Anaesthesia and Anaesthesiology

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Browsing Anaesthesia and Anaesthesiology by Author "Abrar, Meron (PhD)"

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    Assessing the Analgesic Efficacy of Transversus Abdominis Plane Block After Cesarean Section Delivery Under Spinal Anesthesia as Part of Multimodal Analgesia
    (Addis Abeba University, 2016-03) Dessie, Wubet; Abrar, Meron (PhD)
    Background: Transverses abdominals plane block was a kind of nerve block performed on the triangle of petit to block a number of abdominal nerves. Objectives: To assess analgesic efficacy of transversusabdominis plane block after cesarean section delivery under spinal anesthesia at zewditu memorial hospital from February to march 2016. Methods: A prospective cohort study design was conducted. 42 patients undergoing caesarean section under spinal anesthesia were followed postoperatively. Those who undergo TAP block with bupivacaine (n = 21) versus non-TAP (n = 21) with standard analgesia with intravenous agents were followed. Each patient was assessed post-operatively by a blinded investigator for visual analogue score (VAS) at 2, 4, 6 and 12 hours, time to 1st analgesic request and total analgesic consumption with in the 1st 12 postoperative hours. SPSS window version 20.0 software was used for analysis. Results: Postoperative VAS outcomes based on( mean ±SD) for TAP group and non- TAP group include at 2 hr (5.23±3.34) vs (15.28±6.51), at 4 hr (7.09±3.11) vs (17.52 ± 3.9) , at 6 hr (8.9±4.63) vs 21.04±5.06) and at 12 hr (11.33 ± 4.98) vs (25.2 ± 5.9).There was also decreased postoperative analgesic consumption and increased time to 1st analgesia in TAP group. Conclusion and Recommendation: It is concluded that bilateral single injection of TAP block prolonged the time to 1st analgesic request , reduced total postoperative analgesic consumption and had lower postoperative severity of pain when compared with non TAP groups in patients after cesarean section under spinal anesthesia when it is used as part of multimodal analgesia. I recommend TAP block as part of multimodal analgesia after cesarean delivery. I also recommend further study to find out the effect of TAP block after 12 hr
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    Assessment of Blood Requisition, Transfusion Practices and Factors Associated with Transfusion in Elective Surgical Procedures at Tikur Anbessa Specialized Hospital, from February 1, 2016 To March 31, 2016 Addis Ababa, Ethiopia
    (Addis Abeba University, 2016-06) Asfaw, G/Hiwot; Abrar, Meron (PhD)
    Background: For elective surgeries preoperative over ordering of blood is very common practice and leads to holding up of the blood bank reserve, ageing of the blood unit and wastage of blood bank resources. That can be decreased by simple means of changing the blood cross matching and ordering schedule depending upon the type of surgery performed. Objectives: To assess blood requisition, transfusion practices and factors associated with transfusion in elective surgical proceduresat TikurAnbessa specialized HospitalfromFebruary 1 to March 31, 2016 G.C. Methods:An Institution based cross sectional study was conducted from February 1, 2016 to March 31, 2016 G.C at Tikur Anbessa specialized Hospital. Using sequential sampling technique and structured checklist data was collected from all elective surgical patients that came during the 2 months period. Blood utilization was calculated using cross match to transfusion ratio (C/T), transfusion probability (%T), transfusion index (TI) and Maximum surgical blood- ordering schedule (MSBOS) is formulated by Mead's criterion for common surgical procedures. Multivariate logistic regression analysis was conducted to identify significant predictors of transfusion based on p-value less than 0.05 with 95% confidence level. Results: Among all 242 elective surgical patients 55 (22.7%) of patients were transfused with 107(20.4%) units of the prepared blood giving cross-match to transfusion ratio of 4.9,transfusion probability (%T) 22.7% and transfusion index of 0.44. The independent predictors of perioperative blood transfusion were being neurosurgery (craniotomy) [AOR= 5.868 (95%CI 1.364, 25.239)] (P=0.017), Hgb <11.0 g/dl [AOR=7.553 (95%CI 2.915, 19.576)] (p =0.00) and intraoperative blood loss of >15 %( [AOR=12.830, (95% CI, 5.613, 29.323)] (P = .000). Conclusion and Recommendation: The amount of blood requested and cross-matched for patients undergoing elective surgery is much greater than the amount actually used. So blood ordering pattern needs to be revised and over ordering of blood should be minimized. This can be possible by implementing an updated, institution-specific MSBOS along with an Emergency Blood Releasing system.
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    Assessment of Laryngeal Mask Airway Insertion Conditions, With Co-Administration of Thiopentone, Fentanyl and Halothane
    (Addis Abeba University, 2015-07) Tesfa, Abulu; Abrar, Meron (PhD)
    Background: The laryngeal mask airway (LMA) provides a useful alternative for airway management during spontaneous or controlled ventilation. Because of benefits like, less hemodynamic changes, minimal increase in intraocular pressure after insertion; and a lower incidence of sore throat in adults, the use of LMA as an alternative to tracheal intubation is gaining popularity. So choosing an induction agent that better suppresses the airway reflexes, at usual induction dose, while, inserting LMA remains important. Objectives: To assess conditons of LMA insertion by the co-administration of Thiopentone, Fentanyl and Halothane in elective patients, scheduled for surgery at Tikur Anbessa Referral Hospital from March16- May 30, 2015. Methodology: -The study was conducted in TikurAnbessa Referral Hospital March16 - May 30, 2015.The study population was all elective patients, who was scheduled for elective surgery and for whom intubation with laryngeal mask airway was indicated. Institution based cross-sectional study was conducted. The total sample size is 42. Data was collected by observing the patients intubated with LMA under Thiopentone, Fentanyl and Halothane. Data was analyzed by using SPSS version 16. Association factors were checked by using cross-tabulation and chi-square. Results: - Total number of patients involved in this research was 42. Only patients with ASA classification of class I & II and Mallampati class I &II are involved. The mean age of the patients involved in the research was 18.13 ± 12.26. The mean weight was 41.92 ± 17.78. Concerning the responses of the patients to LMA insertion, 95.2% of the patients have adequate jaw relaxation. 41(97.6%) did not develop laryngeal spasm. In 92.7% of cases LMA was inserted during the first trial. Gagging did not occur in 90.5% of the cases. Coughing did not occur in 95.2% of the cases. . No movement is recorded in most of the cases (95.2%). There was no statistically significant change in the MAP and HR of the patients immediately, 5 minute and 10 minute after LMA insertion. Most of the patients (45.2%) start spontaneous breathing within the first 10sec after the combination of the drugs was administered. Conclusion: - Thiopentone 5.12mg/kg, fentanyl 1.2mcg/kg and halothane 3% mask ventilated with 100% oxygen for 2.7 min is effective for the insertion of LMA in elective patients.
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    Assessment on Maginitude and Associated Factors on Suxamethoneum Induced Post Operative Myalgia in Adult Elective Surgical Patients From January 1, 2017 To March 1, 2017 At Zewuditu Memorial Hospital, Addis Ababa. Cross Sectional Study
    (Addis Abeba University, 2017-06) Abebe, Gashaw; Abrar, Meron (PhD)
    Background: - Suxamethoneum is a depolarizing muscle relaxant first introduce into clinical practice in 1951, it remains the drug of choice in clinical situations in which rapid paralysis and air way control are priorities. The administrations of succinylcholine may produce post-operative myalgia. Post-operative myalgia is thought to be caused by motor units firing at physiological higher rate following Suxamethoneum administration, leading to unsynchronized muscle contractions causing shearing forces of skeletal muscle fibers. The postoperative myalgia is generalized aches and pains that commonly occur 24 to 48 hours after Suxamethoneum Objectives: - To assess the magnitude and associated factors of Suxamethoneum induced post- operative myalgia in adult elective surgical procedures that were under gone from January 1, 2017 to March 1, 2017 in Zewuditu memorial hospital, Addis Ababa, Ethiopia. Method:-On 283 eligible patients Hospital based cross sectional study was conducted from January 1, 2017 to March 1, 2017 G.C at Zewuditu Memorial Hospital, using structured questionnaires and checklists and data were collected from all elective surgical patients who fulfill the inclusion criteria during study period and the magnitude of post-operative myalgia was calculated (%), associated factors with myalgia was investigated. Multivariate logistic regression analysis was conducted to identify significant predictors based on p-value less than 0.05 with 95% confidence level. Results:-Among 160 elective surgical patient the magnitude of Suxamethoneum induced post operative myalgia in the first 24 to 48hours were in 92(57.5%) and in which at 24hour the magnitude were about 84(52.5%) where as at 48 hour 74(46.2). The independent predictors of Suxamethoneum induced post operative myalgia in this study are being female, incidence fasciculation during induction and analgesia preoperatively. Conclusion and recommendation:-The magnitude of Suxamethoneum induced post operative myalgia in the first 24-48hrs was higher. To minimize the magnitude of Suxamethoneum induced post operative myalgia and post operative patient discomfort different prevention techniques should be applied. If possible it better to avoid the use of Suxamethoneum regularly for elective surgical patients. It is also recommended that premedication of patients with analgesic agent before induction anesthesia and defaciculat with NDNMBA.
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    Magnitude and Associated Factors of Difficult Airway in Pregnant Mothers who Underwent Caesarean Section Under General Anesthesia in all Governmental Hospitals of Addis Ababa
    (Addis Abeba University, 2016-05) Tesfaye, Biruk; Abrar, Meron (PhD)
    Background: Difficult airway contributes to higher number of maternal morbidity and mortality attributed to anesthesia. Especially in developing countries like Ethiopia in which economical problems impart wide varieties of infrastructural challenges such as lack of appropriate facilities, equipments, highly trained anesthetists, antenatal care of pregnant women and continues and up to date trainings for the professionals who are part of the clients care. Objectives: To assess the magnitude and risk factor of difficult airway among pregnant mothers who underwent general anesthesia for caesarean section in all governmental hospitals of Addis Ababa from February 1- April 30 2016. Methods: Institutional based cross sectional study was conducted from February 1- April 30, 2016 in eight governmental hospitals of Addis Ababa city that provide General Anesthesia for Caesarean section. A total of 302 participants were included in the study period. Patient demographics, airway management, difficult intubation, failed intubation were studied among participants in which general anesthesia was given. Result: The study found that the magnitude of difficulty intubation was 5.6%. The result of multivariate analysis showed that age group 25-29, 30-34, mandibular protrusion and history of exposure to anesthesia were strongly associated with difficulty intubation at p-value less than 0.05. The odd of developing difficulty intubation was five times less in mallampati class I than the odd of developing difficulty intubation in mallampati class II (AOR, 5.436, 95%C.I;.627- 47.089) Conclusion: General anesthesia is most commonly used in cases where emergent delivery was needed. The magnitude of difficult intubation and failed intubation is higher in this study than studies conducted in other parts of the world. Keyword: difficult airway, difficult intubation, caesarean section, failed intubation
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    Magnitude and Associated Factors of Immediate Postoperative Hypoxemia Among Elective Surgical Procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, January 30, 2017 To March 31, 2017 G
    (Addis Abeba University, 2017-06) Dendir, Getahun; Abrar, Meron (PhD)
    Background: definition Hypoxemia is insufficient amount of oxygen in the blood. There are different contributing risk factors for occurrence of post-operative hypoxemia which may lead to myocardial ischemia, organ dysfunction, wound infection, hospital stay and increase cost for the hospital and patient. Objectives: To assess the magnitude and associated factors of immediate post-operative hypoxemia in elective surgical procedures at Tikur Anbessa specialized Hospital from JANUARY 30,2017 to MARCH 31, 2017 G.C. Methods: Institutional based Observational study design was conducted. Using Systemic random sampling technique and structured questioners data was collected from sampled elective surgical patients’ age≥18 that came during the 2 months period. Data was entered into Epi info version 7 computer software by investigators and transported to SPSS version 20 computer program for analysis. Frequency and cross tabulation was conducted to describe relevant variables in relation to the outcome variables. Variables that demonstrated a significant relationship on biviarite analysis (p-value<0.2) were included Multivariate regression analysis was applied to evaluate independent variable relationships with a dependent variable that was continuous. A p-value <0.05 was considered to represent a statistically significant relationship Results: Among sampled 238 elective surgical patients magnitude of hypoxemia was 54(22.7%).Frequency of hypoxemia was high in first 10 minute after admission to post anesthesia care unit.. The independent predictors of hypoxemia were who had Respiratory co morbidity [(AOR=8.8; CI 2.264, 34.117)] (p =0.002) and cardiothoracic surgery [AOR=4.904; CI1.385, 17.368] (p =0.014). Conclusion and Recommendation: Magnitude of hypoxemia was high and so specials consideration should given co morbid diseases patients by pre operative optimization of patient that have other factors additional to the surgical procedure.
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    Prospective Cohort Study on Effect of Timinig on Fluid Administration for Prevention of Spinal Anesthesia Induced Hypotension in Obstetric Mothers at Ghandi Memorial Hospital, December 2016 to February 2017 Addis Ababa, Ethiopia
    (Addis Abeba University, 2017-06) Tiruneh, Abebe; Abrar, Meron (PhD)
    Introduction: Neuraxial anesthesia remains the preferred choice for Cesarean deliveries across the world. Hypotension is the physiologic consequence of spinal anesthesia and can have a potentially deleterious maternal and fetal impact. Measures to decrease the incidence and severity of maternal hypotension include left uterine displacement, fluid preload, fluid co-load, prophylactic vasoconstrictors, trendelen burg position and leg elevation. Acute hydration has become the cornerstone of prophylaxis of hypotension in obstetrics previously but recently studies showed that co-loading also may be better option in prevention of spinal induced hypotension. Objective: To compare crystalloid preload and coload for the prevention of maternal hypotension in pregnant mothers undergoing elective cesarean section under spinal anesthesia. Secondary outcomes studied included requirement of vasssopressor for treatment of hypotension, maternal nausea and vomiting and neonatal APGAR scores. Materials and Methods: Prospective cohort study design;96 parturients, American Society of Anesthesiologist (ASA) physical status 1 or 2, with uncomplicated pregnancies scheduled for cesarean section under spinal anesthesia were involved into two groups. The preload group takes fluid over 20 min before the placement of spinal block; while the coload group received fluid rapidly starting as soon as CSF was tapped. Independent sample t test, Chi-square test or fisher exact test were used and p value <0.05 considered as statistically significant. Results: The number of mothers who develop hypotension in preload group and Coload group was 39 and 17 respectively and which was statistically significant. Incidence of nausea vomiting was higher in preload group than coload group 25/48 (52%) VS 13/48 (27 %) respectively (x2 =6.27,RR=1.65 ,95%CI1.24-6.86) .Neonatal wt and APGAR score at 1 and 5 minute are comparable and there is no statistically significant difference between the groups. Conclusions: Even if both techniques were in effective in the prevention of spinal-induced maternal hypotension, coloading was better than preloading in the prevention of hypotension after spinal anesthesia. Therefore it is unnecessary to delay surgery in order to deliver a preload of fluid before spinal anesthesia.