Annals of Cardiac Anaesthesia
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Item Superior Vena Cava Syndrome after Epicardial Pacing Wires Removal(Wolters Kluwer – Medknow, 2024-10) González-Suárez, Susana; Barbosa, Carlos Sureda; García-Navia, Jusset TeresaAlthough most superior vena cava (SVC) syndromes are due to intrathoracic malignancies, some are iatrogenic, such as those following the intravenous implantation of pacemaker wires. To date, the occurrence of this syndrome after epicardial pacemaker removal has not been described. The initial auricular laceration after removal can be complicated by the administration of anticoagulant and antiplatelet drugs, forming a hematoma that compresses the SVC cranially. Therefore, standardized practice may be necessary in these patients to address anticoagulant and antiplatelet therapy, perform serial echocardiography, and pay attention to underlying symptoms, which may be insidious and delayed.Item Intraoperative Innovation Leading to a Modified Endotracheal Tube: A Case Report of Endobronchial Intubation of Total Laryngectomy Stoma(Wolters Kluwer – Medknow, 2024-10) Tersakyan, Sarven; Gemelga, Gio; Lee, Joseph; Mahyar, Babak; Dean, AlanThe post?total laryngectomy airway poses perioperative challenges to anesthesia management. While endobronchial intubation is a cited complication, a low?lying stoma may increase this risk. Furthermore, the stoma’s proximity to a median sternotomy increases surgical and airway management complexity. This report highlights a case of endobronchial intubation in a patient with a low?lying stoma who presented for coronary artery bypass graft. With a stoma at the upper border of the sternum, intraoperative innovation was required to prevent endobronchial intubation while remaining out of the surgical field. This innovation may be useful in urgent surgical situations.Item A Successful Awake Fiberoptic Bronchoscopy Intubation of a Cardiomorbid Patient: A Case Report(Wolters Kluwer – Medknow, 2024-10) Alsalah, Qusai A.; Bael, Peter R.; Abufara, Arein A. M.; Alsahouri, Mohammad I.; Abu Asbeh, Yousef; Hamamdh, MajdeBronchoscopy is a widely used technique for diagnostic and therapeutic purposes. Though it requires anesthesia, many options are available, depending on the patient’s health status, the purpose of the procedure, and the type of bronchoscope used. One such health status is heart failure, a leading cause of death, and a common challenge of anesthesiology. We report a 60?year?old male patient who is a known case of heart failure with an ejection fraction of 15%, and an implanted cardioverter defibrillator, along with concurrent ischemic heart disease, diabetes mellitus, and hypertension, who presented complaining of dysphagia. This highly morbid patient was able to successfully undergo a bronchoscopic biopsy with nerve block anesthesia considering his inadequacy for conventional methods. This report aims to shed light on these challenging cases and alert anesthesiologists on how to manage such situations in patients with cardiac morbidities.Item When is the Ideal Time to Calculate the Vasoactive Inotropic Score as a Predictor of Mortality and Morbidity in Cardiac Surgery? A Retrospective Study(Wolters Kluwer – Medknow, 2024-01) Kele?, Bilge Olgun; Y?lmaz, Elvan Tekir; Alt?nba?, Ali; Zengin, Sabür; Y?lmaz, SeyhanIntroduction: The aim of this study was to evaluate the prediction of vasoactive inotropic score (VIS) on early mortality and morbidity after coronary artery bypass grafting (CABG) and to determine the ideal time for score calculation. Materials and Methods: The study included patients who underwent isolated on?pump CABG surgery between November 2021 and November 2022. Pre, intra, and postoperative data were obtained by retrospective chart review. The final VIS value in the operating room (VISintra) and the highest VIS value in the first 24 hours in the intensive care unit (VISmax) were calculated. The patients were divided into two groups; Group 1 who developed early postoperative morbidity and mortality and Group 2 who did not. And the data were analyzed by groups. Results: A total of 221 patients with a mean age of 63.49 ± 9.96 years were evaluated and 73 (33%) were in Group 1. The cut?off value for VISintra was determined to be 6.20, VISmax was 6,05. VISintra and VISmax values were significantly higher in the poor outcome group. Multivariate analysis showed that only VISmax value was an independent variable on mortality?morbidity. Conclusions: Our results imply that the vasoactive inotropic score is an easy and inexpensive score to calculate and can be used as a specific scoring system to predict poor early outcomes in CABG patients. According to statistical analyses, the most predictive time among VIS measurements was VISmax, the highest value calculated in the ICU in the first 24 hours postoperatively.Item Intraoperative Transesophageal Echocardiographic Assessment of Aortic Valve Repair in a Child – What to Look for?(Wolters Kluwer – Medknow, 2024-01) Munaf, Mamatha; Babu, Saravana; Sukesan, Subin; Gadhinglajkar, Shrinivas V.Aortic valve (AV) repair is the desired surgical treatment option for young patients with aortic regurgitation (AR). It is considered as a class I indication for the surgical treatment of severeAR. The success of an AV repair depends on the detailed intraoperative transesophageal echocardiographic (TEE) examination which should fulfil the information required by the surgeon. The objective of this echo round is to describe the role of intraoperative TEE in systematic evaluation of the AV, before and after repair.Item Re-Expansion Pulmonary Edema Following Minimally Invasive Cardiac Surgery: A Case Report(Wolters Kluwer – Medknow, 2024-10) Prakasa, Stephanus A.; Alatas, AnasRe?expansion pulmonary edema (RPE) is a rare complication of minimally invasive cardiac surgery (MICS). We present a case of RPE following atrial septal defect (ASD) closure using a thoracotomy approach and cardiopulmonary bypass (CPB). REP contributes to significant morbidity and extends the length of stays in the intensive care unit. Understanding the pathophysiology and risk factors of RPE allows us to prevent or minimize the incidence.Item ProtekDuo Cannula for Pre-, Intra-, and Postoperative Lung Transplantation Management(Wolters Kluwer – Medknow, 2024-10) Ricks, William A.; Rackauskas, Mindaugas; Weir, William B.; Emtiazjoo, Amir M.; Saha, Biplab K.; Gries, Cynthia J.; Maybauer, Marc O.We present a 61?year?old patient with pulmonary hypertension, acute respiratory failure, and acute severe right ventricular (RV) dysfunction. Preoperatively, a ProtekDuo® was inserted for extracorporeal membrane oxygenation (ECMO) and RV protection with venopulmonary (VP) ECMO in (dl) V?P ECMO configuration. Intraoperatively, it provided venous drainage for venoarterial (VA) ECMO in (dl) VP?/AO configuration for bilateral orthotopic lung transplantation (BOLT). Postoperatively, the patient remained on (dl) V?P ECMO for RV support and was decannulated with mild RV dysfunction after 5 days. This is the first description of the ProtekDuo® used in (dl) V?P to (dl) VP?/AO to (dl) V?P configuration for the entire perioperative period of BOLT.Item Perioperative Management of Lower Limb Surgery in a Patient with Asymptomatic Left Ventricular Systolic Dysfunction: A Case Report(Wolters Kluwer – Medknow, 2024-10) Nagalingam, Saranya; Srinivasan, Arunkumaar; Charles, Antony John; Kumar, V R HemanthHeart failure poses significant challenges in perioperative settings, with an increasing prevalence in India. While much attention has been given to the management of symptomatic heart failure, there is a dearth of literature on asymptomatic left ventricular systolic dysfunction (ALVSD). In this case report, we present the successful perioperative management of a 35?year?old male with ALVSD and a low ejection fraction undergoing lower limb surgery under combined spinal epidural anesthesia. Our approach aimed to maintain hemodynamic stability, minimize myocardial overload, and mitigate the adverse effects of neuraxial blockade.Item Comparative Effect of High-Frequency Nasal Cannula and Noninvasive Ventilation on the Work of Breathing and Postoperative Pulmonary Complication after Pediatric Congenital Cardiac Surgery: A Prospective Randomized Controlled Trial(Wolters Kluwer – Medknow, 2024-01) Goel, Alisha; Kumar, Bhupesh; Negi, Sunder; Mahajan, Sachin; Puri, Goverdhan D.; Khan, Waseem A.Background: Various forms of commonly used noninvasive respiratory support strategies have considerable effect on diaphragmatic contractile function which can be evaluated using sonographic diaphragm activity parameters. Objective: To compare the magnitude of respiratory workload decreased as assessed by thickening fraction of the diaphragm and longitudinal diaphragmatic strain while using high?flow nasal cannula (HFNC) and noninvasive ventilation (NIV) modes [nasal intermittent positive pressure ventilation (NIPPV) and bilevel positive airway pressure (BiPAP)] in pediatric patients after cardiothoracic surgery. Methodology: This prospective randomized controlled trial was performed at a tertiary care surgical intensive care unit in postcardiac surgery patients aged between 1 and 48 months, who were randomly allocated into three groups: 1) HFNC (with flows at 2 L/kg/min), 2) NIPPV via RAMS cannula in PSV mode (pressure support 8 cmH2O, PEEP 5 cmH2O), and 3) BiPAP in nCPAP mode (CPAP of 5 cmH2O). Measurements were recorded at baseline after extubation (R0) and subsequently every 12 hourly (R1, R2, R3, R4, R5) at 12, 24, 36, 48, and 60 hours respectively until therapy was discontinued. Results: Sixty patients were included, with 20 patients each in the NIPPV group, HFNC group, and BiPAP group. Longitudinal strain at crura of diaphragm was lower in the BiPAP group as compared to HFNC group at R2?R4 [R2 (?4.27± ?2.73 vs ? 8.40± ?6.40, P = 0.031), R3 (?5.32± ?2.28 vs ?8.44± ?5.6, P = 0.015), and R4 (?3.8± ?3.42 vs ?12.4± ?7.12, P = 0.040)]. PFR was higher in HFNC than NIPPV group at baseline and R1?R3[R0 (323 ± 114 vs 264 ± 80, P = 0.008), R1 (311 ± 114 vs 233 ± 66, P = 0.022), R2 (328 ± 116 vs 237 ± 4, P = 0.002), R3 (346 ± 112 vs 238 ± 54,P = 0.001)]. DTF and clinical parameters of increased work of breathing remain comparable between three groups. The rate of reintubation (within 48 hours of extubation or at ICU discharge) was 0.06% (1 in NIPPV, 1 in BiPAP, 2 in HFNC) and remain comparable between groups ( P = 1.0). Conclusion: BiPAP may provide better decrease in work of breathing compared to HFNC as reflected by lower crural diaphragmatic strain pattern. HFNC may provide better oxygenation compared to NIPPV group, as reflected by higher PFR ratio. Failure rate and safety profile are similar among different methods used.Item The Shared Airway: Tracheal Mass Excision(Wolters Kluwer – Medknow, 2024-10) Shringarpure, Amruta; Saba, Surendhar; Umbarkar, Sanjeeta; Sarkar, ManjulaWe report a case of successful airway management of a 26?year?old male patient who was posted for tracheal mass excision. The main challenge in such a case is to formulate a plan to provide maximum surgical access to the trachea for mass excision through an intraoral approach while ensuring adequate oxygenation and airway management. The patient presented with acute respiratory distress in the emergency ward. On computed tomography (CT), the patient was diagnosed with a polypoidal tracheal tumor occluding more than 90% of the tracheal lumen and 5.8 cm away from the carina. The case was successfully managed using a peripheral bypass for airway management. After the removal of the tumor, a tracheostomy tube was placed through the tracheotomy hole used for tumor excision. The whole process was uneventful.Item Systemic Mastocytosis Successfully Managed using Cytosorb® During Cardiopulmonary Bypass for Aortic Valve Replacement(Wolters Kluwer – Medknow, 2024-10) Gross, Adrien; Colombier, Sébastien; Arlettaz, Lionel; Delay, DominiqueWe describe the case of a 72?year?old male with a history of systemic mastocytosis scheduled for on?pump aortic valve replacement for severe aortic insufficiency. Anesthesia and peri?operative management included avoidance of histamine?releasing drugs, methylprednisolone and clemastin prophylaxis. Furthermore, a CytoSorb® cartridge has been added to the bypass circuit and hemoadsorption was performed throughout the entire cardiopulmonary bypass (CPB) duration. CytoSorb® is a hemoadsorption device designed to remove various cytokines and drugs from the blood. The use of CytoSorb® during CPB in our case was not associated with adverse events, and the patient did not present any allergic or anaphylactic reaction.Item Quadricuspid Aortic Valve: Interesting Images(Wolters Kluwer – Medknow, 2024-01) Singh, Ajmer; Mukati, RavinaThe quadricuspid aortic valve is a rare congenital anomaly, usually associated with aortic regurgitation requiring surgical intervention. It may be associated with other congenital anomalies such as coronary anomalies, patent ductus arteriosus, ventricular septal defect, pulmonary stenosis, and subaortic stenosis. The diagnosis is generally established by either transthoracic or transesophageal echocardiography. Herein, we report a case of a 52?year?old woman who was diagnosed to have quadricuspid aortic valve by intraoperative transesophageal echocardiography.Item Exploring Recidivism in Cardiac Surgical ICU: Can this Understanding Translate to Enhanced Patient Outcomes?(Wolters Kluwer – Medknow, 2024-10) Sahajanandan, Raj; Varsha, A V; Rao, Vinay M.; Kurien, Ben B.; Kuruvilla, Korah; Thankachen, Roy; Philip, Madhu A.Objective: The need for reinstitution of intensive care unit (ICU) care (“recidivism”) in post?cardiac surgery patients is associated with increased morbidity, mortality, resource use, and healthcare costs. Recidivism is propounded as a quality indicator of ICU care. There is a paucity of studies from India regarding cardiac surgical ICU readmissions, their outcomes, and risk factors. Methods: Nested case?control study including 1,711 consecutive adult patients who underwent cardiac surgery over a two?year period at a tertiary care institute. The patients were grouped into recidival (R) and control (C) groups. The reasons for readmission, outcomes, and predictive risk factors were analyzed. Results: Fifty?four of 1,711 (3.1%) patients were readmitted to ICU, main reasons being cardiac arrhythmias (24, 41%), pericardial effusion (9, 15.2%), and infection (8, 13.5%). Readmission was significantly higher for valvular interventions (39 patients, 24.3%, mitral valve 25 patients) than coronary artery bypass grafting (13, 10.6%), P value 0.003*. On multivariate analysis, EuroSCORE 2 (>5), age, surgical reexploration, postoperative pulmonary complications, and infections were independently associated with a need for ICU readmission. The mortality rate among the readmitted patients was 7.4% compared to 1.4% overall mortality. The mean total postoperative length of stay was significantly longer for recidival patients (17.6 ± 14 days vs 7.6 ± 2.4 days; P < 0.0001). Conclusions: Recidivism is associated with longer hospital stay, suboptimal outcomes as well higher risk of mortality. Postoperative cardiac dysrhythmia was the most common cause of recidivism in our cohort. Early identification of patients at risk for recidivism and timely management of cardiopulmonary complications can translate to better outcomes.Item Perioperative Management of an Obstetric Patient with Eisenmenger Syndrome and Pre-Eclampsia Using Milrinone(Wolters Kluwer – Medknow, 2024-07) Deepak Chakravarthy, C.D.; Thangaswamy, Chitra Rajeswari; Balachander, HemavathiPregnancy in a patient with pulmonary hypertension carries a high risk of mortality. It poses multiple problems in the management of pregnancy, labor, and postpartum, thereby emphasizing the need for a multidisciplinary team for a successful outcome. We describe the successful management of a case of Eisenmenger syndrome who developed pre?eclampsia during her 28 weeks of pregnancy. As far as our knowledge, this is the first case report that describes the use of milrinone in a parturient for a successful outcome.Item To Study the Efficacy of Ultrasound Guided Pecto-Intercostal Fascial Plane Block in Patients Undergoing Midline Sternotomy in Open Cardiac Surgery: A Randomized Prospective Comparative Study(Wolters Kluwer – Medknow, 2024-10) Singh, Ganesh; Dhiraaj, Sanjay; Shamshery, Chetna; Agarwal, Surendra Kumar; Goyal, Puneet; Ambasta, SuruchiBackground: The incidence of acute poststernotomy pain after cardiac surgery is 80%1. Pecto?intercostal fascial plane block (PIFB) adjacent to the sternum anesthetizes the anterior cutaneous branches of the intercostal nerves and may provide effective analgesia after sternotomy. Methodology: A randomized controlled, double?blinded, prospective comparative trial was conducted at a tertiary care center on patients of midline sternotomy between 18 and 65 years and NYHA Class 2 and 3 for open cardiac surgery with the primary aim to evaluate analgesia on deep breathing after 3 hours of PIFB block bilaterally. A total of 60 patients were enrolled and randomly divided into three groups. PIFB was administered bilaterally before extubation, with 15 ml 0.125% bupivacaine plain (Group B), and bupivacaine+ clonidine 0.25 mcg/kg (Group B+C). Group C did not receive any intervention. All patients received acetaminophen 1 gram three times a day and injectable tramadol 1 mg/kg as a rescue analgesic. Results: Baseline characteristics were similar among all the groups. The Numeric Rating Scale (NRS) for pain was statistically lower ( P < 0.05) in Groups B and B+C compared to Group C at rest, deep breathing, and coughing at 3, 6, and 12 hours after extubation. NRS on deep breathing in Groups B, B+C, and C was {(2.3, 1.5, 4.4) at 3 hours, (2.3, 1.6, 4.3) at 6 hours, (2.8, 2.1, 3.9) at 12 hrs, and {(4.3, 3.5, 3.6)} at 24 hours after extubation. The peak expiratory flow rate was the highest in Group B. Rescue analgesia was not required in Group B. Conclusion: PIFB reduces sternotomy pain compared to the control group on deep breathing at 3 hours after block, with delayed requirement of rescue analgesia and improved respiratory mechanics in terms of peak expiratory flow rate at all time points. There is no benefit from adding clonidine.Item Bilateral Ultrasound-Guided Erector Spinae Plane Block for Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy(Wolters Kluwer – Medknow, 2024-10) Mogahed, Mona M.; Abd El-Ghaffar, Mohamed S.; Elkahwagy, Mohamed S.Background: Ultrasound (US) guided erector spinae plane block (ESPB) is a safe and effective technique in providing perioperative pain management in pediatrics with a high success rate. The Aim of this Study: Was to compare the efficacy of bilateral ultrasound?guided erector spinae plane block for management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy. Methods: One hundred patients aged 4?12 years were randomly assigned into two groups, both groups received general anesthesia followed by bilateral sham erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg normal saline on each side in the control group (group C) or bilateral ultrasound?guided erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg ropivacaine 0.2% with a maximum dose of 2 mg/kg mixed with adrenaline 2 mcg/ml in erector spinae plane block group (group E). The postoperative pain scores were evaluated immediately post?extubation, at 1 hour, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24 hours after extubation, total consumption of intraoperative fentanyl and time to first rescue analgesic administration were also recorded. Results: There was a statistically high significant delay in the group E (314.72 ± 45.94) compared with the group C (36.7 ± 7.22) as regards to the mean (SD) of the time of the rescue analgesia ( P < 0.001) (with 95% CI), moreover; the number of rescue analgesic was significantly higher in the group C compared with the group E ( P < 0.001) (with 95% CI) and the mean (SD) of total intraoperative and postoperative levels fentanyl requirements in the group C were significantly higher compared with the group E (6.47 ± 0.98 and 5.09 ± 0.83) (with 95% CI) in group C versus (4.69 ± 0.71 and 2.31 ± 0.66) (with 95% CI) in group E respectively ( P < 0.001) (with 95% CI). Conclusion: Ultrasound?guided bilateral ESPB with ropivacaine and adrenaline delays the postoperative need of analgesia and reduces postoperative fentanyl consumption at 24 h in pediatric patients undergoing cardiac surgery through midline sternotomy.Item Ibrutinib-Induced Ventricular Electrical Storm Successfully Managed with Veno-Arterial ECMO and Intralipid Administration: A Rare Case Report(Wolters Kluwer – Medknow, 2024-10) Torre, Debora E.; Stecco, Carla; Porzionato, Andrea; Mangino, Domenico; Macchi, Veronica; De Caro, Raffaele; Pirri, CarmeloWe report a 55?year?old men patient with a primitive central nervous system non?Hodgkin lymphoma B cell (LNH PNSLC), treated with chemotherapy rituximab, methotrexate, and ibrutinib (first treatment) who developed a refractory ventricular arrhythmic storm two hours after the ibrutinib intake. Indeed, ibrutinib could be associated with severe and occasionally fatal cardiac events. The swift emergence of a ventricular electrical storm with cardiac arrest demanded the prompt initiation of veno?arterial extracorporeal membrane oxygenation to effectively navigate this critically ill patient toward recovery. This intervention was deemed imperative, given the absence of any available antidote for the effects of ibrutinib. Veno?arterial extracorporeal membrane oxygenation proved successful in rescuing this patient, resulting in a complete neurological recovery. Consequently, he was able to resume his chemotherapy treatment.Item Confounding Factors Responsible for Elevated Lp(a) Levels in Patients with Coronary Artery Disease(Wolters Kluwer – Medknow, 2024-01) Amin, Navaneeth; Devasia, Tom; Kamath, Shobha Ullas; Paramasivam, Ganesh; Shetty, Prasad Narayana; Singh, Ajit; Prakash, Ganesha N. S.Background: Cardiovascular diseases (CVDs) are a leading cause of global mortality, motivating research into novel approaches for their management. Lipoprotein(a) (Lp(a)), a unique lipoprotein particle, has been implicated in atherosclerosis and thrombosis, suggesting its potential as a therapeutic target for CVDs. Aim: This study aimed to investigate the association of Lp(a) levels with various cardiovascular parameters and events among patients with confirmed cardiovascular disease. Methodology: A prospective study was conducted, enrolling 600 participants, predominantly comprising males (79%), with a mean age of 52.78 ± 0.412 years diagnosed with cardiovascular disease. The follow?up was done for 18 months. Patient demographics, blood investigations, and occurrence of major adverse cardiac events (MACE) were collected. SPSS version 21 was used to statistically analyze the relationships between elevated Lp(a) levels and factors such as age, glycated hemoglobin, mortality, MACE, cardiac death, target vessel revascularization, and stroke. Results: The study revealed significant ( P < 0.05) associations between elevated Lp(a) levels and advanced age, increased glycated hemoglobin levels, as well as occurrences of all?cause mortality, MACE, cardiac death, target vessel revascularization, and stroke. Notably, a significant ( P < 0.05), association between high Lp(a) levels and acute coronary syndrome (ACS) emerged, suggesting Lp(a)’s role in advanced cardiac events. Conclusion: The findings highlight the potential significance of Lp(a) as a notable risk factor in cardiovascular health. The observed associations between elevated Lp(a) and adverse cardiovascular events, including ACS, underscore its pathogenic role. Consequently, this study supports the rationale for further research into Lp(a)?specific therapeutic interventions, offering substantial promise in refining the management strategies for cardiovascular diseases.Item Transesophageal Echocardiography-Guided ProtekDuo Percutaneous Temporary Right Ventricular Assist Device Cannulation Technique(Wolters Kluwer – Medknow, 2024-07) Crawford, Bronson; Rawal, Shiv; Rackauskas, Mindaugas; Maybauer, Marc O.Item Diagnostic Accuracy of a Novel Wireless, Bluetooth-Enabled Simultaneous 12-Lead Portable ECG Device Compared with Standard ECG in Preoperative Patient Population(Wolters Kluwer – Medknow, 2024-10) Borde, Deepak P.; Khade, Sujitkumar; Joshi, Pooja; Bhosale, Reshma; Shinde, Pradnya; Takalkar, Unmesh; Takalkar, Manisha; Wavhal, Diksha; George, Antony; Borgaonkar, DevendraBackground and Objectives: Significant proportion of patients undergoing various surgeries have abnormal ECG findings and it is known to have prognostic value. Recently, portable ECG with Bluetooth technology with smartphone have been gaining popularity. One such novel device, Wellnest ® is a Bluetooth enabled portable ECG machine, can capture simultaneous 12 lead ECG on smartphone application. This is probably only such device available device in India. The objective of this study was to test diagnostic accuracy of Wellnest 12L ECG device compared to standard 12 lead ECG. Methods and Material: This was a Prospective, observational, diagnostic accuracy study conducted at a tertiary care level hospital. During, pre-anaesthesia check-up visit of 109 patients undergoing cardiac and non-cardiac surgeries, whenever indicated, a preoperative 12 lead ECG was done. The Wellnest 12 lead ECG was done within 24 hours of standard ECG. Matching was done between Minnesota codes assigned to ECG findings of Wellnest and standard 12 lead ECG. Also, grading of Wellnest ECG quality was done as excellent, good, bad and poor. Results: In all, 216 various Minnesota codes were assigned to 109 patients undergoing various surgeries. The primary endpoint of Wellnest ECG in comparison to standard ECG were- sensitivity of 96.51% (CI 90.14- 99.27%); specificity of 86.96% (CI 66.41- 97.22%); positive likelihood ratio of 7.4 (CI 2.57- 21.27) and negative likelihood ratio of 0.04 (CI 0.01- 0.12).Performance of Wellnest ECG as per individual Minnesota Codes compared to standard ECG was also acceptable. Wellnest ECG was graded as excellent in 55(50%) patients, good in 51(47%) patients and only 3 (3%) patients were graded as bad. Conclusions: Wellnest ECG had satisfactory performance in comparison with standard 12 lead ECG in preoperative patient population. It is easy to use, portable and can give simultaneous 12 leads ECG and its use in preoperative population can be recommended.