Hemodynamics, fluids & transfusion
Efficacy and safety of intraoperative controlled hypotension: a systematic review and meta-analysis of randomised trials
Authors' conclusion
Anaesthesia researchers prioritised safety outcomes, whereas surgery researchers emphasised efficacy in controlled hypotension trials. Controlled hypotension significantly reduces blood loss. In contrast, safety outcomes were poorly studied.
Study context
- Population
- Randomised trials of intraoperative controlled hypotension, led by anaesthesia or surgery investigators
- Participants
- 48 eligible trials
- Comparison
- Controlled hypotension vs usual care
- Outcome
- Focus of trials' primary outcome (safety vs efficacy) by investigators' affiliation
Methodological detailstrial sequential analysis, trials categorised by investigators' affiliation
- Trial sequential analysis
- Trials categorised by investigators' affiliation
Pooled result
As reported in the abstract
Primary outcome focus by investigator affiliation
- Anaesthesia-led trials (n=37) with primary outcome focused on safety
- 54%
- Surgery-led trials (n=11) with primary outcome focused on efficacy
- 100%
- Difference between anaesthesia- and surgery-led trials
- P=0.004
Further pooled results
| Outcome | Estimate |
|---|---|
| Mean arterial pressure, by trial affiliationControlled hypotension vs Usual care · anaesthesia trials | % lower 23% (95% CI 17–29%) |
| Mean arterial pressure, by trial affiliationControlled hypotension vs Usual care · surgery trials | % lower 30% (95% CI 14–37%) |
| Estimated blood loss, by trial affiliationControlled hypotension vs Usual care · anaesthesia trials | % less 44% (95% CI 30–55%) |
| Estimated blood loss, by trial affiliationControlled hypotension vs Usual care · surgery trials | % less 38% (95% CI 30–49%) |
Blood loss, overall
- Overall blood loss reduction
- 43% (95% CI 32-53%)
- Trial sequential analysis supported an efficacy conclusion
Association of MAP and estimated blood loss reductions
- MAP and estimated blood loss reductions associated (P=0.002)
- R2=0.41
Safety
- All trials underpowered for safety outcomes; none adequately evaluated myocardial or renal injury
Original publication
Efficacy and safety of intraoperative controlled hypotension: a systematic review and meta-analysis of randomised trials. Br J Anaesth. Published 14 July 2024. doi:10.
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