Background and Objectives: This study aimed to investigate the role of the pre- and postoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting intensive care unit (ICU) admission and postoperative length of stay (LOS) in bariatric surgery. Materials and Methods: We retrospectively analysed 96 patients who underwent bariatric surgery at our institution. The NLR and PLR were calculated in the pre- and postoperative stages. Changes in pre- and postoperative hematological ratios were compared using the Wilcoxon signed-rank test. The optimal cutoff values and area under the curve (AUC) for each ratio were calculated using receiver operating characteristic (ROC) analysis. Multivariate linear regression analysis was used to assess the relationship between each ratio and the postoperative LOS after adjusting for age, sex, and American Society of Anesthesiologists (ASA) score. Results: The median age of our patients was 35.50 years, and 54.2% were male. The preoperative NLR showed a significant increase from 1.44 to 6.38 postoperatively (p < 0.001). The PLR increased from 107.08 preoperatively to 183.58 postoperatively, p < 0.001). ROC analysis showed that the postoperative NLR was a moderate to high predictor of ICU admission (AUC = 0.700, optimal cutoff point = 5.987). The postoperative PLR had less predictive power for ICU admission (AUC = 0.641, optimal cutoff point = 170.950). Ratios that had a statistically significant relationship with the postoperative LOS were the preoperative NLR (standardized β [95% CI]: 0.296 [0.115–0.598]), postoperative NLR (0.311 [0.034–0.161]), and postoperative PLR (0.236 [0.000–0.005]). Conclusions: The NLR and PLR demonstrated an independent relationship with the postoperative LOS after bariatric surgery and the predictive ability of ICU admission. Both ratios might be useful as simple markers to predict patient outcome after surgery.

Purpose: Many risk factors, such as the duration of surgery and higher ASA scores, are associated with longer hospitalization in patients undergoing orthopedic surgery. However, no studies have evaluated the relationship between the preoperative systemic immune-inflammation index (SII) and length of hospital stay in orthopedic surgical patients. Therefore, this study aimed to investigate whether the SII is associated with the length of hospital stay in orthopedic surgery in adults. Patients and Methods: This was a retrospective cohort study, and data were extracted from electronic health records. Patients were included if they were older than 18 years and had undergone orthopedic surgery between [2016– 2021]. The patients were divided into two groups according to the median duration of hospitalization and according to SII cut-off value (high-SII group: ≥ 799.86, low-SII group: < 799.86). Univariate and multivariate linear regression analyses were used to identify the association between SII and length of hospitalization. Results: A total of 196 patients who underwent orthopedic surgery were included, and 62 were hospitalized for > 21 days. There were significant differences in terms of ASA score (P = 0.041). Patients who required a longer hospitalization of > 21 days had significantly lower hemoglobin level (P < 0.001), higher duration of surgery (P = 0.015), and increased requirement of ICU admission (P < 0.001). The optimal cut-off value for preoperative SII of 799.86 stratified the patients into high-SII and low-SII groups. Patients in high-SII group had higher median LOHS (22 days) compared to low-SII group (17 days; P = 0.006). In the multivariable linear regression analysis, the SII was significantly related to the length of hospital stay (β = 0.246, 95% confidence interval [CI] 0.000– 0.005, P = 0.031). Conclusion: A high-SII value is associated with an increased risk of longer hospitalization after orthopedic surgery.

Background and Aims: The use of Artificial Intelligence (AI) relies on computer science and large datasets, with the technology mimicking human intelligence as it makes logical decisions. This study aims to assess the perceptions and experiences of anesthesiology practitioners toward AI and identify its benefits to healthcare professionals and patients, along with current and future applications of AI.Methods: This cross‐sectional descriptive online survey study was disseminated to physicians who work in anesthesiology practice in Saudi Arabia. Descriptive statistics were used to report the characteristics of the respondents and summarize the results of the survey.Results: There were 109 responses, with 85.32% being male, 35.78% being aged 40–49 years, and 69.72% being consultant anesthesiologists. The majority of participants (73.39%) believed that AI could be used in multiple settings related to anesthesiology practice. Participants also believed that AI could facilitate access to data (76.15%), enable precise decision‐making (75.23%), reduce medical errors (55.04%), reduce workload and shortage of healthcare personnel (53.21%), and allow healthcare personnel to focus on more demanding cases (69.72%). In addition, the majority of participants believed that AI can be beneficial to patients, in which 69.72% believed that AI can improve patient access to care, 77.06% believed that AI can facilitate patient education, and 65.14% believed that AI can guide patients during treatment. Lastly, 70.64% believed that AI would be beneficial to anesthesiology practices in the future. However, 61.47% claimed that their workplace has no plan for adopting AI.Conclusions: The anesthesiologists showed generally positive attitudes towards AI, in spite of its limited utilization and implementation challenges. Strong beliefs exist about AI's future potential in anesthesia care and postgraduate education.

Background and Objectives: Patients undergoing liver transplantation (LT) often require increased blood product transfusion due to pre-existing coagulopathy and intraoperative fibrinolysis. Strategies to minimise intraoperative bleeding and subsequent blood product requirements include platelet transfusion and tranexamic acid (TXA). Prophylactic TXA administration has been shown to reduce bleeding and blood product requirements intraoperatively. However, its clinical use is still debated. The aim of this study was to report on a single-centre practice and analyse clinical characteristics and outcomes of LT recipients according to intraoperative treatment of TXA or platelet transfusion. Materials and Methods: This was a retrospective observational cohort study in which we reviewed 162 patients’ records. Characteristics, intraoperative requirement of blood products, postoperative development of thrombosis and outcomes were compared between patients without or with intraoperative TXA treatment and without or with platelet transfusion. Results: Intraoperative treatment of TXA and platelets was 53% and 57.40%, respectively. Patients who required intraoperative administration of TXA or platelet transfusion also required more transfusion of blood products. Neither TXA nor platelet transfusion were associated with increased postoperative development of hepatic artery and portal vein thrombosis, 90-day mortality or graft loss. There was a significant increase in the median length of intensive care unit (ICU) stay in those who received platelet transfusion only (2.00 vs. 3.00 days; p = 0.021). Time to extubate was significantly different in both those who required TXA and platelet transfusion intraoperatively. Conclusions: Our analysis indicates that LT recipients still required copious intraoperative transfusion of blood products, despite the use of intraoperative TXA and platelets. Our findings have important implications for current transfusion practice in LT recipients and may guide clinicians to act upon these findings, which will support global efforts to encourage a wider use of TXA to reduce transfusion requirements, including platelets.

Neutrophil extracellular traps (NETs) represent a critical defensive mechanism against pathogens. However, dysregulated NETs have been implicated in a range of pathological conditions. More recently, increasing attention has been given to its implications in perioperative settings. This has led to increasing interest in how common anesthetics would modulate the neutrophil ability to form NETs. Although their ability to modulate the immune system has long been recognized, a better understanding of the impact of common anesthetics on NETs release is still needed. This may reveal considerations for optimizing immune function and personalizing anesthetic techniques, especially for vulnerable perioperative and intensive care unit patients. In this review, we comprehensively discuss recent advancements in understanding the role of common anesthetics in modulating the capacity of neutrophils to form NETs and the related mechanisms. Gaining insights into the effects of anesthetics on NETs may guide new strategies to reduce complications and improve the recovery and survival of perioperative and ICU patients.

Background/Objectives: Occupational burnout poses a significant burden to healthcare personnel, institutions, and service users. Anesthesia technologists and technicians work in the shadow of the perioperative team, and a lack of attention to anesthesia support personnel may pose a significant risk to their wellbeing and the quality of care delivered. To date, only a few studies have investigated the prevalence of burnout among anesthesia technologists and technicians worldwide and in Saudi Arabia. Thus, the aim of this cross-sectional study was to assess the prevalence and contributing factors to burnout among anesthesia technologists and technicians in a single tertiary hospital in Saudi Arabia. Methods: The study utilized the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) to assess burnout and a 10-point scale to assess stress levels. The MBI-HSS inventory consists of three subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Univariate and multivariate linear regression analyses were used to identify correlates of each burnout subscale. Gender was included in the multivariable regression analysis in addition to significant variables from univariable analysis. Results: A total of 89 participants completed the survey. Based on each subscale of the MBI-HSS, more than 60% of the participants reported high to moderate EE, and more than half reported high to moderate DP. For PA, only 25.8% of participants reported low PA. We found that age (β = −0.58, 95% CI: −0.95, −0.20; p = 0.003) and stress (β = 3.3, 95% CI: 2.1, 4.5; p < 0.001) were independently associated with EE. In addition, night shift (β = 3.3, 95% CI: 0.44, 6.1; p = 0.024) and stress (β = 0.73, 95% CI: 0.13, 1.3; p = 0.017) were independently associated with DP. Independent factors for PA were identified including night shifts (β = 6.6, 95% CI: 1.4, 12; p = 0.014) and stress levels (β = −1.3, 95% CI: −2.4, −0.12; p = 0.03). Conclusions: This research underscores the alarmingly high prevalence of burnout and the strong link between elevated EE and DP rates and workplace stress, emphasizing the necessity to identify and mitigate these stressors. It is therefore crucial to evaluate the effectiveness of the current wellbeing and mental health initiatives and programs in Saudi Arabia to ensure that they address evolving challenges and the overall mental health of healthcare personnel.