A 74-year-old man with peripheral neuropathy due to diabetes presented with deliberate ingestion of 450 mg of pregabalin (PBG) over a period of 8 hours followed by altered mental status. A bedside electroencephalogram was performed to rule out nonconvulsive status epilepticus, which showed continuous triphasic waves (TWs) with slow background activity. He recovered after 48 hours of stopping PBG, and his repeat electroencephalogram after 72 hours did not show any TWs. We present a rare case of PBG-induced TWs thereby highlighting the extent of the etiologic spectrum of TWs and discussing the literature related to this association.

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ARTICLE INFO ABSTRACTBackground and Aims: American College of Cardiology (ACC) and American Heart Association (AHA) have issued revised guidelines in 2007 for pre operative assessment of cardiac patients before non-cardiac surgery. We studied the pattern of practice for assessment of cardiac patients for non-cardiac surgery at our centre to find gap in existing practice from the ACC/AHA 2007 perioperative guidelines. Methods:We evaluated 100 consecutive case records of patients undergoing non-cardiac surgery referred to department of Medicine for preoperative assessment of cardiac problem. We analyzed clinical notes of anaesthesiologists and physicians to identify pattern of practice and analyze if the surgical team proceeded for surgery or physician requested further investigations like ECG, Echocardiography or TMT (Tread Mill Test) before proceeding to surgery. Results:We observed that emergency surgeries, active cardiac conditions and major cardiac risk factors were identified in all patients (100%) as per guidelines. All surgeries (100%) were not categorised according to risk. ECG was not necessary but advised in 13(13%) out of 100 patients and echocardiography was advised in 49 patients, out of which 40(81.6%) were not necessary. From the kappa statistic calculation, there was poor agreement between the guidelines and actual practice of advising Echocardiography (kappa value = 0.167). Conclusion:We found that there is significant gap in actual clinical practice and the recommendations of ACC/AHA 2007 guidelines on preoperative assessment of cardiac patients for non-cardiac surgery at our institute. We recommend development and application of guidelines on preoperative assessment of cardiac patients for non-cardiac surgery appropriate for our setting.

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