Anesthesiology

MAP ≥60–65 mmHg likely adequate for most noncardiac surgical patients

This narrative review integrates large observational cohorts, randomized trials, and consensus statements on intraoperative blood pressure in adult noncardiac surgery. Observational data link even MAP 60–70 mmHg, in a duration-dependent fashion, to myocardial injury, acute kidney injury, and mortality. Yet multicentre RCTs totalling over 13,000 patients found no outcome benefit when targeting higher or individualized MAP versus routine MAP ≥65 mmHg. Only one small trial reported benefit from individualized systolic blood pressure targets. 1

PROSPECT update: structured multimodal analgesia for elective neuraxial caesarean

This PROSPECT systematic review of 61 RCTs updates procedure-specific postoperative analgesia recommendations for elective caesarean under neuraxial anesthesia. The panel recommends intrathecal morphine 50–100 μg or diamorphine 300 μg preoperatively, plus paracetamol, NSAIDs, and dexamethasone after delivery. If neuraxial opioid is omitted, they advise a fascial plane block or local anesthetic wound infiltration to provide regional analgesia. Postoperative care should include regular paracetamol and NSAIDs, using systemic opioids only as rescue therapy. 2

Perioperative diabetes consensus: pathway-based, individualized management

This multidisciplinary statement issues 38 recommendations for perioperative management of patients with diabetes undergoing surgery. It targets contributors to excess morbidity and mortality, including dysglycaemia, hospital-acquired ketoacidosis, insulin errors, fluid issues, and infections. The authors emphasize organizational pathways, standardized protocols, and staff training alongside individualized care rather than rigid HbA1c cutoffs for scheduling surgery. They detail principles for capillary glucose and ketone monitoring, safe insulin prescribing and administration, and structured handovers. 3

Low-dose intraoperative dexmedetomidine linked to less postoperative delirium

This retrospective cohort of 114,786 adults undergoing noncardiac, non-transplant surgery examined dose–response between intraoperative dexmedetomidine and postoperative delirium. Only 4.2% received dexmedetomidine, with a median cumulative dose of 0.49 μg·kg⁻¹. Compared with no dexmedetomidine, low doses (≤0.49 μg·kg⁻¹) were associated with lower delirium risk (adjusted OR 0.61; 95% CI 0.44–0.85). Higher doses (>0.49 μg·kg⁻¹) were not protective (adjusted OR 1.06; 95% CI 0.84–1.34). 4