Year :
2024
| Month :
April
| Volume :
18
| Issue :
4
| Page :
UC06 - UC11
Perioperative Dysrhythmias in Adult Patients for Non Cardiac Surgery: A Prospective Cohort Study
Amruta Vinod Hippalgaonkar, Amala Gurunath Kudalkar, Bharati Anil Tendolkar
1. Assistant Professor, Department of Anaesthesiology, KIMS, Karad, Maharashtra, India.
2. Professor and Head, Department of Anaesthesiology, GSMC and KEM Hospital, Mumbai, Maharashtra, India.
3. Professor and Head, Department of Anaesthesiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India.
Correspondence Address :
Amruta Vinod Hippalgaonkar,
Arogyadarshan, 3, Yadogoapl Peth, Satara-415002, Maharashtra, India.
E-mail: h.amruta1@gmail.com
Abstract
Introduction: The vulnerable perioperative period is prone to the development of a heterogeneous group of conditions characterised by abnormal electrical activity in the heart, termed as cardiac dysrhythmias.
Aim: To determine the incidence of dysrhythmias in the perioperative period, identify predisposing factors, evaluate the effect of anaesthesia, analyse haemodynamic consequences, and document the treatment provided.
Materials and Methods: A prospective cohort study involving 9666 adult patients undergoing non cardiac surgery was conducted in the Department of Anaesthesiology at Lokmanya Tilak Municipal College and General Hospital, Sion, Mumbai, Maharsahtra, India from January 2012 to December 2013. Parameters studied included preoperative clinical data (history, examination, and relevant investigations), type of anaesthesia, occurrence of dysrhythmias, and clinical outcomes of persistent dysrhythmias or those requiring treatment. Data was collected prospectively and analysed using Statistical Package for Social Sciences (SPSS) software version 15.0.
Results: The overall incidence of dysrhythmias was 1.2%. Consistent factors included age over 40 years (68.1%), male gender (52.59%), gastrointestinal and orthopaedic procedures (65.5%), preoperative hypertension (25%), and patients receiving general anaesthesia (61.2%). Most patients were classified as American Soceity of Anesthesiologists (ASA) Class-I and II (93.97%) and underwent elective surgery (61.21%). The majority (81.89%) of dysrhythmias occurred intraoperatively and were ventricular in origin (68.97%). Unstable haemodynamic conditions [Systolic Blood Pressure (SBP) <90 mmHg, Heart Rate (HR) <50 /min and/or Ventricular Premature Contraction (VPCs) >5/min or multifocal VPCs)] were observed in 56.9% of patients. Of patients with ventricular dysrhythmias, 57% exhibited unstable haemodynamics. Treatment was provided to 84.48% of patients, with 74.14% responding positively, leading to the termination of dysrhythmias. Anticholinergics were used in 40.52% of treatment modalities. The majority of dysrhythmias were transient 80 (68.9%) patients, and 83 of patients had a favourable outcome. Unfortunately, 5 (6.9%) of patients could not be revived, with three patients 3 (2.5%) succumbing in the operating room. Mortality was not directly linked to the dysrhythmia but was due to underlying causes.
Conclusion: Transient intraoperative ventricular cardiac dysrhythmias are common in adult patients undergoing noncardiac surgeries. Therefore, it is crucial to identify high-risk patients, analyse contributing factors, and promptly correct issues under expert medical guidance.
Keywords
Analysis, Arrhythmias, Ventricular cardiac dysrhythmias
DOI and Others
DOI: 10.7860/JCDR/2024/67217.19224
Date of Submission: Aug 28, 2023
Date of Peer Review: Nov 14, 2023
Date of Acceptance: Jan 30, 2024
Date of Publishing: Apr 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 30, 2023
• Manual Googling: Nov 23, 2023
• iThenticate Software: Jan 26, 2024 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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