[Epidemiological profile of patients seen in the pre-anesthetic assessment clinic of a university hospital]

Importance of Pre-anesthetic Evaluation in Diagnosing Coexisting Asymptomatic Medical Conditions: A Report of Two Cases

The preoperative assessment of patients undergoing surgery, often conducted in pre-anesthesia clinics, plays an important role in ensuring patient safety and optimizing perioperative outcomes. This assessment aids in identifying underlying medical conditions that might otherwise remain asymptomatic until they manifest as complications during or after surgery. Through these two case reports, the importance of pre-anesthesia assessment is highlighted. The first case involves a 67-year-old male whose surgery for lymph node excision was planned. However, during the preoperative assessment, atrial fibrillation and pulmonary hypertension were identified, necessitating further intervention and treatment adjustments before surgery. In the second case, an eight-year-old child with a history of vomiting and abdominal pain planned for tonsillectomy was discovered to have congenital hypothyroidism through a vigilant preoperative evaluation. Timely intervention and consultation with an endocrinologist ensured a safe surgery without complications. These cases emphasize the role of preoperative cardiovascular assessment, the utility of electrocardiograms (ECGs), and the relevance of routine laboratory tests in reducing perioperative mortality. Hence, pre-anesthesia assessments are not mere routine steps; they are essential components of patient care that significantly impact perioperative results.

Effectiveness of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies

OBJECTIVES

The aim of this systematic review was to examine the effectiveness of pre-anaesthesia assessment clinics (PACs) in improving the quality and safety of perioperative patient care.

DESIGN

Systematic review.

DATA SOURCES

The electronic databases CINAHL Plus with Full Text (EBSCOhost), Medline and Embase (OvidSP) were systematically searched on 11 September 2018 and updated on 3 February 2020 and 4 February 2021.

ELIGIBILITY CRITERIA

The inclusion criteria for this study were studies published in English or Scandinavian language and scientific original research that included randomised or non-randomised prospective controlled studies. Additionally, studies that reported the outcomes from a PAC consultation with the patient present were included.

DATA EXTRACTION AND SYNTHESIS

Titles, abstracts and full texts were screened by a team of three authors. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies. Data extraction was performed by one author and checked by four other authors. Results were synthesised narratively owing to the heterogeneity of the included studies.

RESULTS

Seven prospective controlled studies on the effectiveness of PACs were included. Three studies reported a significant reduction in the length of hospital stay and two studies reported a significant reduction in cancellation of surgery for medical reasons when patients were seen in the PAC. In addition, the included studies presented mixed results regarding anxiety in patients. Most studies had a high risk of bias.

CONCLUSION

This systematic review demonstrated a reduction in the length of hospital stay and cancellation of surgery when the patients had been assessed in the PAC. There is a need for high-quality prospective studies to gain a deeper understanding of the effectiveness of PACs.

PROSPERO REGISTRATION NUMBER

CRD42019137724.

Utilization of Pre-Anesthetic Medications for Major Surgical Procedures at a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction:

Drug utilization research is an important tool to analyze the use of drugs with special emphasis on medical, social, and economic consequences in society. This study aims to find out the utilization of pre-anesthetic medications in a major surgical procedure.

Methods:

A descriptive cross-sectional study was conducted from 15th April - 15th August 2019 in the postoperative ward at Birat Medical College and Teaching Hospital. The convenience sampling method was used after ethical clearance from the Institutional Review Committee (IRC) of Birat Medical College and Teaching Hospital, Biratnagar, Nepal. About 400 patients were studied. The collected data were entered into a statistical package for social science version 20 for further calculations at 95% Confidence Interval.

Results:

Out of 400 patients, 215 (53.8%) of patients were underwent into different major surgeries. All patients received midazolam 2 mg except children (1 mg) and Pethidine 25 mg along with 0.2 mg glycopyrrolate 352 (88%), ondansetron 276 (69%) and others 58 (14.5%) as a preanesthetic agent. For general anesthesia propofol, 30 mg have been utilized followed by fentanyl 306 (76.5%) and others (halothane, isoflurane, etc) 115 (28.8%). In case of prophylactic drug were ceftriaxone 500 mg, 100 mg metoclopramide 387 (96.8%), dexamethasone 251 (62.8%), tramadol 237 (59.3%), 15 mg ketorolac 368 (92%), ranitidine 163 (40.8%), and pantoprazole 237 (59.3%).

Conclusions:

The most commonly administered pre-anesthetic drugs were midazolam, pethidine, glycopyrrolate, and ondansetron. The incidence of postoperative nausea and vomiting the patient within 24 hours after surgery was significantly very low.

EPIDEMIOLOGICAL PROFILE AND OUTCOMES IN POSTOPERATIVE NEUROMUSCULAR ESCOLIOSIS

ABSTRACT Objective To outline the epidemiological profile and identify the hospital outcomes of patients submitted to neuromuscular scoliosis correction surgery. Methods This was a descriptive study that included 50 patients hospitalized following surgery for neuromuscular scoliosis in a tertiary-level hospital in São Paulo from January 2017 to July 2017. The variables were collected retrospectively from the patients’ medical records: age, sex, main diagnosis, length of hospital stay, duration of surgery, hospital complications, and mobility. Results Surgeries were performed in boys and girls in similar proportions, adolescents, many with cerebral palsy (42%), with mean hospital stay of 10.8 days. Fifty-two percent presented some complication, such as constipation. Infection of the surgical site was present in 12% of the sample. Forty-two percent had moderate to intense pain and only 2% did not achieve the proposed mobility goals. Conclusion We observed that the epidemiological profile presented data consistent with the scarce literature available, while the definitions of complications, incidence, and hospital outcomes available in the literature were varied quite a bit from the findings in this study. Level of evidence III; Retrospective study.

Risk factors for elective laparoscopic cholecystectomy morbimortality in elderly

OBJECTIVE

to identify risk factors for the occurrence of postoperative complications in laparoscopic cholecystectomies (LC) in elderly patients.

METHODS

an observational study with analysis of medical records of patients aged 60 years and older, submitted to elective LC at Gaffree e Guinle Universitary Hospital, from 2006 to 2018. Surgeries performed on an emergency basis or converted to the conventional technique were excluded from our study.

RESULTS

a total of 345 patients were included in our study, being 80% females and 62% aged 60-69 years. There were 39 cases of postoperative complications (11.3%), mostly (87%) classified as grades I or II of Clavien-Dindo surgical complication scale. There was only one death. The presence and the number of coexisting diseases and ASA II or III physical status classification of preoperative patients conferred a greater risk for the development of postoperative complications and mortality.

CONCLUSION

our study identified the presence of coexisting diseases, as well as their severity, according to ASA classification, as risk factors for the development of postoperative complications of LC in elderly patients. However, LC proved to be a safe technique when used in these patients with low morbidity and mortality rates.