Perioperative Dysrhythmias in Adult Patients for Non Cardiac Surgery: A Prospective Cohort Study

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 highrisk patients, analyse contributing factors, and promptly correct issues under expert medical guidance.