A 20% fall from baseline pressure tracked postoperative pneumonia better than fixed MAP thresholds

The edition in brief

Today's anaesthesia edition ends on how intraoperative hypotension is defined. A retrospective cohort of 151,036 adults having non-cardiac surgery under general anaesthesia at three Chinese hospitals found that a 20% fall in mean arterial pressure from the patient's baseline was associated with postoperative pneumonia (subdistribution HR 1.11), with more episodes carrying more risk, whereas fixed absolute thresholds were not consistently associated after adjustment. It is observational, but it supports anchoring targets to each patient's own baseline. A Bayesian meta-analysis of 14 trials (903 kidney transplant recipients) found quadratus lumborum and TAP blocks reduced 24-hour opioid use by about 15 and 10 morphine milligram equivalents, both likely clinically important, but pain reductions fell short of the minimal important difference, certainty was very low and graft outcomes were unreported. A laboratory study found the crystals forming in lidocaine–bicarbonate mixtures are pure local anaesthetic and do not lower its concentration in solution. A secondary analysis of the A2B trial found dexmedetomidine linked to greater recalled awareness of surroundings than propofol, with no difference in frightening memories or satisfaction. The pearl covers recording a true baseline blood pressure before induction.