ABSTRACT
Background:Perioperative evaluation is an important step before considering a patient for surgery to deal with cardiovascular risk factors.The aim of the study is to e valuate the risk of cardiovascular events during perioperative period in non-cardiac & non-vascular surgery, even in patients with no previous evidence of cardiac disease.Material And Methods:All patients admitted in Orthopaedic, Surgery, Gynaecology department were evaluated clinically as well as with laboratory and radiological investigation. All patients with age > 40 years were subjected to electrocardiography. All the data was collected & recorded in standard Proforma. Clinical evaluation was done preoperatively & 24 hour post operatively. In patients developing cardiovascular complications, additional evaluation was done on the basis of need. Result:Highest number of patients undergoing elective non-cardiac surgery belonged to the younger age group. General surgery had the highest number of patients 45.3%, followed by Orthopaedics (36%), Gynaecology (18.7%). In view of surgery done by 3 above-mentioned surgical branches, there was not much difference in the rate of risk ofcardiovascular events. Diabetes mellitus, hypertension, and cardiac diseases were found as frequent risk factors (44 (29.3%), 52 (34.6%), 26 (17.3%) respectively.) Postoperative cardiovascular complication rate was most commonly seen in cardiac diseases, which were 8 (30.7%) patients. The incidence of perioperative cardiac complication in our study was 8.7% with 4% mortality. Conclusion:The incidence of complication was highest in patients undergoing high risk surgeries like intraperitoneal surgery. The RCRI classification was a good preoperative tool for risk stratification of patients undergoing non-cardiac surgery.
ABSTRACT
Background:Chronic obstructive pulmonary disease / COPD is a multifactorial disease involving various electrolyte abnormalities. This study aimed at evaluating serum electrolyte levels in patients with acute exacerbation of COPD. Material And Methods:This study aimed at evaluating serum electrolyte levels in patients with acute exacerbation of COPD. This study included 100 cases & 100 controls with acute exacerbation of COPD admitted in intensive care unit. All the patients from the cases group were screened for Ca+2 & Mg+2 abnormalities during their intensive care unit stay. In group 1 (cases) correction for abnormal electrolytes were given on the day of admission. Treatment, antibiotics selection, metabolic parameters correction & acid base correction were considered equally in both the groups as per GOLD (Global initiative for chronic obstructive lung disease) guidelines. Symptomatic patients after 48 hours of intensive care unit admission were screened for calcium & magnesium levels & prevalence of hypocalcemia & hypomagnesemia was calculated.Result:It was found out that average duration of intensive care unit stay was reduced significantly in group 1 (cases) in whom the correction of electrolyte imbalance was considered at the time of admission. Also, in the control group, who were still symptomatic after 48 hours of intensive care unit treatment, a significant proportion was found to have hypocalcaemia and hypomagnesaemia (Electrolytes measured after 48 hours).Conclusion:In stable COPD patients there are abnormal serum electrolytes that may get further deranged during acute exacerbations. Thus serum electrolytes level should be monitored routinely in these patients & an attempt should be made to correct them at the earliest to avoid poor outcomes.