The edition · Anaesthesiology
A plain MAP alarm at 72 mmHg prevented hypotension as well as the Hypotension Prediction Index
A randomised non-inferiority trial questions the need for a proprietary hypotension algorithm, low-dose esketamine reduced chronic pain after thoracoscopic surgery, EIT-guided PEEP was linked to fewer pulmonary complications, and a US lidocaine ointment recall.
The edition in brief
In a single-centre blinded trial of 143 adults having moderate- or high-risk non-cardiac surgery with arterial lines, an alarm at MAP below 72 mmHg was non-inferior to a Hypotension Prediction Index alarm above 85 for time and depth below MAP 65 (median area 3.75 vs 4.00 mmHg·min). No secondary outcome differed. In a multicentre double-blind trial of 873 adults having thoracoscopic lung resection, perioperative low-dose esketamine lowered chronic pain at three months from 21.2% to 14.7% (adjusted OR 0.62, 0.43-0.90). In 117 patients at intermediate-to-high pulmonary risk having laparoscopic colorectal surgery, EIT-guided PEEP lowered driving pressure and 30-day pulmonary complications (49.2% vs 72.4%; HR 0.53, 0.33-0.85) compared with fixed PEEP of 5. A validation study found perioperative and ICU CGM readings within acceptable error for 98% of paired values, with accuracy worse during hypoperfusion. In the US, a Class II recall covers one 5% lidocaine ointment for failed content uniformity.
Low-dose esketamine cut chronic pain three months after thoracoscopic lung resection
Consider low-dose perioperative esketamine for thoracoscopic lung resection to reduce chronic postsurgical pain.
EIT-guided PEEP was linked to fewer pulmonary complications in laparoscopic colorectal surgery
In high-risk laparoscopic colorectal surgery, individualise PEEP rather than leaving it at 5; EIT-guided titration was linked to fewer pulmonary complications.
Perioperative CGM was accurate for most readings, but less so during hypoperfusion
Use a patient's CGM as a trend monitor around surgery, but confirm with point-of-care testing before acting, particularly when perfusion is poor.
US Class II recall of one 5% lidocaine ointment for failed content uniformity
Check stock of the named lidocaine ointment against the recall notice; other lidocaine products are not affected.
Local anaesthetic toxicity: stop, call for help, give lipid
Treat suspected local anaesthetic toxicity with early lipid emulsion and prolonged resuscitation if needed.
A MAP alarm set at 72 mmHg matched the Hypotension Prediction Index
An arterial-line MAP alarm at 72 mmHg is a pragmatic alternative to the Hypotension Prediction Index for preventing intraoperative hypotension.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free