Guideline evolution is driven by ongoing research; recent studies like PeriOperative ISchemic Evaluation-3 Trial (POISE-3) and trials such as OPtimisation of Peri-operaTive CardIovascular Management to Improve Surgical outcomE II (OPTIMISE II) trial may influence recommendations on hemodynamic management and the use of tranexamic acid. Future guidelines are expected to integrate machine learning models for risk prediction, addressing complex patient phenotypes and interactions. Discontinuation vs. continuation of renin–angiotensin system inhibition before non-cardiac surgery: the SPACE trial has challenged existing practices regarding the discontinuation of ACE inhibitors or ARBs, highlighting the dynamic nature of medical guidelines and the continuous incorporation of new evidence to enhance patient care.

Presented by Andy Cumpstey and Joff Lacey with Mark Edwards, Consultant in Anaesthesia and Perioperative Medicine, University Hospital Southampton Honorary Senior Clinical Lecturer, University of Southampton and John Whittle, Clinical Academic working in Perioperative Translational Medicine at UCL and Honorary Consultant in Perioperative Medicine, Anaesthesia and Critical Care at University College Hospitals London.

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More on POISE-3 here: https://clinicaltrials.gov/study/NCT03505723

More on OPTIMISE II here: https://optimiseii.org/

More on the SPACE trial here: https://doi.org/10.1093/eurheartj/ehad716