Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
2Activity
0 of .
Results for:
No results containing your search query
P. 1
Pre-Anaesthetic Incidental Detection of Systemic Diseases

Pre-Anaesthetic Incidental Detection of Systemic Diseases

Ratings: (0)|Views: 161 |Likes:
Published by rabiulalam
The findings revealed a possibility of increased peri-operative morbidity and mortality if meticulous and proper attention was not given while preparing the patients for anaesthetic procedures. Thus it was concluded that every hospital must run an effective anaesthesia out-patient department with the capability of careful and efficient check-up system to detect the undiagnosed diseases during pre-anaesthetic assessment for safe anaesthesia.
The findings revealed a possibility of increased peri-operative morbidity and mortality if meticulous and proper attention was not given while preparing the patients for anaesthetic procedures. Thus it was concluded that every hospital must run an effective anaesthesia out-patient department with the capability of careful and efficient check-up system to detect the undiagnosed diseases during pre-anaesthetic assessment for safe anaesthesia.

More info:

Published by: rabiulalam on Mar 26, 2011
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

04/14/2013

pdf

text

original

 
JAFMC Bangladesh
2005, June; 1: 27-31
Rabiul et al
Pre-anaesthetic incidental detection of systemic diseases
 
27
PRE-ANAESTHETIC INCIDENTAL DETECTION OFSYSTEMIC DISEASES
Rabiul M Alam
1
, Mahbubul M Alam
2
, Zahurul M Islam
2
 Abstract Purpose:
Pre-anaesthetic assessment provides the
patients’
preoperative physical status, existingmedical conditions and their severity. Peri-operative morbidity and mortality are reduced by pre-anaesthetic optimisation of the patients. This prospective study was aimed to find out theincidence of detection of the pre-existing systemic diseases which were not diagnosed earlier.
Method:
A total of 2,086 indoor patients were studied during pre-anaesthetic assessment whowere from all age-groups and of both sexes requiring routine surgical procedures under any typeof anaesthesia. Check-up was carried out basing on history, physical examinations andinvestigation reports. The numbers of incidentally detected diseases were tabulated, analysedand compared with that of those pre-existing diseases, prevailed in the population.
Result:
The major incidental findings of diseases were: conduction heart block [18.75%], chronicobstructive pulmonary disease (COPD) [15%], anaemia [11.62%], ischaemic heart disease (IHD)[5.55%], and some other conditions like bronchial asthma, systemic hypertension, peptic ulcerdisease (PUD) and drug allergy. The findings were statistically significant (
p
<0.05) in respectof conduction defects, COPD, anaemia, IHD, PUD and drug allergy.
Conclusions:
The findings revealed a possibility of increased peri-operative morbidity andmortality if meticulous and proper attention was not given while preparing the patients foranaesthetic procedures. Thus it was concluded that every hospital must run an effectiveanaesthesia out-patient department with the capability of careful and efficient check-up system todetect the undiagnosed diseases during pre-anaesthetic assessment for safe anaesthesia.
Key words:
pre-anaesthetic assessment, P/A checkup, incidental detection, systemic disease.
 Introduction
Surgical mortality and morbidity arenot only the consequences
 
of the surgical
procedure itself, but also of the patient’s
 
preoperative physical status. Thepreoperative anaesthetic
 
visit is aimedprimarily at detecting these medicalconditions
 
and assessing their severity.Subsequent preoperative optimization
 
of the
patient’s condition reduces perioperative and
anaesthesia-related
 
risks [1]. Thepreoperative anaesthetic visit also serves to
 
guide the most appropriate anaesthetictechnique and to provide
 
patientinformation. Medical assessments enablephysicians to reduce morbidity by obtaininghealth status and planning peri-operativemanagement.
1
Department of Anaesthesia, Combined Military Hospital, Chittagong, Bangladesh.
2
Department of Anaesthesia, Combined Military Hospital, Dhaka, Bangladesh.
Corresponding author:
Dr. (Lt Col) Rabiul M Alam, MBBS, MCPS, FCPS; Department of Anaesthesia,Combined Military Hospital, Chittagong cantonment, Chittagong, Bangladesh.
E-mail:
 
JAFMC Bangladesh
2005, June; 1: 27-31
Rabiul et al
Pre-anaesthetic incidental detection of systemic diseases
 
28
Peri-operative morbidity and mortal-ity increase with the severity of pre-existingdiseases [2]. Preoperative evaluation is anessential screening to ensure that the patientis in the best possible physical conditionbefore surgery [3]. During pre-anaestheticassessment, if proper attention is notensured, there are chances to remain somesystemic diseases undetected. Failure toundertake this activity may place the patientat increased risk of peri-operative morbidityor mortality.
Materials & methods
A total of 2,086 indoor patientsproposed for various type of routine surgicalprocedures of all ASA classes and of bothsexes were included in this prospectivestudy. With the approval of local ethicalcommittee the study was conducted in theAnaesthesia OPD of a Combined MilitaryHospital in Bangladesh. Patients scheduledto undergo any type of anaesthesia wereincluded. Obtaining detailed history,performing relevant physical examinations,evaluating investigations results, enormousendeavour were there to find out anyundiagnosed systemic disease.
 Results
Demographic data of all age group patientsare presented in Table 1. The total numberof patients was 2,086, amongst which adultspredominated. Out of 2,086 patients 1,379(66.1%) were adult, 493 (23.63%) werefrom paediatric age group and 214 (10.25%)were geriatric patients. Male were 55.6%and 44.4% were female. Table 2 shows theproposed variety of surgical procedures,amongst which laparotomy (16.34%) waspredominant. Table 3 shows the numbers of incidentally detected diseases, which werecompared with that of those pre-existingdiseases. The incidental findings of diseaseswere: conduction heart block (18.75%),COPD (15%), anaemia (11.62%), IHD(5.55%), bronchial asthma (1.61%), hyper-tension (1.3%), and some other conditionslike peptic ulcer disease and drug allergy.The findings were statistically significant(
p
<0.05) in respect of conduction defects,COPD, anaemia, IHD, PUD and drugallergy.
 
Table 1: Demographic DataAge No of case Percentage (%)SexMale Female
Paediatric 493 23.65 368 125Adult 1,379 66.10 675 704Geriatric 214 10.25 117 97
Total 2,086 100 1,160 (55.6%) 926 (44.4%)
Note: Total no of patients was 2,086; in which adults predominated amongst the age groups.
 
JAFMC Bangladesh
2005, June; 1: 27-31
Rabiul et al
Pre-anaesthetic incidental detection of systemic diseases
 
29
Table 2: Types of proposed surgical procedures
 
Proposed types of Surgery No of case Percentage (%)
Abdominal/Laparotomy 341 16.34Gynaecological/Obstetric 156 7.47Orthopaedic 124 5.94Neurosurgical 45 2.15ENT 245 11.34Ophthalmological 320 15.34Urological 277 13.27Reconstructive 114 5.46Others 464 22.24
Total 2,086 100
Note: Abdominal surgery was predominated among the types of proposed surgical procedures. Most of the varieties of surgery were included in the study.
Table 3: Detected diseasesName of DiseasesPre-existingdiseasesNo of detecteddiseasesPercentage(%)
p
-values
Heart block 16 3 18.75<0.05COPD 20 3 15Anaemia 43 5 11.62IHD 54 3 5.55HTN 227 3 1.3 >0.05PUD 5 16-<0.05Hypersensitivity 1 6Diabetes Mellitus 135 nil-Congenital heart disease 11 nilValvular heart disease 3 nilCRF 10 nilCVA 5 nilThalassaemia 4 nilNote: Peptic ulcer disease and hypersensitivity were detected more than they werediagnosed earlier and highly significant.
Discussion
 Preoperative medical assessmentrelied primarily on accurate history-takingand physical examination from 1940 to1960s. Then, laboratory tests were includedin late 1960s, which can aid in optimizing a
patient’
s preoperative condition once a

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->