Cerebral oximetry may cut early cognitive decline after cardiac surgery, a premixed fentanyl bag is recalled over expiry labelling, and HIV status raises perioperative risk

The edition in brief

A systematic review of 17 randomised trials (2,288 adults having on-pump cardiac surgery) found that cerebral near-infrared spectroscopy (NIRS) guided care probably reduces early postoperative cognitive decline (risk ratio 0.65, 95% CI 0.42-0.99, moderate certainty), with little or no effect on stroke (RR 0.89), mortality (RR 0.84) or delirium (RR 0.78, 95% CI 0.56-1.09), all low certainty; most trials were small, single-centre and used different thresholds. The FDA lists a Class II recall (D-0864-2026) of fentanyl citrate 1,000 mcg/100 mL in 0.9% sodium chloride bags from OurPharma LLC after a complaint about a mismatch between the IV bag expiry dates and the product expiry; the status is ongoing. In a US National Inpatient Sample cohort of 41.6 million surgical admissions, people living with HIV had more perioperative organ injury (64.6% vs 19.9%, unadjusted) and higher adjusted in-hospital mortality (OR 1.66, 95% CI 1.54-1.78); this was observational, based on administrative codes. In an 80-patient randomised trial after ACL reconstruction with a femoral triangle block, IPACK and selective tibial nerve block gave similar 24-hour morphine use (median 12 vs 16 mg, p = 0.073) and functional outcomes.