A preload bolus did not prevent post-induction hypotension in 504 high-risk patients

The edition in brief

An Austrian trial randomised 504 adults aged 45 or over with cardiovascular risk factors, having major non-cardiac surgery, to a crystalloid bolus within an hour before induction or to standard care. Time-weighted hypotension below a mean arterial pressure of 65 mmHg in the first 20 minutes after induction did not differ, so a routine pre-induction bolus is unlikely to prevent post-induction hypotension. A Bayesian meta-analysis of 15 randomised trials found that protocolised intraoperative blood pressure targets did not reduce mortality (OR 1.00) or myocardial injury compared with usual care; acute kidney injury estimates leaned towards benefit (OR 0.87, 0.73 to 1.03) but were fragile. In a multicentre trial of 161 children under two having distal or midshaft hypospadias repair, urethrocutaneous fistula rates were similar after caudal and penile block (8.9% vs 7.3%), and caudal block used fewer opioids; the trial stopped early and is exploratory. A laboratory study found that crystals forming in lidocaine–bicarbonate mixtures were pure local anaesthetic and did not change solution concentration over 13 hours. The pearl covers preventing post-induction hypotension.