Protocolised blood pressure targets showed no consistent benefit in noncardiac surgery

The edition in brief

A Bayesian meta-analysis of 15 randomised trials in major noncardiac surgery found that protocolised intraoperative arterial pressure targets did not reduce mortality (OR 1.00, 95% CI 0.83 to 1.21) or myocardial injury compared with usual care. Acute kidney injury had the most favourable estimate (OR 0.87, 95% CI 0.73 to 1.03) but remained compatible with no meaningful benefit and was sensitive to single trials. Avoiding sustained hypotension remains sensible; an elaborate personalised protocol has not shown added value. An Australian and New Zealand registry of 5,398 matched patients aged 90 or over admitted to ICU after elective surgery found frailty associated with 66% higher one-year mortality and lower odds of returning home. A multicentre trial in 161 children under two having hypospadias repair found fistula rates similar after caudal and penile blocks (8.9% vs 7.3%), with less opioid use after caudal block; the trial stopped early and is imprecise. A meta-analysis of 58 studies found fibrinogen concentrate for acquired hypofibrinogenaemia was associated with fewer red cell, plasma and platelet units, mostly in cardiac surgery. The pearl covers local anaesthetic systemic toxicity.