Evaluation of Postoperative Pain After Cardiothoracic Surgery in Patients With and Without Significant Preoperative Anxiety: A Prospective Observational Study.

BACKGROUND AND AIMS: Anxiety plays a distressing role in cardiothoracic operations. It may trigger hemodynamic instability, increased morbidity, and very crucially, postoperative pain and analgesic use. Our aim is to look at the association between anxiety, postoperative pain, and analgesic use. MATERIALS AND METHODS: One hundred and twenty-two patients scheduled for cardiothoracic surgeries were asked questions according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the evening prior to the surgery. Different factors that could affect anxiety perioperatively were recorded through the patient's hospital records. The visual analog score (VAS) was recorded at arrival in the ICU after surgery. Paracetamol (1 g) and Inj Tramadol (1 mg/kg) were administered as postoperative analgesia. Additional fentanyl boluses (1 mcg/kg) were administered whenever the VAS exceeded 4. Analgesic doses were documented. All the data were then analyzed statistically. RESULTS: Preoperative anxiety was recorded in 63.9% of the 122 subjects included in the study, with younger patients and patients with very low socioeconomic status being the majority. VAS, at 20 and 24 hrs of assessment, was higher in both groups, and there was a statistically significant difference, with patients that were preoperatively anxious, recording higher VAS scores. Postoperative analgesic doses were also significantly higher for patients with anxiety. CONCLUSIONS: This clinical trial demonstrated that greater than 60% of the participants presented with preoperative anxiety, the majority being young participants. Lower socioeconomic status is also a risk factor for preoperative anxiety. Patients who suffered from preoperative anxiety are more likely to have greater pain scores and analgesic needs during postsurgical assessment.

Spectrum of perforated peptic ulcer disease in a tertiary care hospital in South India: predictors of morbidity and mortality.

BACKGROUND: Perforated peptic ulcer remains one of the most common surgical emergencies in India with significant morbidity and mortality. The aim of this study was to identify the perioperative risk factors influencing the post-operative morbidity and mortality in patients with perforated peptic ulcer disease. METHODS: Five-hundred patients who underwent surgery for perforated peptic ulcer in our institution in the preceding 8 years were included in this observational retrospective study. Their clinical presentations, peri-operative managements were studied and analysed. RESULTS: Five hundred cases were analysed of which 96% were males. Mean age was 46.5 years. A total of 160 patients had duodenal perforation and 328 had gastric perforation with a mean size of 8.6 mm. Most patients (96.2%) underwent omental patch closure of the perforation with mean length of hospitalization being 14 days. The most common major and minor postoperative complications were prolonged intubation and pulmonary complaints respectively. Re-exploration was needed in 6.2% of cases with a post-operative leak rate of 5.8%. Age >60 years, presence of comorbid illnesses, shock at presentation and perforation size >1 cm were identified as independent predictors of postoperative morbidity. Overall mortality was 11.6% while specific mortality among males and females were 11.8% and 5% respectively. Age >60 years, shock at presentation, presence of abdominal rigidity and size of perforation >1 cm were independent predictors of mortality. CONCLUSION: Old age, comorbidities, shock at presentation, perforation size >1 cm, higher ASA grade, prolonged surgery and biliopurulent contamination >500 mL were independent predictors of both increased post-operative morbidity and mortality.