Despite acceptance of the surgical pleth index (SPI) for monitoring the intraoperative balance between noxious stimulation and anti-nociception under general anesthesia, its efficacy for predicting postoperative moderate-to-severe pain remains unclear. We searched electronic databases (e.g., Google Scholar, MEDLINE, Cochrane Library, and EMBASE) to identify articles focusing on associations of SPI at the end of surgery with immediate moderate-to-severe pain in the postanesthesia care unit from inception to 7 July 2022. A total of six observational studies involving 756 adults published between 2016 and 2020 were eligible for quantitative syntheses. Pooled results revealed higher values of SPI in patients with moderate-to-severe pain than those without (mean difference: 7.82, 95% CI: 3.69 to 11.95, p = 0.002, I² = 46%). In addition, an elevated SPI at the end of surgery was able to predict moderate-to-severe pain with a sensitivity of 0.71 (95% confidence interval (CI): 0.65–0.77; I² = 29.01%) and a specificity of 0.58 (95% CI: 0.39–0.74; I² = 79.31%). The overall accuracy based on the summary receiver operating characteristic (sROC) curve was 0.72. In conclusion, this meta-analysis highlighted the feasibility of the surgical pleth index to predict postoperative moderate-to-severe pain immediately after surgery. Our results from a limited number of studies warrant further investigations for verification.

This meta-analysis assessed the predictive efficacy of perfusion index for hypotension following spinal anesthesia (SA) in parturients undergoing elective cesarean section (CS). Electronic databases, including Google Scholar, EMBASE, Cochrane Library, and MEDLINE, were searched from inception to June 2023. The primary outcome was the diagnostic accuracy of the perfusion index in predicting the probability of perioperative hypotension following SA. The review included 12 studies involving 2009 patients, published between 2017 and 2023. The pooled sensitivity and specificity were 0.81 (95% confidence interval (CI) = 0.72–0.87) and 0.75 (95% CI = 0.67–0.82), respectively. Additionally, the pooled area under the curve (AUC) was calculated as 0.84 (95% CI = 0.81–0.87), suggesting a moderate to good accuracy of the diagnostic test. Using Fagan’s nomogram plot, the positive likelihood ratio (LR) and negative LR were found to be 3 and 0.26, respectively. The results demonstrated that the perfusion index exhibited an acceptable level of accuracy in predicting perioperative hypotension after spinal anesthesia in parturients undergoing elective CS. These findings highlight the potential value of incorporating a perfusion index as a useful tool for clinicians to integrate into routine clinical practice, which necessitates further large-scale studies for verification.

Background: This study aimed at providing an updated evidence of the association between intraoperative lidocaine and risk of postcardiac surgery cognitive deficit. Methods: Randomized clinical trials (RCTs) investigating effects of intravenous lidocaine against cognitive deficit in adults undergoing cardiac surgeries were retrieved from the EMBASE, MEDLINE, Google scholar, and Cochrane controlled trials register databases from inception till May 2021. Risk of cognitive deficit was the primary endpoint, while secondary endpoints were length of stay (LOS) in intensive care unit/hospital. Impact of individual studies and cumulative evidence reliability were evaluated with sensitivity analyses and trial sequential analysis, respectively. Results: Six RCTs involving 963 patients published from 1999 to 2019 were included. In early postoperative period (i.e., 2 weeks), the use of intravenous lidocaine (overall incidence = 14.8%) was associated with a lower risk of cognitive deficit compared to that with placebo (overall incidence = 33.1%) (relative risk = 0.49, 95% confidence interval: 0.32–0.75). However, sensitivity analysis and trial sequential analysis signified insufficient evidence to arrive at a firm conclusion. In the late postoperative period (i.e., 6–10 weeks), perioperative intravenous lidocaine (overall incidence = 37.9%) did not reduce the risk of cognitive deficit (relative risk = 0.99, 95% confidence interval: 0.84) compared to the placebo (overall incidence = 38.6%). Intravenous lidocaine was associated with a shortened LOS in intensive care unit/hospital with weak evidence. Conclusion: Our results indicated a prophylactic effect of intravenous lidocaine against cognitive deficit only at the early postoperative period despite insufficient evidence. Further large-scale studies are warranted to assess its use for the prevention of cognitive deficit and enhancement of recovery (e.g., LOS).

The safety of tranexamic acid (TXA) in patients with recent coronavirus disease (COVID-19) infection undergoing major arthroplasty remains unclear. We aimed to evaluate whether TXA increases thromboembolic risk in post-COVID-19 patients undergoing major arthroplasty. Using the TriNetX database, we identified patients aged ≥50 years who underwent total knee or hip arthroplasty with documented COVID-19 within 3 months prior to surgery. Patients who received TXA on the day of surgery were compared with those who did not. The primary outcome was 6-month risk of venous thromboembolism (VTE), with secondary outcomes including cerebral infarction, mortality, intensive care unit (ICU) admission, acute kidney injury (AKI), sepsis, and pneumonia. After matching (26,366 patients for each group), analysis revealed that TXA use was not associated with an increased risk of VTE (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.90–1.32, P = .404), cerebral infarction (OR 0.86, 95% CI 0.67–1.09, P = .215), mortality (OR 0.81, 95% CI 0.60–1.10, P = .174), or other complications at 6 months. Notably, TXA was associated with a significantly reduced risk of ICU admissions (OR 0.74, 95% CI 0.62–0.89, P = .001). Sensitivity analysis showed that TXA provided additional benefits in patients with prior COVID-19 hospitalization, including reduced mortality (OR 0.53, P = .003), lower risk of AKI (OR 0.79, P = .002), and decreased incidence of sepsis (OR 0.77, P = .038). Sex-based analysis revealed more pronounced benefits in female patients, particularly for ICU admission and AKI. TXA use in post-COVID patients undergoing major arthroplasty was associated with better long-term outcomes without increasing thromboembolic risk, supporting the continued use of TXA in this patient population.

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