Importance of preoperative assessment: a view of anaesthetic outpatient at JPMC Karachi

To evaluate the patients preoperatively and follow them for any significant morbidity or mortality in peri or post operative period in relation to American Society of Anesthesiologist [ASA] physical status grading system. Design: A prospective study on 400 patients visiting our Preanaesthetic Outpatient Clinic in one month. Setting: Anaestnetic Outpatient clinic at Jinnah Postgraduate Medical Centre and their follow up in theatre and surgical wards. Subjects: Four hunderd patients Four hundred patients scheduled for elective surgery were evaluated in one month. 70% were new while 30% were reassessed. 78.75% were fit for anaesthesia while 21.25% were called back for reassessment. 79,25% were scheduled for major to moderate surgery while 20.25% for minor surgery. 21% patients were in ASA physical status grade I, 54% in ASA grade II, 22.50% were in ASA grade III while 2.5% in ASA grade Iv showing significant distribution of proportion with P< 0.001. Maximum patients i.e. 46.25% had cardiovascular problems while 32.25% had respiratory diseases, 4,50% were diabetic while 14.25% had haenologlobin below 10 gm%. There was no peri operative mortality in this series. Patients in ASA grade I and II had no postoperative mortality as well while morbidity was 2.38% and 3.24% respectively. In ASA grade III and IV mortality was 3.30% and 30% with morbidity of 11.11% and 40%respectively. Total mortality in this series was 1.5% and morbidity was 5.75%. By evaluating the patients preoperatively unsuspected abnormalities were detected and patients with associated problems were optimized clinically. A definite correlation was found between ASA physical status of the patients and their overall outcome

Cerbral aneurysmal surgery: anaesthetic management and outcome

Twenty-one patients were admitted to out Neurosurgical Unit with subarachnoid haemorrhage due to ruptured cerebral aneurysm in the year 1995. Five patients in Hess and Hunt Grade V died within 48 hours, four patients in Grade III and IV were judged to be unfit for surgery while twelve patients underwent surgical intervention at about 17.50 +/- 0.20 days after the first subarachnoid bleed. All underwent a strandard cerebral protective general anaesthesia. They were kept normotensive. Normocapnic and normothermic intra-operatively; brain relaxation was achieved with lumbar drainage and mannitol. Ten patients underwent temporary clipping prior to clipping of aneurysm. Thiopentone sodium 2 mg/kg was given for cerebral protection. Blood pressure and central venous pressure were increased by giving haemaccel. Mean clipping time was 8.7 +/- 2.58 minutes, range [5-14 min]; no deterioration was noted in the neurological status of these patients postoperatively. There were no per- or post-operative mortality in this series. One operative morbidity [rupture of an aneurysm in the anterior communicating artery during operation] and one postoperative morbidity [hydrocephalus on the seventh postoperative day] were encountered. The mean GCS [Glasgow Coma Scale] at the time of discharge of all these patients was 14.42 +/- 0.28. It is concluded that patients with cerebral aneurysms can safely be operated upon under normotensive, normocapnic and normothermic anaethesia with provision of drugs for cerebral protection between temporary arterial occlusion and clipping of aneurysm