Higher intraoperative blood pressure targets did not reduce kidney or myocardial injury

The edition in brief

A meta-analysis of 15 randomised trials (15,603 adults having elective noncardiac surgery) found that targeting higher intraoperative blood pressure did not reduce acute kidney injury (RR 0.95, 95% CI 0.85 to 1.06) or myocardial injury (RR 1.02, 0.94 to 1.12), with trial sequential analysis judging those findings firm; mortality was unchanged and a reduction in delirium (RR 0.73) remained inconclusive. In a randomised trial of 178 patients having posterior lumbar fusion, deep neuromuscular block lowered chronic postsurgical pain at three months (19.1% vs 34.8%; RR 0.6), though not at six months, with less opioid use and lower muscle injury markers. A Japanese registry of 4878 children with recent respiratory infection, asthma exacerbation or smoke exposure found supraglottic airways were associated with fewer respiratory adverse events than tracheal intubation (adjusted RR 0.41). A single-centre trial of 106 anxious day-surgery patients found one 20-minute virtual reality session reduced state anxiety by about 19 points more than usual care. The pearl covers quantitative monitoring before extubation.