The edition · Anaesthesiology
A simple MAP alarm at 72 matched the Hypotension Prediction Index
A blinded trial found a plain mean arterial pressure threshold did as well as a proprietary algorithm; alongside, EIT-guided PEEP and pulmonary complications, opioid use disorder and surgical risk, and how far to trust CGM in theatre and ICU.
The edition in brief
A single-centre blinded randomised trial of 143 adults having moderate- or high-risk noncardiac surgery found that an alarm at mean arterial pressure below 72 mmHg was noninferior to the Hypotension Prediction Index alarm in limiting time below 65 mmHg (log mean difference 0.03, 95% CI −0.24 to 0.29), with no differences in secondary outcomes. In 117 patients at intermediate to high risk having laparoscopic colorectal surgery, PEEP titrated by electrical impedance tomography lowered driving pressure and 30-day pulmonary complications, 49.2% against 72.4% with fixed PEEP of 5 (HR 0.53, 95% CI 0.33 to 0.85). A meta-analysis of 40 studies associated opioid use disorder with higher odds of postoperative pain (OR 2.87) and respiratory complications (OR 2.10). In 58 surgical and ICU patients with diabetes, continuous glucose monitoring agreed with point-of-care testing with a median absolute relative difference of 10.9%, worse by 4.5 points during hypoperfusion. The FDA lists a Class II recall of lidocaine 5% ointment jars for failed content uniformity. The pearl covers lung-protective ventilation settings.
Opioid use disorder doubles the odds of postoperative respiratory events
Screen for opioid use disorder before surgery and plan multimodal analgesia and respiratory monitoring for those identified.
EIT-guided PEEP cut pulmonary complications after laparoscopic colorectal surgery
In high-risk laparoscopic colorectal surgery, consider individualising PEEP rather than using a fixed 5 cmH2O.
CGM in theatre and ICU: usable, but less accurate when perfusion falls
Use CGM for perioperative glucose trends, but confirm values with point-of-care testing before acting, particularly during hypoperfusion.
FDA recall: lidocaine 5% ointment jars for uneven content
Check lidocaine 5% ointment stock against the FDA Class II recall and stop using affected lots.
Lung-protective ventilation: set tidal volume by predicted, not actual, weight
Set tidal volume at 6 to 8 mL/kg of predicted body weight, apply PEEP, and track driving pressure.
A MAP alarm at 72 mmHg prevented hypotension as well as the prediction index
Set the intraoperative MAP alarm at about 72 mmHg; it limited hypotension as well as a proprietary prediction algorithm.
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