PubMed, Google Scholar, and the Cochrane Library. We included RCTs that compared general and regional anesthesia in adult patients having hip fracture surgical interventions. The primary outcome was perioperative mortality. The secondary outcomes were peri- or postoperative complications and duration of hospital stay. We conducted a meta-analysis in RevMan (version 5.4). We examined the quality of the methodology with the Cochrane risk of bias 2 tool, while the quality of evidence was determined with GRADE. Fifteen studies with 4110 patients were included. Our findings revealed no significant difference between general and regional anesthesia in risk of perioperative mortality (RR = 1.42 [0.96, 2.10], p-value = 0.08), intraoperative complications, or duration of hospital length of stay. Our results suggest that regional anesthesia and general anesthesia have comparable safety and can be used as alternatives based on specific patient requirements.

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Ultrasound-Guided vs. Fluoroscopy-Guided Interventions for Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The objective of this study was to compare the outcomes of the ultrasound- and fluoroscopy-guided techniques in the management of back pain. Using PubMed, Scopus, and the Cochrane Library, we searched randomized controlled trials (RCTs) published before May 2023, which reported relevant data on the topic. The effectiveness of the ultrasound-guided (US-guided) and fluoroscopy-guided (FL-guided) approaches for back pain management was compared in terms of postoperative pain intensity, postoperative functional outcomes, and postoperative complications. Subgroup analyses were conducted for different postoperative periods. Eight studies were included in the analysis. There was no significant difference in post-procedural pain relief at one week, two weeks, one month, two months, and three months between the US-guided and FL-guided interventions for back pain management (SMD with 95% CI is -0.01 [-0.11, 0.10]), p = 0.91, I2 = 0%). In terms of the postoperative functional outcomes assessed by the "Oswestry Disability Index" (ODI) functionality score, the model tends to favor the FL-guided injections over the US-guided injections (SMD with 95% CI: 0.13 [-0.00, 0.25], p = 0.05, I2 = 0). Finally, the US-guided and FL-guided injections did not show significantly different results in terms of postoperative complications (RR with 95% CI is 0.99 [0.49, 1.99], p = 0.97, I2 = 0). The subgroup analysis also did not demonstrate differences between the US-guided and FL-guided techniques in the following outcomes: vasovagal reaction, transient headache, and facial flushing. There was no significant difference between the US-guided and FL-guided injections for treating back pain in terms of postoperative pain intensity and complications. Still, the model tends to favor the FL-guided injections over the US-guided injections in terms of functionality.

Rectus Sheath Block in Abdominal Surgery: A Systematic Review with Meta-Analysis.

Background and aims: With the development of ultrasound-guided and laparoscopic techniques of rectus sheath block (RSB), regional analgesia promises to be efficient and safe. However, studies show controversial results. Our systematic review with meta-analysis aims to evaluate the effect of rectus sheath block in abdominal surgery. Method: We searched PubMed, Google Scholar, and the Cochrane Library from inception to October 2021 for randomised controlled trials written in English. We included studies on adult populations undergoing abdominal surgery. The primary outcomes of our meta-analysis were postoperative pain intensity and postoperative opioid consumption. Data analysis was conducted using the Review Manager software (RevMan, v. 5.4). Statistical heterogeneity was estimated by the I2 statistic. The methodological quality of the included studies was assessed using the Oxford quality scoring system (Jadad Scale). Results: Eight randomised controlled trials (RCTs) in English with a total of 386 patients were included in this meta-analysis. Patients in the RSB group did not consume fewer anaesthetics and opioids after abdominal surgery when compared with patients in the control group. In addition, postoperative pain intensity (out of 10) was not lower in the RSB group when compared with the control group. Finally, RSB did not improve the time to the first opioid/analgesic (min) compared with the non-RSB option. Conclusion: There is no statistically significant evidence in favour of RSB over non-RSB in reducing anaesthetics and opioid consumption, postoperative pain intensity, and increasing time to first opioid/analgesic.

Effect of Ketamine on Postoperative Neurocognitive Disorders: A Systematic Review and Meta-Analysis.

BACKGROUND: Neurocognitive alterations in the perioperative period might be caused by a wide variety of factors including pain, blood loss, hypotension, hypoxia, micro- and macroemboli, cardiopulmonary bypass (CPB), reperfusion damage, and surgery itself, and all are risk factors for developing postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). The objective of this study was to evaluate the effect of ketamine on neurocognitive dysfunction after anesthesia. METHODS: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing ketamine use (experimental group) with placebo (controls). RESULTS: The model favors the control group over the experimental group in terms of frequency of hallucinations (the risk ratio with 95% CI is 1.54 [1.09, 2.19], p-value = 0.02), the number of patients readmitted within 30 days (RR with 95% CI is 0.25 [0.09, 0.70]), and the number of adverse events (overall RR with 95% CI is 1.31 [1.06, 1.62]). In terms of morphine consumption, the model favors the experimental group. CONCLUSION: There was no statistically significant difference in incidences of postoperative delirium, vasopressor requirement, and fentanyl consumption between the ketamine and control groups. However, hallucinations were more frequently reported in the ketamine group.

Virtual reality for pain management: an umbrella review.

Background and objective: Virtual reality is a promising pain control strategy for various pain conditions. This umbrella review of systematic reviews and meta-analyses aims to evaluate the analgesic effects of virtual reality. Methods: We searched for the relevant reviews in Scopus, PubMed and Cochrane library. Our primary outcome was pain, with secondary outcomes including disability, general health status, patient satisfaction, depression, balance, fear of movement, and adverse events. The quality of included articles was evaluated using the AMSTAR-2 tool. Results: 21 systematic reviews and meta-analyses with 274 studies and 17,680 patients were included in this review. All the reviews concluded benefits of virtual reality in managing pain conditions, including chronic and pain. Discussion and conclusions: This umbrella review demonstrates successful application of virtual reality in pain control, including perioperative, periprocedural, and chronic pain settings. Virtual reality can be used as an alternative therapy for pain management in children and adults.

High-intensity laser therapy in low back pain management: a systematic review with meta-analysis.

Low back pain (LBP) is a widespread health issue affecting people globally and is the second leading cause of missed workdays. High-intensity laser therapy (HILT) promises to decrease pain intensity in LBP patients. The aim of this work was to evaluate the effect of HILT in adult LBP patients. We searched for randomized controlled studies (RCTs) published before January of 2023. Our primary outcome was pain intensity, while our secondary outcomes included disability and flexibility scores. We synthesized the evidence using RevMan v.5.4 and assessed methodological quality with the Oxford/Jadad scale and the Cochrane collaboration's risk of bias tool 1. The model favors the HILT group over the control group in terms of pain intensity after treatment (MD with 95% CI is -1.65 [-2.22, -1.09], p-value < 0.00001, I2=67%), Oswestry disability index (MD with 95% CI is -0.67 [-1.22, -0.12], p-value = 0.02, I2=73%), and Roland disability index (MD with 95% CI is -1.36 [-1.76, -0.96], p-value <0.00001, I2=0%). The patients in the high-intensity laser therapy had statistically significantly lower (low back) pain intensity compared to the patients in the control group. Based on three RCTs, our model also showed the positive effect of the HILT on LBP in terms of the Oswestry disability index and Roland disability index.

Deep Learning Methods for Interpretation of Pulmonary CT and X-ray Images in Patients with COVID-19-Related Lung Involvement: A Systematic Review.

SARS-CoV-2 is a novel virus that has been affecting the global population by spreading rapidly and causing severe complications, which require prompt and elaborate emergency treatment. Automatic tools to diagnose COVID-19 could potentially be an important and useful aid. Radiologists and clinicians could potentially rely on interpretable AI technologies to address the diagnosis and monitoring of COVID-19 patients. This paper aims to provide a comprehensive analysis of the state-of-the-art deep learning techniques for COVID-19 classification. The previous studies are methodically evaluated, and a summary of the proposed convolutional neural network (CNN)-based classification approaches is presented. The reviewed papers have presented a variety of CNN models and architectures that were developed to provide an accurate and quick automatic tool to diagnose the COVID-19 virus based on presented CT scan or X-ray images. In this systematic review, we focused on the critical components of the deep learning approach, such as network architecture, model complexity, parameter optimization, explainability, and dataset/code availability. The literature search yielded a large number of studies over the past period of the virus spread, and we summarized their past efforts. State-of-the-art CNN architectures, with their strengths and weaknesses, are discussed with respect to diverse technical and clinical evaluation metrics to safely implement current AI studies in medical practice.

Postoperative Delirium and Cognitive Dysfunction after General and Regional Anesthesia: A Systematic Review and Meta-Analysis.

Background: Perioperative disorders of neurocognitive function are a set of heterogeneous conditions, which include transient post-operative delirium (POD) and more prolonged post-operative cognitive dysfunction (POCD). Since the number of annually performed surgical procedures is growing, we should identify which type of anesthesia is safer for preserving neurocognitive function. The purpose of this study was to compare the effect of general anesthesia (GA) and regional anesthesia (RA) in patients undergoing surgical procedures under general anesthesia and regional anesthesia. Material and methods: We searched for randomized controlled studies, which studied post-operative cognitive outcomes after general and regional anesthesia in the adult patient population. Results: Thirteen articles with 3633 patients: the RA group consisted of 1823 patients, and the GA group of 1810 patients, who were selected for meta-analysis. The overall effect of the model shows no difference between these two groups in terms of risk for post-operative delirium. The result is insensitive to the exclusion of any study. There was no difference between RA and GA in terms of post-operative cognitive dysfunction. Conclusions: There was no statistically significant difference between GA and RA in the incidence of POD. There was no statistically significant difference in the incidence of POCD per-protocol analysis, psychomotor/attention tests (preoperative/baseline, post-operative), memory tests (postoperatively, follow up), mini-mental state examination score 24 h postoperatively, post-operative reaction time three months postoperatively, controlled oral word association test, and digit copying test. There were no differences in the incidence of POCD in general and regional anesthesia at one week postoperatively, three months postoperatively, or total events (one week or three months). The incidence of post-operative mortality also did not differ between two groups.

Artificial Intelligence in Resuscitation: A Scoping Review.

INTRODUCTION: Cardiac arrest is a significant cause of premature mortality and severe disability. Despite the death rate steadily decreasing over the previous decade, only 22% of survivors achieve good clinical status and only 25% of patients survive until their discharge from the hospital. The objective of this scoping review was to review relevant AI modalities and the main potential applications of AI in resuscitation. METHODS: We conducted the literature search for related studies in PubMed, EMBASE, and Google Scholar. We included peer-reviewed publications and articles in the press, pooling and characterizing the data by their model types, goals, and benefits. RESULTS: After identifying 268 original studies, we chose 59 original studies (reporting 1,817,419 patients) to include in the qualitative synthesis. AI-based methods appear to be superior to traditional methods in achieving high-level performance. CONCLUSION: AI might be useful in predicting cardiac arrest, heart rhythm disorders, and post-cardiac arrest outcomes, as well as in the delivery of drone-delivered defibrillators and notification of dispatchers. AI-powered technologies could be valuable assistants to continuously track patient conditions. Healthcare professionals should assist in the research and development of AI-powered technologies as well as their implementation into clinical practice.

Thoracolumbar Interfascial Plane Block in Spinal Surgery: A Systematic Review with Meta-Analysis.

OBJECTIVE: As the thoracolumbar interfascial plane (TLIP) block may be a promising alternative in spinal surgery, there is a need for timely meta-analysis of this method's effectiveness in different medical outcomes. METHODS: The meta-analysis of 6 randomized controlled studies on the application of TLIP block in spinal surgery was performed under the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The primary outcome used for comparison was the mean difference (MD) of pain intensity scores at rest/in motion between patients receiving TLIP block and those receiving no block care. RESULTS: Our analysis favors TLIP block over no block (control group) for pain intensity at rest (MD with 95% confidence interval [CI] is -1.14 [-1.29, -0.99], P value <0.00001, I2 = 99%) and pain intensity in motion (MD with 95% CI is -1.49 [-1.73, -1.24], P value <0.00001, I2 = 99%) on postoperative day 1. Analysis also favors TLIP block in terms of cumulative fentanyl consumption on postoperative day 1 (MD is -166.64 mcg with 95% CI [-204.48, -128.80], P value <0.00001, I2 = 89%), postoperative side effects (risk ratio with 95% CI is 0.63 [0.44, 0.91], P value = 0.01, I2 = 0%), requests for supplementary/rescue analgesia (risk ratio with 95% CI is 0.36 [0.23, 0.49], P value <0.00001, I2 = 0%). The results are statistically significant. CONCLUSIONS: The TLIP block reduces postoperative pain intensity, opioid consumption, side effects, and requests for rescue analgesia after spinal surgery more than the no-block alternative.

Comparison of dexmedetomidine and propofol for sedation in awake craniotomy: A meta-analysis.

BACKGROUND: Awake craniotomy (AC) is the preferred option for the resection of tumors adjacent to eloquent cortical areas and in cases of intractable epilepsy. It is mostly used to maintain the integrity of the brain during intracranial neurosurgical procedures. Awake craniotomy requires the use of ideal anesthetics, hypnotics, and analgesics to balance sedation, prompt the reversal of sedation, and prevent respiratory depression while maintaining communication between patient and medical team. Although a wide variety of anesthetics and hypnotics have been used for awake craniotomy over the past several decades, the optimal drug for the procedure has yet to be determined. The purpose of this meta-analysis was to compare dexmedetomidine and propofol in terms of intraoperative adverse events (i.e., hypertension, hypotension, nausea, vomiting, respiratory depression), patient and surgeon satisfaction, and procedure duration. METHODS: We searched PubMed, Google Scholar, and the Cochrane Library for relevant articles published between the inception of these databases and April of 2022. The systematic search yielded 781 articles. After screening, we excluded 778 articles. The remaining three articles reporting 138 patients were selected for meta-analysis. RESULTS: This meta-analysis showed no statistically significant difference between propofol and dexmedetomidine related to intraoperative adverse events, patient satisfaction, or procedure duration. The only statistically significant result was surgeon satisfaction, which appeared to be higher in the dexmedetomidine group. CONCLUSIONS: Further high-quality randomized and controlled trials are needed to find a preferred agent for intraoperative sedation in awake craniotomy.

Risk Factors and Outcomes in Critically Ill Patients with Hematological Malignancies Complicated by Hospital-Acquired Infections.

Background and objectives: Patients admitted to the intensive care unit (ICU) have an increased risk of hospital-acquired infection (HAI). A diagnosis of cancer alone increases the risk of sepsis three-five-fold, which further increases the risk of nosocomial infection, subsequently deteriorates results, and leads to high mortality. In this study, we aimed to assess the mortality rate among hematologic oncologic patients with suspected infection who were subsequently admitted to the ICU and the predictive factors that are associated with high ICU mortality. Materials and Methods: This retrospective cohort study was conducted in the hematological oncology critical care unit of a tertiary care hospital between November 2017 and February 2021. We analyzed anonymized medical records of hospitalized hematologic oncologic patients who were suspected or proven to have infection in the hematology-oncology department and were subsequently transferred to the ICU. Results: Both shorter hospitalization and shorter ICU stay length were observed in survivors [9.2 (7.7-10.4)] vs. non-survivors [10 (9.1-12.9), p = 0.004]. Sepsis had the highest hazard ratio (7.38) among all other factors, as patients with sepsis had higher mortality rates (98% among ICU non-survivors and 57% among ICU survivors) than those who had febrile neutropenia. Conclusions: The overall ICU mortality in patients with hematologic malignancies was 66%. Sepsis had the highest hazard ratio among all other predictive factors, as patients with sepsis had higher mortality rates than those who had febrile neutropenia. Chronic hepatitis (HBV and HCV) was significantly associated with higher ICU mortality.

Epidural dexamethasone for acute postoperative pain management: a systematic review with meta-analysis.

Aim: To study the effect of epidural dexamethasone in postoperative pain management. Methods: Random-effects meta-analysis was conducted in RevMan 5.4. Results: We included nine randomized-controlled trials (RCT) with 657 patients. Dexamethasone demonstrated longer analgesia duration (mean difference 266.18 minutes, 95% CI [3.21,529.14]; p 0.05), lower incidence of nausea and vomiting during the first postoperative day (risk ratio 0.36, 95% CI [0.18,0.71]; p 0.004), and lower antiemetic requirements (risk ratio 0.33, 95% CI [0.14,0.79]; p 0.01). No difference in pain reduction and the length of hospital stay was observed between the groups. Conclusion: Dexamethasone was associated with a longer analgesic effect, a lower number of patients requiring antiemetics, and lower incidences of nausea and vomiting.

Pain after major surgeries can be severe. Sometimes patients need to take additional analgesics after surgery. Dexamethasone is a steroid, which can potentially reduce this pain and the need for pain-relieving medications. We wanted to know whether dexamethasone reduces the use of analgesics, nausea and vomiting after surgeries, pain, or length of hospital stay. We found nine articles with 657 patients, which compared dexamethasone with a placebo. According to our analysis, dexamethasone does not decrease pain or length of hospital stay. However, surgery patients can benefit from a decrease in nausea and vomiting and the need for medications for these side effects. Due to the small number of participants, our conclusions should be taken with caution.

Mechanisms of cerebral vasospasm and cerebral ischaemia in subarachnoid haemorrhage.

Subarachnoid haemorrhage (SAH) is a cerebrovascular emergency associated with significant morbidity and mortality. SAH is characterized by heterogeneity, interindividual variation and complexity of pathophysiological responses following extravasation of blood from cerebral circulation. The purpose of this review is to integrate previously established pre-existing factors, pathophysiological pathways and to develop a concept map of mechanisms of SAH-induced cerebral vasospasm and delayed cerebral ischaemia using a systematic approach. We conducted an extensive mapping of a hypothesized sequence of pathophysiological events. Documentation of supporting evidence was done alongside a concept map building. After finalizing the model, we conducted an analysis of the consequences and connections of pathophysiological events. We included the findings of experimental research, focusing on pathophysiological processes. We focused on SAH-induced cerebral vasospasm and delayed cerebral ischaemia as a component of cerebral injury and potential systemic consequences. SAH-induced brain injury occurs within 72 h following haemorrhage. Pathophysiology of cerebral vasospasm may include reduction in NO production, direct activation of calcium channels, upregulating genes involved with inflammation and extracellular matrix remodelling, triggering oxidative stress and free radical damage to smooth muscle and lipid peroxidation of cell membranes, cortical spreading depolarizations, sympathetic activation, finally resulting in the failure of cerebral autoregulation, microthrombosis and cerebral ischaemic injury. This cascade of events might explain why medical therapy often fails to reverse resistant cerebral vasospasm and to prevent cerebral ischaemia.

Artificial intelligence in ultrasound-guided regional anesthesia: A scoping review.

Background: Regional anesthesia is increasingly used in acute postoperative pain management. Ultrasound has been used to facilitate the performance of the regional block, increase the percentage of successfully performed procedures and reduce the complication rate. Artificial intelligence (AI) has been studied in many medical disciplines with achieving high success, especially in radiology. The purpose of this review was to review the evidence on the application of artificial intelligence for optimization and interpretation of the sonographic image, and visualization of needle advancement and injection of local anesthetic. Methods: To conduct this scoping review, we followed the PRISMA-S guidelines. We included studies if they met the following criteria: (1) Application of Artificial intelligence-assisted in ultrasound-guided regional anesthesia; (2) Any human subject (of any age), object (manikin), or animal; (3) Study design: prospective, retrospective, RCTs; (4) Any method of regional anesthesia (epidural, spinal anesthesia, peripheral nerves); (5) Any anatomical localization of regional anesthesia (any nerve or plexus) (6) Any methods of artificial intelligence; (7) Settings: Any healthcare settings (Medical centers, hospitals, clinics, laboratories. Results: The systematic searches identified 78 citations. After the removal of the duplicates, 19 full-text articles were assessed; and 15 studies were eligible for inclusion in the review. Conclusions: AI solutions might be useful in anatomical landmark identification, reducing or even avoiding possible complications. AI-guided solutions can improve the optimization and interpretation of the sonographic image, visualization of needle advancement, and injection of local anesthetic. AI-guided solutions might improve the training process in UGRA. Although significant progress has been made in the application of AI-guided UGRA, randomized control trials are still missing.