Hemodynamic Outcomes of Anesthesia Management Assisted by Nurses Trained in Specific Medical Acts in Gastrointestinal...

Introduction Task-shifting in anesthesia care is increasingly recognized as a vital approach to managing anesthesiologist shortages. In Japan, a national certification system for Nurses Trained in Specific Medical Acts (NTSMAs) was introduced to support perioperative management. This pilot study aimed to compare intraoperative hemodynamic outcomes between NTSMA-assisted anesthesia management and physician-only management in gastrointestinal surgery using a propensity score-matched design. Materials and methods We retrospectively reviewed patients who underwent elective gastrointestinal surgery under general anesthesia between 2023 and 2026. A 1:1 propensity score matching (PSM) was conducted using age, sex, American Society of Anesthesiologists Physical Status (ASA-PS), and surrogate markers of anticipated procedural complexity (anesthesia time and surgical time) to balance baseline characteristics between the NTSMA-assisted group and the physician-only control group. The primary outcome was the incidence of intraoperative hypotensive screening events, defined as systolic blood pressure <80 mmHg at least once. Secondary outcomes included total intraoperative doses of vasopressors, including phenylephrine, ephedrine, and norepinephrine. Results After 1:1 matching, 99 pairs (total N = 198) were analyzed, with all covariates achieving a standardized mean difference of <0.1. The incidence of intraoperative hypotensive screening events was not significantly different between the NTSMA-assisted and physician-only groups (67.7% vs. 64.6%). Conditional logistic regression analysis demonstrated no statistically significant association between NTSMA involvement and hypotensive events (OR: 1.150, 95% CI: 0.632 to 2.094, p = 0.648). Additionally, no significant differences were observed in total intraoperative requirements, evaluated using the Wilcoxon signed-rank test, for phenylephrine (p = 0.385), norepinephrine (p = 0.930), or ephedrine (p = 0.069). Conclusions In this retrospective pilot study, NTSMA-assisted anesthesia management did not show a statistically significant difference in the incidence of intraoperative severe hypotension compared with physician-only management. However, given the limited sample size and the highly sensitive nature of our primary outcome, these findings should be considered strictly hypothesis-generating. Larger, prospectively designed non-inferiority trials are required to definitively establish the clinical safety and non-inferiority of NTSMA-assisted task-shifting in anesthesia care.