This report describes the anesthetic management of four elderly patients with hip fractures complicated by different types of severe cardiac disease, including severe mitral stenosis, post–myocardial infarction status, severe pulmonary hypertension, and acute exacerbation of chronic heart failure. All patients underwent individualized, ultrasound-guided precision anesthesia strategies, incorporating ultrasound-guided vascular access, nerve blocks, neuraxial anesthesia, and dynamic perioperative assessment using transthoracic echocardiography. Management followed a pathophysiology-oriented approach, emphasizing multimodal analgesia and multidisciplinary collaboration. All four patients completed the perioperative period uneventfully. This report aims to explore individualized anesthetic strategies for extremely high-risk patients in the era of visualization-based medicine.

Emergency surgery anesthesia is performed in an extremely time-critical and high-risk setting, where delayed or inaccurate assessment may lead to severe perioperative complications. Patients often present with hemodynamic instability, limited preoperative information, and complex comorbidities, creating major challenges for anesthesiologists to rapidly evaluate airway, circulation, and physiological reserve. Although multiple assessment tools exist, conventional approaches remain fragmented and insufficient for dynamic, real-time decision-making in emergency contexts. There is a clear need for an integrated rapid anesthesia assessment framework that combines advanced monitoring, intelligent decision support, and team-based coordination. This perspective article systematically analyzes rapid assessment models that integrate multimodal point-of-care ultrasound, artificial intelligence–assisted regulation, and closed-loop clinical decision support system (CDSS) protocols. Key applications in perioperative airway management, hemodynamic and respiratory assessment, and risk stratification for special populations, including elderly and pediatric patients, are discussed. We further summarize the rapid titration and hemodynamic advantages of novel anesthetic agents in emergency induction, the role of CDSS and closed-loop communication in clinical emergency management, and the optimization of team collaboration using standardized tools such as Situation–Background–Assessment–Recommendation. Ethical and legal considerations, including informed consent, presumed consent, and proxy decision-making in time-sensitive scenarios, are also addressed. Overall, integrated rapid assessment strategies supported by technology, interdisciplinary teamwork, and ethical safeguards may substantially enhance the safety, efficiency, and clinical outcomes of anesthesia management in emergency surgery, providing a practical framework for future perioperative practice and multicenter validation.

Bile duct stenosis is a common condition in gastroenterology and hepatobiliary surgery and can be divided into benign stenosis and malignant stenosis according to different etiologies. The implantation of a gall stent into the site of the stenosis or obstruction is currently an important means of treating the bile duct stenosis. Biliary stents encompass two main types: plastic stents and metal stents. In recent years, biodegradable biliary stents and drug-eluting stents have also emerged. The material and structure of biliary stents have an important influence on their performance. In this paper, the research progress on biliary stent implantation technology in the treatment of biliary stenosis is reviewed. Besides, the advantages and disadvantages of biliary stents made from different materials and structures, along with their respective indications are summarized, and the development trend of degradable biliary stents is prospected.

This review comprehensively examines current intestinal anastomosis techniques. Traditional manual suturing methods, including intermittent and continuous sutures, provide high flexibility but but vary in infection risk and operation time. Continuous suturing is particularly effective in reducing operative time and infection risk. Suture materials include non-absorbable sutures, absorbable sutures, and natural materials, with absorbable sutures the most preferred for intestinal anastomosis. Mechanical anastomosis has gained widespread adoption, featuring both linear and circular metal staplers. Linear staplers are simple to operate, while circular staplers better align with physiological structures. Materials used in staplers include non-degradable metals (e.g., titanium, titanium alloy) and biodegradable anastomosis (e.g., magnesium alloy). Metal nail anastomosis often results in fewer complications than manual suturing in specific surgeries. Magnetic pressure anastomosis, relying on magnet attraction, has been successfully applied in clinical scenarios following extensive research. The adhesive-based approach involves medical adhesives such as cyanoacrylate and fibrin glue, offering auxiliary support for anastomosis. Energy tissue welding encompasses laser and radio frequency energy tissue welding. While laser welding poses a risk of thermal damage, radio frequency welding offers significant advantages, including faster, seamless anastomosis with reduced complications. The support method for intestinal anastomosis is a novel concept, involving the addition of support materials to the original anastomosis. It can be divided into composite and simple support methods. The simple support method, as evidenced by the "degradable internal scaffold method for digestive tract anastomosis" developed by Cai et al. in China, has demonstrated promising results in animal experiments. In conclusion, selecting the appropriate intestinal anastomosis technique depends on clinical scenarios to optimize surgical outcomes and reduce complications. The diverse technological advancements reviewed here present valuable opportunities for enhancing the quality and safety of intestinal surgery.

Perioperative management is essential for ensuring surgical safety and improving patient outcomes. With increasing surgical complexity and patient heterogeneity, traditional experience-based decision-making is no longer sufficient to meet the demands of precision medicine. Recent advances in artificial intelligence (AI), big data analytics, and large language models (LLMs) provide new opportunities to transform perioperative clinical decision support. AI-driven models enable accurate risk stratification and prediction of perioperative complications, while big data technologies facilitate multimodal data integration, real-time monitoring, and personalized intervention strategies. Meanwhile, LLMs enhance clinical communication, support medical documentation, and assist knowledge-based clinical decision-making through advanced natural language processing capabilities. However, despite rapid technological development, a comprehensive framework integrating AI, big data, and LLMs for perioperative intelligent decision-making remains insufficiently explored. This article reviews emerging applications of AI in preoperative risk assessment, intelligent anesthesia management, and postoperative complication prediction, and summarizes the role of big data in integrated clinical platforms and personalized treatment strategies. It also highlights the potential of  LLMs in patient education, clinical decision support systems, and automated knowledge synthesis. Overall, integrating AI, big data, and LLMs may establish an interpretable closed-loop perioperative decision-support ecosystem that improves surgical safety, clinical efficiency, and personalized healthcare delivery.