Preoperative Anxiety Among Cardiac Surgery Patients and Its Impact on Major Adverse Cardiac Events and Mortality– A Randomized, Parallel?Group Study

Background:Patients undergoing elective cardiac surgery often experience pre?operative anxiety. Preoperative anxiety influences surgical outcome. There are very few studies which have assessed the impact of clonidine and Gabapentin in the treatment of anxiety especially in Indian populations and its implications on major adverse cardiac events (MACE) and 30 days mortality. Materials and Methods: Adult patients aged 18 to 80 years old who were scheduled to have an elective coronary artery by?pass graft (CABG) were included in the study.Those who satisfied the inclusion criteria were given either Gabapentin (800 mg) or Clonidine (300 mcg) 90?120 minutes before the induction. State trait anxiety inventory (STAI) was used to assess anxiety in baseline and taking just before operating room. The primary endpoint was a reduction in the STAI associated with the study drug, while the secondary endpoint was the incidence of MACE in the perioperative period (30 days), which included composite episodes of non?fatal cardiac arrest, chaotic rhythm, acute myocardial infarction, congestive heart failure, cardiac arrhythmia, angina, and death. Results: A total of 75 patients were considered for the statistical analysis. The demographic and clinical features of the study participants were similar in both groups. Nearly 75?80% of participants had severe anxiety in the preoperative period while 10?20% had moderate anxiety. While both the drugs showed a reduction in the anxiety levels, the clonidine group fared better (statistically insignificant). The incidence of MACE was similar in both groups. Conclusion:The preoperative anxiety levels were high among cardiac surgery patients.Both clonidine and gabapentin were equally effective in reducing the levels of preoperative anxiety. Preoperative STAI scores in the range of 32?53 is not associated with MACE and 30?day mortality among cardiac surgery patients.

Minoxidil poisoning presenting as acute coronary syndrome: a rare case scenario.

We present a case of severe minoxidil poisoning (3000 mg) with resultant severe hypotension, tachycardia and subendocardial ischemia initially treated crystalloid, dopamine, aspirin, clopidogrel on the lines of acute coronary syndrome with partial haemodynamic improvement. After getting the history of minoxidil poisoning, the patient was treated with bolus doses of norepinephrine, and norepinephrine infusion, resulting in resolution of hypertension, tachycardia and reversal of ischemia. Topical minoxidil is commonly used agent for male pattern baldness. It also has got antihypertensive action when ingested, acute coronary syndrome and compensatory tachycardia with successful management with norepinephrine bolus and infusion.