Browsing by Author "Berhanu Tseganesh"

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    Efficiency of Blood Utilization in Elective Surgical Patients and Associated Factors in Addis Ababa, Ethiopia from November 2023 to April 2024.
    (Addis Ababa University, 2024-05) Demsie Yidersal; Tilahun Rahel; Berhanu Tseganesh
    Background: Blood transfusion is vital for managing patients with significant blood loss preoperatively.However, over-ordering of blood is prevalent, resulting in increased costs and resource wastage. Implementing various transfusion indices can help reduce unnecessary blood requests for elective surgical patients without compromising patient care. Objective: To assess the efficiency of blood utilization in elective surgeries and associated factors at different hospitals in Addis Ababa from November 1, 2023, to April 30, 2024. Methods: A multi-center cross-sectional analytical study was conducted over a period of six months from November 1, 2023, to April 30, 2024, at TASH, MH, GMH, and LGH. Using sequential sampling and a structured checklist, data were collected from all elective surgical patients during this period. Collected data were coded, entered into a Google form and Excel, and analyzed using SPSS version 26. Blood utilization was assessed using various parameters including cross-match to transfusion ratio (C/T), transfusion probability (%T),transfusion index (TI), and Maximum Surgical Blood Ordering Schedule (MSBOS) based on Mead's criterion for common surgical procedures. Bivariate binary logistic regression analyses were employed to identify independent predictors of intraoperative blood transfusion, with odds ratios and 95% confidence intervals estimated for each predictor. Statistical significance was considered at a p-value ≤ 0.05. Results: A total of 574 elective surgical patients (30% from TASH, 26% from MH, 22% from GMH, and 22% from LGH) participated in the study; with 22% (126 patients) receiving intraoperative blood transfusions. From all, 469(81.7%) had blood requested and prepared. The cross-match to transfusion ratio (C/T) was 4.5(C/T<2.5is indicative of efficient blood usage), with a transfusion probability (%T) of 26.8% (%T>30% is considered efficient blood usage), and a transfusion index (TI) of 0.39(TI>0.5 is considered efficient blood usage), leading to a Maximal Surgical Blood Order Schedule (MSBOS) of 0.59.Independent predictors of intraoperative blood transfusion that we get from this study include ASA class III and above (p=0.000), ASA class II(p=0.018), Patient Transfused Preoperatively (p=0.000), Intraoperative blood x loss > 15% (p=0.000), Duration of surgery greater than three hours (p=0.017), Type of Anesthesia (General Anesthesia) (p=0.002), of the study groups. Conclusion and Recommendations:In this study, we observed that there is a concerning disparity between the quantity of blood requested and cross-matched for elective surgery patients and the actual amount utilized. This excessive cross-matching results in resource wastage, heightened workload, and increased financial burden. Moreover, it poses potential challenges to the blood supply, prompting a need to revise our blood requisition protocols. To optimize blood utilization, we recommend revising the current blood ordering pattern and minimizing over-ordering. This can be achieved by implementing an updated Maximum Surgical Blood Order Schedule (MSBOS) tailored to our institution, alongside an emergency blood-releasing system. Utilizing parameters such as Crossmatch-to-Transfusion (C/T) ratio and Transfusion Index (TI) can guide the development of the MSBOS, with consideration for a Group Save and Hold (GSH) for procedures with low TI values. Regular surveillance of utilization patterns and feedback mechanisms are essential for continuous improvement in transfusion practices
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    Incidence and Associated Factors of Acute Postoperative Pain in Adult Elective Surgical Patients at Tikur Anbessa Specialized Hospital from November 2023 to January 2024 GC.
    (Addis Ababa University, 2024) Asefa Eyob; Berhanu Tseganesh; Abebe,Yona
    Background:According to IASP revised definition pain is defined as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”Countless patients that need surgical intervention are handled by Ethiopia's healthcare facilities and their expanding off erings.In these facilities, managing acute postoperative pain is a serious concern. The prevalence and contributing variables of acute postoperative pain in Ethiopia, notably at Tikur Anbessa Specialized Hospital, are little understood. And there is no published research done with similar topic in Ethiopia as well as in the study area. Objectives:To assess the prevalence and associated factors of acute postoperative pain after elective surgery among adult patients at Tikur Anbessa specialized Hospital, Addis Ababa, Ethiopia,2023. Methodology:An institution based cross sectional study design was employed. A single population proportion formula is used to determine the sample size. Total sample size is 219. A structured data collection format was used to collect data from the patients and their records, after taking verblconsent by trained data collectors. The data was entered, polished and analyzed using SPSSversion 27. Bivariate and multivariate logistic regressions were used to describe association between independent and dependent variables. P value less than 0.05 was considered statistically significant. Results:A total of 219 patients were included in our study, among the participants 180 or 82.2%developed acute postoperative pain while 39 or 17.8% did not develop acute postoperative pain.The incidence of moderate to severe pain was found to be 34.24%. Preoperative anxiety, use of intraoperative analgesics, incision size and duration of surgery were the main factors associatedwith the incidence of acute postoperative pain. Conclusion:Our study demonstrated that the overall incidence of postoperative pain was relatively low in the study area. This reflects that the attention given to postoperative pain recognition an management is better when compared to other areas, but there is still significant gap in managing postoperative pain.
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    Incidence of Postoperative Complications in the Major Operation Room Post Anesthesia Care Unit of Tikur Anbessa Specialized Hospital, 2018
    (Addis Ababa University, 2018-10) Berhanu Tseganesh; Kinfe Mahider
    Background: Emergence from anesthesia is the critical period. This early emergence period is ubiquitous with potential complications. In order to enable early detection and prompt treatment of these potential complications by the practitioner, there needs to be an effective system of detection and reporting of all adverse events occurring during the period of emergence.A wide spectrum of critical incidents occur in the PACU, many of which are related to the cardiovascular and respiratory systems. Critical incidents have a major impact on healthcare utilization and result in prolonged PACU stays and higher levels of postoperative care than initially anticipated. Events occurring during the PACU period continue to be a source of patientmorbidity. The overall incidence of complications occurring during the post anesthesia care unit stay may be higher than previously expected. Objectives: To investigate the incidence of postoperative complications among patients admitted to the PACU at the major operation room in TASH. And to identify factors that are associated with the complications and to propose an instrument that addresses thecomplications, risks and individualized interventions.11 Methodology: After approval from the university, institutional based prospective cross-sectional study was conducted from June 14- July 29, 2017 to investigate the incidence of complications in all patients admitted to PACU who had surgery (elective and emergency) under general anaesthesia (GA), Monitored Anaesthesia Care (MAC), Regional Anaesthesia (RA). Data was collected using survey data sheet (a standardised data collection form), which is a three page check-box form and was analyzed using Statistical Package for Social Sciences, version 21. Results: During the study period 312 patients were admitted to the PACU of the major OR. Total number of patients who had complications in the PACU was 65 (20.83%). The type ofcomplications is characteristically of respiratory system in the first place (35.4%); followed by cardiovascular system complications (21.1%), and PONV (13.8%) which comes third on the list. Of all the studied variables only the presence of pre-existing co-morbidity and duration of the surgery had significant association with the incidence of complications. But none of the 65 patients who had complications was found having any significant correlation to: Age (P=0.714),Sex (P=0.717), Urgency of procedure (P=0.472), Type of surgery (P=0.887), Type of anesthesia(P=0.150), Attending anesthesia provider (P=0.378) and Position during surgery (P=0.370) Conclusion and recommendation: The presence of pre-existing co-morbidity and the longer the duration of the surgery, the higher the incidence of the post-op complication will be.There was a very small number of patients in the study, I believe that inclusion of more patients and different surgical specialties such as Obstetrics and orthopedic surgeries would have changed the results in terms of kind and percentage of complications. I recommend that a prospective follow-up trial be undertaken in large number of patients, with data on criticalincidents being collected by clinicians, to strengthen the findings of this study.
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    Magnitude of Adverse Events and Outcome of Foreign Body Aspiration Removal among Pediatric Patients at Tikur Anbessa Specialized Hospital from July 1 to November 30, 2020
    (Addis Abeba University, 2020-12) Eseyneh Netsanet; Berhanu Tseganesh ; Abate Ananiya
    Background: Foreign body Aspiration is a life threatening emergency situation among pediatric age group worldwide. Early intervention is crucial to save lives. Objective: The aim of this study is to determine magnitude of adverse events and outcome of foreign body aspirations removal among pediatric patients at TASH. Materials and Methods: Institution based Prospective; observational study was conducted among 60 foreign body aspiration cases with census sampling technique. Standard structured observational tool was used. Data cleaned and entered to Epi data version 3.1 and exported to SPSS version 26. Descriptive and Chi square and Fisher Exact test were done. Result- A total of 60 FBA cases were studied in 56 patients. Four of the cases were repeat procedure. The commonest adverse event encountered was desaturation 51(85%) followed by one lung ventilation 45 (75%), persistent hypoxia 34(56.7%), air way mucosal bleeding 34(56.7%), laryngospasm 14 (23.3%), air way or laryngeal edema 13(21.7%), bradycardia 9(15%), esophageal intubation 5(8.3%) and inadequate depth of anesthesia 2(3.3%). There were 2 cases of tracheobronchial fistula with tension pneumothorax. Among the study participants 7 patients needed PICU admission. There was no death. Mode of ventilation, duration of surgery, surgeon experience, and occurrence of adverse events such as Laryngeal edema, persistent hypoxia and bradycardia had statistically significant association with PICU admission. Conclusion- The incidence of adverse events, DOS and DOA were higher in comparison to any other researches. The incidence of serious complication is also higher than other researches and surgeon experience also had significant risk factors for patient disposition of PICU transfer.
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    Patient Satisfaction Study With Anesthesia Sedation Service for Patients Undergoing Endoscopy in Tikur Anbesa Specialized Hospital Addis Ababa Ethiopia From November 2023 to April 2024.
    (Addis Ababa University, 2024-05) Teshale Zelalem; Berhanu Tseganesh ; Abebe Yonatan
    Background- The diagnostic and therapeutic potential of endoscopy has been significantly increased. Nowadays non-operative room anesthesia service also incorporate provision of anesthesia service for endoscopic procedures it the one of the determinant factor for patient tolerance of the procedure Objective- The aim of this study is to determine patient satisfaction with sedation service and associated factors in adult patients undergoing upper GI endoscopy at Tikur Anbessa specialized hospital Addis Ababa Ethiopia from November 1, 2023 to April 30, 2024 GC. Method- Institutional based cross-sectional survey was used. The study period was from November 1, 2023 to April 30, 2024 in Addis Ababa University School of Medicine College of health sciences using patient sedation satisfaction questionnaire. The data collected by using a phone call within 48-72 hours of the procedure. Data was analyzed by using SPSS version 27software. By using mean split technique rate of satisfaction was classified satisfied patients and unsatisfied patients. Bivariate and Multivariate Binary logistic regression was done for categorical variables and Pearson correlation and linear regression was done for continuous variables.Results: A total of 107 individuals participated in the study with a 97.1% respondent rate.Majority of participants had not got information about sedation (66.3%). The mean satisfaction score was 9.1±1.0. Satisfaction rate was 77.9 and satisfaction rate is not associated with age, sex or level of education Conclusion: compared with similar studies, the satisfaction rate with sedation for endoscopy is low in this study. Unlike other studies patient satisfaction has no significant relation with age and educational level. There is also a huge gap in information provision regarding sedation and what is expected during the procedure, we recommend for the physician to provide adequate information