and mortality. 4,9 Hemodynamic disturbance during OPCAB has been reported to have a biventricular contribution, and the major cause is believed to be diastolic dysfunction and abnormal filling of both ventricles. 10,11 As such, it is possible that an underlying increased LVFP may aggravate the intraoperative hemodynamic disturbance, resulting in a higher rate of postoperative AKI. Although previous studies have reported the effect of diastolic dysfunction on postoperative outcomes, including death or major adverse cardiac events (MACE), 4,12 postoperative renal dysfunction was evaluated only as a secondary outcome and the association between increased LVFP in patients with normal LV systolic function and postoperative AKI has not been fully evaluated.The ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e′) has been reported to have good predictive power for mean LV diastolic pressure or mean LVFP and has been used to estimate the diastolic function of the heart. 13,14 E/e′ >15 is P erioperative acute kidney injury (AKI) has been reported to be an important contributor to postoperative morbidity and mortality especially after cardiovascular surgery, including coronary artery bypass graft (CABG). 1,2 Off-pump coronary artery bypass surgery (OPCAB) has been associated with less severe and a lower incidence of AKI compared with on-pump CABG. 3 Nonetheless, there is still a substantial incidence of AKI after OPCAB and it is caused by transient circulatory arrest, global hypoperfusion, myocardial ischemia-reperfusion injury, and inflammatory response. 3 The incidence of diastolic dysfunction in patients who undergo CABG has been reported as high. 4,5 Although many studies have reported systolic dysfunction of the heart as a risk factor for postoperative AKI, 6,7 the association between preoperative diastolic dysfunction and postoperative AKI has not been investigated. A stiff left ventricle with low compliance would lead to an elevated LV filling pressure (LVFP), 8 which is associated with higher morbidity Background: The ratio of the early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an echocardiographic index of mean left ventricular (LV) filling pressure. We investigated the association between the preoperative E/e′ ratio and postoperative acute kidney injury (AKI) during off-pump coronary artery bypass surgery (OPCAB).

We observed few cardiopulmonary benefits but poor surgical conditions in the low intra-abdominal pressure during laparoscopy. Considering cardiopulmonary dynamics and surgical conditions, the standard intra-abdominal pressure may be preferable to the low pressure for laparoscopic surgery.

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BACKGROUND: Inadvertent perioperative hypothermia is common in patients undergoing off-pump coronary artery bypass grafting (OPCAB). We investigated the association between early postoperative body temperature and all-cause mortality in patients undergoing OPCAB. METHODS: We reviewed the electronic medical records of 1714 patients who underwent OPCAB (median duration of follow-up, 47 months). Patients were divided into 4 groups based on body temperature at the time of intensive care unit admission after surgery (moderate-to-severe hypothermia, <35.5°C; mild hypothermia, 35.5°C–36.5°C; normothermia, 36.5°C–37.5°C; and hyperthermia, ≥37.5°C). Cox proportional hazards models were used to assess the association between body temperature and all-cause mortality. The association between early postoperative changes in body temperature and all-cause mortality was also assessed by dividing the patients into 4 categories according to the body temperature measured at postoperative intensive care unit admission and the average body temperature during the first 3 postoperative days. RESULTS: Compared to the normothermia group, the adjusted hazard ratios of all-cause mortality were 2.030 (95% confidence interval, 1.407–2.930) in the moderate-to-severe hypothermia group and 1.445 (95% confidence interval, 1.113–1.874) in the mild hypothermia group. Patients who were hypothermic at postoperative intensive care unit admission but attained normothermia thereafter were at a lower risk of all-cause mortality compared to patients who did not regain normothermia (adjusted hazard ratio, 0.631; 95% confidence interval, 0.453–0.878), while they were still at a higher risk of all-cause mortality than those who were consistently normothermic (adjusted hazard ratio, 1.435; 95% confidence interval, 1.090–1.890). CONCLUSIONS: Even mild early postoperative hypothermia was associated with all-cause mortality after OPCAB. Patients who regained normothermia postoperatively were at lower risk of all-cause mortality compared to those who did not.

We studied the predictive performance of the Minto pharmacokinetic model during cardiopulmonary bypass in patients undergoing cardiac surgery. Patients received remifentanil target-controlled infusion using the Minto model during total intravenous anaesthesia with propofol. From 56 patients, 275 arterial blood samples were drawn before, during and after bypass to determine the plasma concentration of remifentanil, and the predicted concentrations were recorded at each time. For pooled data, the median prediction error and median absolute prediction error were 21.3% and 21.8%, respectively, and 22.1% and 22.3% during bypass. Both were 148.4% during hypothermic circulatory arrest and measured concentrations were more than three times greater than predicted (26.9 (17.0) vs. 7.1 (1.6) ng.ml ). The Minto model showed considerable bias but overall acceptable precision during bypass. The target concentration of remifentanil should be reduced when using the Minto model during hypothermic circulatory arrest.