INTRODUCTION: The optimized goal of the perioperative medicine can be accomplished through an appropriate risk management focused at an individual patient's problems. We reported the perioperative anesthetic management models (1) to show the relationship between pre- and intra-anesthetic parameters and the anesthetic outcomes and adverse events. Using these models may enable us to predict incidences of perioperative adverse events. In this study, we analyzed how the control or optimization of preoperative patients or anesthetic techniques parameters might reduce incidences of intra- and post-anesthetic adverse events by applying game theory to the models.
METHODS: After obtaining the approval of the study protocol by the local ethical committee, this study was carried out using a simulation application. Using the 6 perioperative adverse event models (1) (intraoperative major cardiovascular event (IO-MCV), intraoperative minor cardiovascular event (IO-CV), intraoperative pulmonary event (IO-RESP), postoperative cardiovascular event (PO-CV), postoperative pulmonary event (PO-RESP), and postoperative central nervous event (PO-CNS)), the independent parameters in all the models were divided into two categories; controllable and uncontrollable parameters. The coefficients of dependent variables in the controllable parameters were calculated for each model, and their values were changed in order for the dependent parameter to be minimum by applying the game theory to reach Nash equilibrium status by modifying anesthetic and surgical techniques and by optimizing preoperative patient's status so far as to meet logically patient's and surgical procedure's capabilities. The perioperative anesthetic database (n=3,408) obtained in Iwaki Kyoritsu General Hospital was used in this study. The original group consisted of the calculated perioperative adverse events' risks using the perioperative anesthetic management models and the modified group consisted of the calculated perioperative adverse events' risks after the game theory application. Statistical analysis was carried out to evaluate the effect of the game theory application to the calculated perioperative adverse events using Student's t-test between the original and the modified groups. P<0.01 was considered significant.
RESULTS: The optimization of independent parameters by applying the game theory significantly reduced IO-MCV, IO-RESP, PO-CV, PO-RESP and PO-CNS values, but not IO-CV values.
CONCLUSIONS: It may be possible to reduce the perioperative adverse events by applying the game theory to the independent parameters in the perioperative models.
REFERENCE: 1. Yamaguchi H. 2005.
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