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While often silent, Myocardial Injury After Noncardiac Surgery (MINS) significantly increases morbidity and mortality in surgical patients. This post is based on a recent article by Wittmann et al., published in Current Opinion in Anesthesiology, which explores the latest findings on how to prevent, identify, and manage MINS in surgical patients. Why This Topic Is Important Up to 20% of adult surgical patients experience postoperative troponin elevation, yet most have no symptoms. Despite the lack of overt clinical signs, studies show that even small postoperative increases in troponin levels are associated with higher mortality and cardiovascular complications for up to a year after surgery. Given that MINS remains largely undetected without troponin screening, early identification and intervention are critical. How the Authors Did the Study Wittmann et al. conducted a narrative review of the latest literature on: The definition and epidemiology of MINS Potential perioperative triggers that contribute to myocardial injury Preventive measures to mitigate risk Management strategies that improve patient outcomes The review analyzed large-scale cohort studies and clinical trials that have shaped our current understanding of MINS, emphasizing its high prevalence, silent nature, and deadly consequences. What the Authors Found MINS is widespread yet underdiagnosed About 18% of patients in the VISION study (a major perioperative study) had postoperative troponin elevations that met the criteria for MINS. 84% of these patients had no symptoms, meaning MINS is often missed without active surveillance. Common perioperative triggers for MINS Hypotension (intraoperative and postoperative) Tachycardia and hypertension Anemia and inadequate oxygen delivery Hypothermia (below 35.5°C) Uncontrolled postoperative pain Coronary artery disease (pre-existing CAD is present in ~72% of perioperative MIs) Postoperative Troponin surveillance is essential 93% of MINS cases would be missed without routine troponin screening. Serial troponin measurements before and after surgery improve detection and help distinguish acute from chronic […]
March 7, 2025
As the ASRA’s latest practice recommendations hit the press—advocating sterile probe covers as part of infection precautions during ultrasound-guided regional anesthesia and pain medicine procedures—the industry is responding by expanding its product portfolio. SonoCover offers a simple, hygienic method to cover medical probes. Available in both a standard linear form and an optional pre-formed chamber, it is engineered for simplified application under sterile conditions using telescope folding. The design includes elastics and tapes for secure fixation, with an option to incorporate sterile ultrasound gel into the kit. This comprehensive, ready-to-use solution is set to enhance infection control protocols for healthcare providers. Learn more: https://pajunk.com/products/pain-management/accessories/ultrasound-probe-cover/
March 6, 2025
Sepsis, a life-threatening organ dysfunction due to a dysregulated host response to infection, requires prompt antimicrobial therapy, source control, and correction of hemodynamic abnormalities. Managing sepsis-induced hemodynamic changes is critical to improving patient outcomes. This review presents evidence-based recommendations for fluid resuscitation, vasopressor use, and hemodynamic targets in adults with sepsis. Key recommendations for hemodynamic support in sepsis Fluid resuscitation Initial fluid therapy: Administer 30 ml/kg of crystalloids within the first 3 hours of sepsis, based on 2021 Surviving Sepsis Campaign guidelines. Tailor fluid administration using hemodynamic monitoring (e.g., echocardiography, dynamic parameters) to avoid overresuscitation. Restrictive vs. Liberal fluid therapy: The CLASSIC trial found no difference in 90-day mortality between restrictive and standard fluid therapy in septic shock. The CLOVERS trial showed no mortality difference between restrictive and liberal fluid strategies but noted earlier vasopressor use in the restrictive group. Fluid responsiveness: Approximately 30% of septic shock patients are non-responders to fluids. Dynamic tests like passive leg raise and end-expiratory occlusion test predict fluid responsiveness and help limit unnecessary fluid administration. Choice of fluids Balanced crystalloids (Lactated Ringer’s, Plasmalyte): Preferred over normal saline to reduce the risk of hyperchloremic metabolic acidosis and improve kidney function. The SMART trial showed fewer major adverse kidney events and lower mortality in sepsis patients receiving balanced crystalloids. Albumin: Hyper-oncotic albumin may reduce fluid balance but has not shown a significant mortality benefit in sepsis. The ALBIOS trial found a mortality reduction in septic shock patients but not in the broader sepsis population. Vasopressor therapy When to start: Initiate norepinephrine as the first-line vasopressor when MAP < 65 mmHg, even if fluid resuscitation is incomplete. Early vasopressor use reduces fluid balance and improves shock control without increasing adverse effects. Peripheral vasopressors: Safe for short-term use in peripheral veins, with a low risk of local complications. […]
March 6, 2025
