AI Tools for Anesthesiologists

Risk stratification: moderate-high risk cardiac patient. Compiled evidence: optimize beta-blockers and antiplatelets (continue aspirin, hold other antiplatelet 5-7 days), ensure perioperative beta-blockade, consider statin continuation, manage glucose (target 140-180 mg/dL perioperatively), assess functional capacity (can walk 4 flights stairs = acceptable). Key: anesthesia plan should minimize hemodynamic swings. Recommended: consult cardiology if EKG/troponin abnormal.

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Cardiac Risk Class

Moderate-High (RCRI 3)

Beta-Blockade

Continue — do not hold perioperatively

Antiplatelet

Hold clopidogrel 5–7 days; aspirin continues

Glucose Target

140–180 mg/dL periop — avoid tight control

Functional Capacity

4 METs confirmed — acceptable for surgery

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MedicationClassAction

MetforminBiguanideHold 48h postop (lactic acidosis risk)

LisinoprilACE inhibitorHold morning of surgery (hypotension)

AspirinAntiplateletContinue — neuraxial block OK

AtorvastatinStatinContinue perioperatively — cardioprotective

4 medications reviewed · 2 require timing adjustment

Succinylcholine: relative contraindication with MAOIs (risk of hypertensive crisis, serotonin syndrome). Induction agents: AVOID meperidine entirely (serotonin syndrome risk); propofol is SAFE; etomidate safe; avoid direct sympathomimetics. Muscle relaxants: rocuronium preferred over succinylcholine. Key: coordinate with psychiatry on when to hold/resume MAOI (typically continue throughout). Regional anesthesia may be safer option if feasible.

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Succinylcholine

Relative contraindication — hypertensive crisis risk

Meperidine

AVOID — serotonin syndrome (potentially fatal)

Propofol

Safe for induction — preferred agent

Rocuronium

Preferred muscle relaxant over succinylcholine

Direct Sympathomimetics

Avoid — exaggerated pressor response

Found 8 RCTs. Regional (femoral nerve block): superior pain control 24-48 hours, reduced nausea, faster discharge, opioid-sparing. General alone: more postop nausea, longer recovery, higher opioid use. Combined (GA + regional): best pain control and lowest opioid use, but takes extra time. Recommendation: combined approach for outpatient if time permits; pure regional if patient suitable for monitored anesthesia; GA alone if contraindications to regional.

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StudyTechniquePain score 24h

Chan et al. 2023Femoral nerve blockNRS 2.1

Mariano et al. 2022GA aloneNRS 4.7

Grant et al. 2023GA + regionalNRS 1.4

8 RCTs analyzed · favors combined approach

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Best Pain Control

Combined GA + femoral nerve block (NRS 1.4)

Fastest Discharge

Regional-only if suitable (1.4 hrs sooner)

PONV Risk

Regional reduces PONV from 28% → 8%

Time Cost

Combined adds ~12 min setup — acceptable for outpatient

Compiled difficult airway management protocol: YES, awake fiberoptic intubation is gold standard for this combination. Preparation: topicalization with nebulized lidocaine, superior laryngeal nerve block, transtracheal block. Alternative: videolaryngoscopy (GlideScope) as backup. DO NOT attempt blind nasal intubation. Emergency backup: have cricothyrotomy kit available. Key: plan beforehand, involve ENT if needed, consider ICU-level monitoring post-intubation.

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Recommended Technique

Awake fiberoptic intubation — gold standard

Topicalization

Nebulized lidocaine + superior laryngeal nerve block

Primary Backup

Videolaryngoscopy (GlideScope) primed and ready

Contraindicated

Blind nasal intubation — avoid entirely

Emergency Backup

Cricothyrotomy kit on table before induction