Background: The hypotension prediction index (HPI) is an algorithm designed to predict hypotension. Some studies have reported that HPI-guided hemodynamic management strategies decrease intraoperative hypotension and complications; however, the effect of HPI on reducing perioperative complications is controversial. This meta-analysis aimed to assess the efficacy of the HPI in reducing major complications and intraoperative hypotension. Methods: We conducted this meta-analysis according to the PRISMA statement and Cochrane Handbook guidelines. A comprehensive literature review was conducted to identify studies focusing on the efficacy of HPI-guided management in reducing intraoperative hypotension and postoperative complications. The PubMed, Embase, Scopus, and Web of Science databases were searched, and the resulting data were combined to calculate the pooled mean differences or risk ratios (RRs) with 95% CIs of both randomized controlled trials (RCTs) and retrospective studies, as appropriate. Heterogeneity and potential publication bias were also assessed. Results: Nineteen articles (12 RCTs and 7 retrospective studies) with 2570 recruited patients were included in this meta-analysis. The critical evaluation of the study quality revealed a low risk of bias in the included RCTs. Among the non-randomized trials, one was rated 7, two were rated 8, and the remaining four were rated 9 on the Newcastle-Ottawa Scale, indicating high quality and a low risk of bias. HPI-guided management significantly reduced intraoperative hypotension and associated major complications (RR = 0.79, 95% CI [0.69–0.90], I2 = 0, P < 0.001). Blood loss and length of hospital stay were comparable between the groups. Conclusions HPI-guided management significantly reduced intraoperative hypotension and major complications.

Objective In order to optimize the perioperative anesthesia management for ESDR patients undergoing arteriovenous fistula,we compared the impact of brachial plexus nerve block and other anesthesia methods on the long-term patency rate of arteriovenous fistula after surgery.Methods In this study,2 parts of work were conducted.Part Ⅰ,a retrospective cohort study:ESRD patients who underwent arteriovenous fistulas in the First Affiliated Hospital of Sun Yat-sen University from January 1,2017 to August 30,2022 were selected.According to the method of anesthesia,patients were divided into BPB group(180 cases)and local anesthesia(LA)group(332 cases).The basic characteristics,postoperative follow-up,fistula patency rate and postoperative complications were collected and statistically analyzed.Part Ⅱ:Meta-analysis:All relevant literatures from CNKI,Wanfang,PubMed,Web of Science,Cochrane Library and Scopus databases were searched up to April 2024,literature screening and data extraction were conducted according to inclusion and exclusion criteria,and data analysis was performed using RevMan 5.3.Results The first part of the retrospective study showed that the primary patency rate in the BPB group was significantly different from that in the local anesthesia group at 1 month and 12 months postsurgery(96.6％vs 91.7％,P＜0.05;68.3％vs 59.0％,P＜0.05),and the patency rate after intervention was significantly different at 1 month,3 months and 12 months(100.0％vs 95.5％,P＜0.05;96.5％vs 86.3％,P＜0.05;85.0％vs 70.8％,P＜0.05).There was no significant difference in postoperative infection,thrombosis and hematoma complications(P＞0.05).The second part of the Meta-analysis results showed that there was a statistically significant difference in the primary patency rate of BPB compared with other anesthesia methods(SMD=1.51,95％CI:1.17～1.96,P＜0.05),and there was no statistically significant difference in postoperative infection and thrombosis complications(P＞0.05).Conclusion As a consequence,BPB has obvious advantages over other anesthesia methods in maintaining long-term patency of upper limb arteriovenous fistula,and it has comparable safety with other anesthesia methods.