Metabolic syndrome is an independent risk factor for stroke and acute renal failure after coronary artery bypass grafting

OBJECTIVES

Metabolic syndrome is common among patients having coronary artery bypass grafting. However, it remains unclear whether it has a significant impact on postoperative complications. We aimed to determine whether metabolic syndrome negatively influences the postoperative outcomes of coronary artery bypass grafting.

METHODS

We enrolled 1183 patients who had coronary artery bypass grafting at Juntendo University Hospital between 1984 and 1992. Patients were categorized by the presence or absence of metabolic syndrome using the modified National Cholesterol Education Program Adult Treatment Panel III definition with body mass index in the place of waist circumference. Multivariate analysis was performed to assess the relationships between preoperative presence of metabolic syndrome and postoperative outcomes.

RESULTS

Metabolic syndrome was present in 551 (46.6%) patients and absent in 632 (53.4%). Postoperative stroke occurred in 4.7% of patients with metabolic syndrome and 2.1% of patients without metabolic syndrome (P < .0001). Postoperative acute renal failure occurred in 3.8% of patients with metabolic syndrome and 1.1% of patients without metabolic syndrome. On multivariate analysis, metabolic syndrome had odds ratios of 2.47 (95% confidence interval 1.22-4.99; P = .012) for postoperative stroke and 3.81 (95% confidence interval 1.42-10.3; P = .008) for postoperative acute renal failure.

CONCLUSIONS

This study showed the clinical importance of metabolic syndrome with respect to postoperative stroke and acute renal failure in patients having coronary artery bypass grafting. Like many established risk factors for postoperative complications, metabolic syndrome should be recognized as a novel risk factor for adverse events.

Cardiac Arrest due to Failed Pacemaker Capture After Peripheral Nerve Blockade With Levobupivacaine: A Case Report

We describe a patient with a pacemaker who developed cardiac arrest shortly after ultrasound-guided rectus sheath block for postoperative analgesia. The cause of cardiac arrest was capture failure due to an increased pacing threshold, and the patient was promptly treated by increasing the pacing amplitude. Local anesthetics used for rectus sheath block might have affected the pacing threshold and caused pacing capture failure, since local anesthetics can block cardiac sodium channels. Anesthesiologists should recognize the risk of pacemaker capture failure when a large amount of local anesthetic is given to patients with a cardiac pacemaker.

[An analysis of the cardiovascular responses under hyper- and hypo-gravity environments using a mathematical model]

Gravity affects cardiovascular control system remarkably. Internal control mechanism responsible for such cardiovascular changes under hypo- and hyper-gravity have not yet been fully understood, although many biological and physiological measurements as to cardiovascular system have been conducted since man's first exploration to space. One reason for this arises from the difficulty in continuous and simultaneous measurements of hemodynamics of many parts of the body. To overcome this difficulty, a mathematical model was constructed based on animal and human physiological evidence in our previous study. In the present study, the model is used for explaining hemodynamics during hyper- and hypo-gravity environments obtained during parabolic flight. The parabolic flight experiment was conducted by a small rear-jet MU300. Three university male students volunteered as subjects. Five to eleven parabolic flights per day were performed for 6 days. The subjects sat on a chair either in an upright position or a 45 degree reclining position. Electrocardiogram and finger blood pressure were measured continuously during the flights. Variable parameters of the model were adjusted so that heart rate and blood pressure of the model fit to those of the experiment. It was shown that the model can quantitatively reproduce and predict experimental heart rate and blood pressure during a parabolic flight. Analysis of internal property of the model revealed hemodynamics of the human cardiovascular system during a parabolic flight which explains the mechanisms of cardiovascular responses under hyper- and hypo-gravitational environments.

[Two Cases of Large Gynecological Tumor Complicated by Preoperative Deep Vein Thromboembolism and Pulmonary Thromboembolism-Should We Use Inferior Vena Cava Filters ?-]

We experienced two cases of large gynecological tumor resection with co-existing deep vein thrombo- embolism (VTE) and pulmonary thromboembolism (PTE). Despite perioperative anticoagulation, one of the two patients developed dyspnea with massive PTE postoperatively, although the other patient did not have any postoperative complications. To prevent fatal mas- sive PTE, temporary inferior vena cava (IVC) filter might have been effective during perioperative period in these cases. Since there are wide variations among institutes regarding the perioperative application of temporary IVC filters for patients with co-existing VTE and/or PTE before surgery, guidelines or recom- mendations for appropriate usage of perioperative IVC filter are necessary.

A low peripheral perfusion index can accurately detect prolonged capillary refill time during general anesthesia: A prospective observational study

Background

Capillary refill time (CRT) is the gold standard for evaluating peripheral organ perfusion; however, intraoperative CRT measurement is rarely used because it cannot be conducted continuously, and it is difficult to perform during general anesthesia. The peripheral perfusion index (PI) is another noninvasive method for evaluating peripheral perfusion. The PI can easily and continuously evaluate peripheral perfusion and could be an alternative to CRT for use during general anesthesia. This study aimed to determine the cutoff PI value for low peripheral perfusion status (prolonged CRT) by exploring the relationship between CRT and the PI during general anesthesia.

Methods

We enrolled 127 surgical patients. CRT and the PI were measured in a hemodynamically stable state during general anesthesia. A CRT >3 s indicated a low perfusion status.

Results

Prolonged CRT was observed in 27 patients. The median PI values in the non-prolonged and prolonged CRT groups were 5.0 (3.3-7.9) and 1.5 (1.2-1.9), respectively. There was a strong negative correlation between the PI and CRT (r = -0.706). The area under the receiver operating characteristic curve generated for the PI was 0.989 (95% confidence interval, 0.976-1.0). The cutoff PI value for detecting a prolonged CRT was 1.8.

Conclusion

A PI <1.8 could accurately predict a low perfusion status during general anesthesia in the operating room. A PI <1.8 could be used to alert the possibility of a low perfusion status in the operating room.

Trial Registration

University Hospital Medical Information Network (UMIN000043707; retrospectively registered on March 22, 2021, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno = R000049905).