The impact of routine preoperative electrocardiogram in patients age > or = 40 years in Srinagarind Hospital.

A 12 lead electrocardiogram (ECG) has been recommended for adult patients before operations involving general or regional anesthesia. However, there is a growing consensus that it is of little benefit and ECG should be done only in selected subsets of patients with cardiac signs and symptoms or older patients. We prospectively surveyed 1,013 patients before operation, 395 patients were 40 years or more, ECG abnormalities were present in 130/395 (32.9%), significant ECG abnormalities in 31/395 (7.9%) and ECG with management change in 10/395 (2.5%). Old or questionable myocardial infarction were found in 8 (4.0%) and acute ischemia or injury in 4 (2.0%). The frequency of ECG abnormalities increased with age in males but not in females. Abnormal physical examination could predict only 20 per cent of abnormal ECG. The variables which could predict ECG abnormalities were age and irregular pulse. The frequency of ECG abnormalities, significant ECG abnormalities and ECG abnormalities which led to management change in those patients with normal physical examination were 31.7, 6.4 and 2.2 per cent respectively. In conclusion we propose that preoperative ECG may be indicated in both men and women aged > or = 40 years.

The impact of routine preoperative chest X-ray in Srinagarind Hospital, Khon Kaen.

We conducted a prospective study of 1,013 consecutive patients who were scheduled for elective surgery in Srinagarind Hospital to determine the prevalence of abnormal chest X-rays and the change in management. Chest X-ray abnormalities were detected in 19.4 per cent (181/933) and lead to management change in 3.6 per cent (34/933). Fifty out of 933 had tuberculosis like lesions and 59 had cardiomegaly. By using Mantel-Haenzel chi-square and logistic regression, age greater than or equal to 45 years old was the most important predictors of the abnormalities found. Other predictors were cough and productive sputum. There was no statistical difference of the intraoperative and postoperative complications among the patients aged less than 45 years who had normal and abnormal chest X-rays. A preoperative chest X-ray may be useful as a routine evaluation only in those aged greater than or equal to 45 years.