Detection of comorbid illnesses during pre-anaesthesia evaluation in a university teaching hospital: A prospective observational study.

Background. Consultation for surgery and anaesthesia is often the first point of contact with a healthcare provider for a majority of patients in developing countries. In India, where patients have poor access to healthcare, they are likely to present with uncontrolled/untreated/undetected coexisting diseases. However, there is little published literature on this aspect. We hypothesized that many of our patients will present to our pre-anaesthesia evaluation clinic (PAC) with undetected comorbid illnesses and will require proper assessment, treatment and optimization before surgery. Thus, we aimed to assess the frequency and type of comorbid illnesses in patients attending the pre-anaesthesia clinic for elective surgery. Methods. We did a prospective observational study on all patients evaluated in the PAC of our university teaching hospital over a 3-month period to assess the frequency and type of comorbid illnesses. The data recorded included demographic profile and presence of coexisting illness and was classified as preexisting or newly diagnosed at the time of the visit to the PAC. The data were then tabulated and analysed statistically using SPSS software version 14.0. The frequency and percentage of occurrence for each comorbid illness was determined. Results. Of 3973 patients, 242 (6%) had 304 comorbid illnesses (135 cardiac, 54 endocrine, 15 respiratory, 12 others). Of these 88 (29%) were newly detected comorbid conditions (69 cardiac, 9 endocrine, 9 respiratory, 1 others). The most frequent comorbid illness both pre-existing and newly diagnosed were cardiac. Hypertension was the commonest problem in our study population (168 patients). Conclusion: We confirmed that a PAC can detect hitherto undetected comorbid illnesses which are likely to impact the perioperative process.

Pre-operative intravenous fluid therapy with crystalloids or colloids on post-operative nausea & vomiting.

BACKGROUND & OBJECTIVE: Post-operative nausea and vomiting (PONV) is a frequent complication and may be a reason for increased morbidity and cost of treatment. Following elective surgery, it is believed to result from gut ischaemia consequent to hypovolemia from overnight fasting. This study was carried out to study the effects of pre-operative intravenous fluid supplementation, either crystalloids or colloids, on PONV. METHODS: In this prospective randomized clinical trial, 60 female patients undergoing elective open cholecystectomy were randomly allocated to three equal groups A, B and C. All patients received preoperative fluid supplementation. Group A patients received 2 ml/kg Ringer lactate iv (intravenously) and served as control, Group B patients received 12 ml/kg Ringer lactate iv whereas Group C patients received 12 ml/kg of 4.5 per cent hydroxyethylstarch (Hetastarch) iv. All patients underwent cholecystectomy under standard anaesthesia technique with intraoperative fluid replacement by Ringer's lactate (6 ml/kg/h). An independent blinded observer assessed PONV during first 24 h following surgery using visual analogue scale (VAS) score (0 = no nausea, 10 = worst imaginable nausea or vomiting). Rescue antiemetic was given whenever VAS was > 5. RESULTS: The three groups were comparable in terms of age, body weight and duration of surgery. VAS scores in Groups B and C patients were less than that of Group A patients at all time intervals post-operatively and became significantly different at 4 h post-operatively. The VAS scores of Groups B and C patients were comparable throughout. A significantly large number (90%) of Group A patients required rescue antiemetic as compared to 50 and 55 per cent patients in Group B and Group C, respectively. INTERPRETATION & CONCLUSION: Pre-operative intravenous fluid supplementation using crystalloids and colloids results in significantly decreased incidence of PONV. Both, crystalloids as well as colloids were found to be equally effective in preventing PONV.

Open indirect cardiac massage in neonate.

Open, direct cardiac massage (OCM), as a technique of resuscitation has not been very inspiring due to its various limitations. We report a case of resuscitation where open 'indirect' cardiac massage was used to resuscitate a neonate successfully. A 24 hr old neonate with multiple gastrointestinal anomalies presented for emergency laparotomy. Intraoperatively she suffered a cardiac arrest. External chest compressions (ECC) failed to produce detectable circulation and surgeons were asked to initiate direct cardiac compressions. They could palpate and successfully compress the heart without the need to split the diaphragm. This 'infra-diaphragmatic' approach resulted in adequate circulation and subsequent uncomplicated recovery.