The edition · Anaesthesiology
Raising the intraoperative pressure target did not protect kidneys or hearts
Fifteen trials and 15,603 patients firmly exclude a kidney or myocardial benefit from targets above the usual MAP of 65. Also: better epidural analgesia and intrapartum fever, ketamine and delirium, age-based preoperative echo, and a lidocaine ointment recall.
The edition in brief
A meta-analysis of 15 randomised trials (15,603 patients) found that higher intraoperative blood pressure targets in elective non-cardiac surgery did not reduce acute kidney injury (RR 0.95) or myocardial injury (RR 1.02), with trial sequential analysis judging those conclusions firm; mortality was unchanged and a possible delirium reduction remains unconfirmed. A multicentre prospective study of 952 nulliparous women with labour epidurals found lower pain scores associated with more intrapartum hyperthermia, with a time-weighted average pain of 3 or less linked to markedly higher odds. A meta-analysis of 25 trials found perioperative ketamine and esketamine associated with less postoperative delirium, but trial sequential analysis called the evidence inconclusive and dizziness increased. A regression discontinuity analysis of 7,270 older patients found no clear benefit from routine age-based preoperative echocardiography at 75, with imprecise estimates. FDA classified a recall of one lot series of lidocaine 5% ointment as Class II for failed content uniformity at stability testing.
The better the labour epidural, the more often the fever
Watch temperature more closely in women with very dense labour epidurals, but keep providing effective analgesia.
Ketamine and esketamine for delirium: a signal, not yet a recommendation
Ketamine shows a possible delirium benefit, but not enough to use it routinely for that purpose.
Routine echo at age 75: no clear benefit near the cutoff
Base preoperative echocardiography in older patients on clinical indication rather than age alone.
FDA Class II recall of a lidocaine 5% ointment for content uniformity
Check stock for the recalled lidocaine 5% ointment and use an alternative supply if affected.
Hypotension after induction is a predictable event, so plan for it
Anticipate post-induction hypotension with titrated doses and a vasopressor ready before induction.
Higher intraoperative blood pressure targets: no kidney or myocardial benefit
Hold mean arterial pressure at about 65 mmHg in elective non-cardiac surgery; higher targets did not protect kidneys or hearts.
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