Right-sided double-lumen endobronchial tubes (DLTs) are often avoided because of technical difficulties and concerns about respiratory complications, although evidence that they increase hypoxemia during anesthesia remains limited and inconsistent. We evaluated the association between DLT side and hypoxemia during anesthesia in patients undergoing unilateral surgery for left-sided lung tumors. This single-center retrospective cohort study included adult patients undergoing unilateral surgery for left-sided lung tumors between October 2008 and May 2023. The primary outcome was hypoxemia during anesthesia, defined as SpO2 ≤ 90
To identify perioperative factors associated with the ionized-to-total magnesium (iMg/tMg) ratio at intensive care unit (ICU) admission and on postoperative day (POD) 1 after major open hepatobiliary-pancreatic surgery. This single-center prospective observational study enrolled adults undergoing elective surgery. Paired iMg and tMg measurements were obtained at ICU admission and on POD 1. The primary analyses evaluated perioperative factors associated with the iMg/tMg ratio at each time point using univariable linear regression and multivariable linear regression with backward elimination. Exploratory analyses assessed temporal changes using paired t tests. Of 150 enrolled patients, 141 were analyzed. At ICU admission, the ratio was positively associated with iMg immediately after anesthesia induction (P = 0.007) and low-density lipoprotein cholesterol (P = 0.041), and negatively associated with anesthesia time (P = 0.005) and total cholesterol (P = 0.018). On POD 1, the ratio was positively associated with intraoperative non-Mg-containing fluid volume (P = 0.016), and negatively associated with operation time (P < 0.001), hypertension (P = 0.013), and albumin (P = 0.007). Model R2 values were 0.10 and 0.20 at ICU admission and on POD 1, respectively. In exploratory analyses, the mean ratio increased between postoperative measurements (0.659 to 0.713; P < 0.001). Mean iMg decreased from 0.589 mmol/L after induction to 0.545 at ICU admission, then increased to 0.640 on POD 1 (all P < 0.001). Perioperative factors associated with the iMg/tMg ratio differed between ICU admission and POD 1 after major open hepatobiliary-pancreatic surgery. Both models had limited explanatory power. These findings should be interpreted in relation to sampling time and require independent validation before informing clinical management.
Goal-directed fluid therapy (GDFT) individualizes perioperative fluid administration according to dynamic hemodynamic variables, but its implementation remains inconsistent and its impact on patient-centered outcomes is still debated. Decision-support and automated systems have been developed to improve adherence, identify fluid responsiveness more efficiently, and reduce the workload of protocolized hemodynamic management. This structured narrative review summarizes the evidence across four outcome levels: process, surrogate hemodynamic, intermediate physiological, and patient-centered clinical. The most consistent evidence concerns process improvement: decision support increases protocol adherence and improves the proportion of fluid challenges that achieve a predefined stroke volume response, largely on non-randomized evidence. Improvements in surrogate hemodynamic control have also been reported, and selected randomized trials suggest favorable effects on microcirculatory flow and lactate. These findings should not be interpreted as evidence of clinical benefit. Fluid responsiveness does not necessarily indicate a need for fluid administration, and most available studies remain small, single-center, or focused on surrogate outcomes. Evidence that these systems improve postoperative complications, acute kidney injury, length of stay, or mortality is currently lacking. Ongoing multicenter trials should address this gap. Decision support appears to improve how perioperative fluids are administered, but whether it improves what ultimately happens to patients remains unresolved.
