A Prospective Controlled Study Comparing the Three PACU Discharge Criteria: Aldrete, White and Sampe in Patients Undergoing Surgical Procedures After General Anaesthesia

Introduction: Paraquat, a widely used herbicide in India, is associated with high mortality due to its severe toxicity and lack of a specific antidote. Northeast India, being agriculturally intensive, frequently encounters cases of paraquat poisoning, often due to intentional ingestion. However, there is limited regional data describing the clinical profile and outcomes of such cases. Objective: To study the clinical presentation, demographic characteristics, laboratory abnormalities, complications, and outcomes of patients with paraquat poisoning admitted to a tertiary care hospital in Northeast India. Methods: This prospective observational study was conducted over 18 months from January, 2024 to June, 2025 at the Department of Medicine in a tertiary care hospital in Northeast India. All patients with a confirmed history of paraquat ingestion and positive urine dithionite test were included. Demographic data, amount of paraquat consumed, time to presentation, clinical signs and symptoms, laboratory parameters (including renal, hepatic, and respiratory functions), and treatment outcomes were recorded. Patients were followed up until discharge or death. Descriptive statistics and relevant analytical tests were applied using SPSS. Results: This prospective study on paraquat poisoning patients at a tertiary care hospital in Northeast India revealed that the majority were young adults aged 21–30 years (42.1%), predominantly from rural areas (72.4%) and engaged in farming (39.4%). Most had formal education (up to class X) and were from non-tribal communities, with a significant proportion reporting suicidal intent (36.8%) and a history of psychiatric illness (26.3%). The quantity of poison consumed was mostly between 21–30 ml (36.9%), with clinical manifestations including vomiting (92.1%), oral ulceration (84.2%), swallowing difficulty (81.6%), and respiratory symptoms. Vital signs often showed tachycardia, tachypnea, hypoxia, and blood pressure abnormalities. Organ dysfunction was frequent, notably acute liver injury (73.7%), acute kidney injury (71.1%), ARDS (47.4%), and lung fibrosis (36.8%). Hematological findings revealed normal mean hemoglobin (12.8 ± 1.9 gm/dL) and elevated WBC in 43% of cases. Hospital stay was prolonged in many, with 27.6% requiring more than 30 days of admission, reflecting the severity and systemic impact of paraquat poisoning. Conclusion: Paraquat poisoning remains a significant health concern in Northeast India with high mortality, especially among young adults. Early diagnosis, aggressive supportive care, and awareness among the rural population regarding its lethality are crucial to reduce fatal outcomes. Regional policies regulating its sale and usage are urgently warranted.