Browsing by Author "Samuel Hirbo"

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    Assessment of the Magnitude and Associated Factors of Unplanned Extubation in Intensive Care Unit at Addis Ababa Governmental Hospitals. Addis Ababa, Ethiopia 2021
    (Addis Ababa University, 2021-08) Minda Zewdu; Samuel Hirbo ; Aweke Senayit
    Background: Unplanned extubation is the premature removal of an endotracheal tube accidentally during procedural activities or by the action of the patient. It is one of the commonly reported complications among mechanically ventilated patients in the intensive care unit. Objectives: Assess the magnitude and associated factors of unplanned extubation in intensive care unit at Addis Ababa governmental hospitals, Addis Ababa Ethiopia January8, 2021-May9, 2021 Methods: Hospital based cross-sectional study conducted on 317intubated patients in the intensive care unit which fulfilled the inclusion criteria at the selected Addis Ababa governmental hospitals, Addis Ababa Ethiopia from January8, 2021-May9, 2021.Data collection method was includes patients chart review, direct observation and by asking the physician.Collected data was entered to Epi-data version 4.6.0.2 and was analyzed by SPSS version 26 statistical software .All independent variables with the dependent variable was analyzed using binary logistic regression to determine the variables independently predictive of unplanned extubation. Odd ratio .P-value and 95% confidence interval was calculated to differentiate risk factors and to assess association strength. Variables with P-value<0.25 on bivariate analysis were going to multivariable analysis and P-value less than 0.05 was cut point to test the statistical significance. Result: The prevalence of unplanned extubation in this study was 19.74 %.Being male (AOR=3.132, 95%CI: 1.276-7.69), duration of intubation <5days (AOR=2.475, 95% CI: 1.0395.894), managed by junior resident (AOR=5.25, 95% CI: 2.125-12.969), being physically restrained (AOR=4.356, 95%CI: 1.786-10.624), night shift (AOR=3.282, 95%CI:1.4517.424)and agitation (AOR=4.934,95%CI:1.934-12.586) were significantly contribute to the occurrence of unplanned extubation. Conclusion and recommendation: This study showed that the prevalence of unplanned extubation was high in ICU at Addis Ababa governmental hospitals. We suggest to ICU staffs in Addis Ababa governmental hospitals to give special attention to early intubated patients especially for male individuals and the stakeholders of hospitals should rearrange the time of shift and physician schedule in ICU.
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    A Comparative Study on Effect of Tracheal Tube Cuffsfilled with Air Versus Alkalinized Lidocaine on Hemodynamic Response Changes During Extubation and Postoperative Laryngotrachial Morbidities in Childrens.
    (Addis Abeba University, 2020-06) Assefa Biniyam; Samuel Hirbo ; Fentie Fisha
    INTRODUCTION: When the lateral pressure exerted by an inflated cuff on tracheal mucosa exceeds capillary perfusion pressure, it can result in tracheal morbidity, loss of mucosal cilia,ulceration, hemorrhage, and tracheal stenosis. Patients may complain of cough, sore throat and hoarseness in the postoperative period. Lidocaine within tracheal tube cuffs seems to exert a localized effect on the trachea after diffusing through the cuff, resulting in improved tolerance to tracheal. Both alkalinized and non-alkalinized lidocaine used to fill tracheal tube cuffs reduces the incidence of postoperative sore throat. OBJECTIVE: was to assess the effectiveness of tracheal tube cuffs filled with air verses alkalinized lidocaine on heamodynamic response changes and laryngotracheal tracheal morbidities during and post extubation in children’s. METHODOLOGY: Institutional based observational prospective cohort study design used to address the study objective. All elective children aged 3-13 years who undergoing operation under general anesthesia with endotracheal intubation greater than one hour at TASH were selected. The outcome variable ware Haemodynamic response changes i.e. (HR,SBP and DBP),was measured in the 5 min before, and 5 min following, tracheal extubation and laryngotracheal morbidities like cough, hoarsens and sore throat, evaluated as dichotomous variables (yes or no). RESULTS: Hemodynamic changes that recorded during the study were the highest systolic and diastolic blood pressure and the heart rate. The results shows the heat rate difference of p value<0.001. Meanwhile the systolic blood pressures 8 hour after extubation between the groups were with p value of 0.003. The incidence of sore throat post operatively measured at 8hr has a significantly lowered in alkalinized lidocaine groups compared to air with p value difference of 0.027.Meanwhile the incidence of postoperative sore throat that is measured at 24 hour shows significant difference among the groups with p value of 0.009. CONCLUSION: Alkalinized lidocaine inflated tracheal tubes have shows improved hemodynamic and larngotracheal morbidities in children’s
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    Comparison of Intravenous Fentanyl and Lidocaine as an Anesthetics Adjuvant on Attenuation of Hemodynamic Pressor Responses to Laryngoscopic Intubation at Tikure Anbessa Specialized Hospital, Addis Ababa, Ethiopia
    (Addis Ababa Universty, 2018-06) Samuel Hirbo; Weldeyohannes Misrak
    Back ground: Laryngoscopic intubation is an insertion of endotracheal tube in to the trachea for maintenance of airway during general anesthesia. Smooth intubation requires attenuation of pressor responses and maintenance of baseline hemodynamic stability. In order to control hemodynamic changes during tracheal intubation and extubation, local anaesthetics, opioids, beta-blocking agents, and calcium channel blockers have been used with varying success rates. Objective: To compare intravenous fentanyl and lidocaine on attenuation of hemodynamic responses to Laryngoscopic intubation in elective surgical patient at Tikur Anbessa Specialized Hospital (TASH) Addis Ababa, Ethiopia. Methods: An institutional based observational prospective cohort study was conducted on one hundred and Fourteen eligible adult patients at TASH from January 1, to March 30, 2018. The study participants were allocated in to two group; Group F (n =57) patients received fentanyl 2mcg/kg and Group L (n =57) patients received lidocaine (2%) 1.5mg/kg three minute before intubation. Observation and chart review were employed for data collection. Data was entered in to Epi info version 7.2 software by investigators and transported to SPSS version 20 program for analysis. Normality of the data was checked by Shapiro wilk test. Independent t- test was used to determine the mean differences between two groups while paired sample t- test was used to determine the mean differences within the groups. Chi square test was used for categorical variables. Those variables with p-value < 0.05 were considered as statistically significant. Results: The heart rate was significantly lower in fentanyl group (98.91±15.6 bpm) compared to lidocaine (107 ±15.45 bpm) at first minute after intubation, t (112) =2.8, p = 0.006. Systolic blood pressure was also significantly lower in fentanyl group (141.9±18.9 mmHg) compared to lidocaine (150mmHg ±18.098 mmHg), t (112) = 2.45, p = 0.016. At third minute after intubation heart rate was lower in fentanyl group compared to lidocaine, t (112), p= 0.037. No difference in heart rate and blood pressure among the group at 5th minute after intubation (p>0.05). Conclusion and recommendations: Fentanyl was better on attenuation of hemodynamic pressor responses to intubation when compared to lidocaine. Therefore, using fentanyl pre-operatively to attenuate pressor responses especial during intubation is important.
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    Comparison of Perioperative Blood Glucose Concentration in Spinal Versus General Anesthesia in Patients Under going Elective Lower Abdominal and Pelvic Surgery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia,2020/21:A Prospective Cohort Study.
    (Addis Abeba University, 2021-06) Negash Mestawet; Girma Betelihem; Samuel Hirbo
    Introduction: Surgery is linked with fear and stress that disrupt metabolic and neuroendocrine activities which impair normal maintained glucose metabolism that leads in stress hyperglycemia.Anesthesia inhibits the stress responses and hyperglycemia but the mechanism at which they reduce surgical induced hyperglycemia is different. Objective: This study compares the effect of GA and SA on perioperative blood glucose levels in patients that undergo lower abdominal and pelvic surgery at Tikur Anbessa Specialized Hospital. Method: An institutional-based prospective cohort study was done on 70 individual patients; 35 in each group that undergo lower abdominal and pelvic surgery under GA and SA by using a systematic random sampling technique. Capillary blood glucose was measured 4 times: T1; 5 minutes before induction in GA and giving SA, T2; after 5 minutes of induction in GA and complete block in SA, T3; immediately at the end of surgery in both groups and T4; 60 minutes after the end of the surgery in both groups. Collected data were entered into SPSS version 24 and the normality was checked by the Shapiro Wilk test. For statistical analysis unpaired t-test and paired t-test were used to compare the mean of normally distributed data between the two groups and within the group respectively, presented by mean and standard deviation. Manny Whitney U test was used for asymmetric data and presented by median and interquartile range. Categorical data were presented by percentage and analyzed by chi-square test. P values <0.05 were considered statistically significant. Result: No statistically significant difference was observed in mean blood glucose levels at T1 and T2 between the two groups. But at T3 (GA:115.57 ± 16.60 vs. SA:104.34 ± 14.06, p= 0.005) and T4 (GA;117.34 ± 16.79 vs. SA;106.00 ± 14.57, p=0.004) the mean blood glucose levels were statistically significantly higher in the GA group than SA group and when compared to the baseline. The incidence of stress hyperglycemia under GA was 34.3% compared to 8.6% under SA. Conclusion and Recommendation: SA reduces the incidence of stress-induced hyperglycemia as compared to GA in patients undergoing lower abdominal and pelvic surgery. We recommend SA over GA whenever possible for patients undergoing lower abdominal and pelvic surgery.
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    Effect of Low-Dose Intravenous Ketamine on Postoperative Pain After Cesarean Section Following Under Spinal Anesthesia in Zewditu Memorial Hospitals, Addis Ababa, Ethiopia, 2021, a Prospective Observational Cohort Study
    (Addis Abeba University, 2021-06) Tuni Jemal; Samuel Hirbo ; Aweke Senait
    Background: Cesarean section is common obstetric procedures worldwide. Following cesarean delivery, mothers experience moderate to severe pain since postoperative analgesia of spinal anesthesia is limited by duration of local anesthesia drug used. Analgesic effect of local anesthesia agents could be extended by adding adjuvants like neostigmine, opioid and low dose of intravenous ketamine. Objective: This study was assess effect of low-dose intravenous ketamine on postoperative pain following cesarean section with spinal anesthesia in Zewditu Memorial Hospital, Ethiopia, 2021 Method: Sixty pregnant mothers planned for elective cesarean delivery under spinal anesthesia were involved in this prospective cohort study at zewditu memorial hospital. Participants were selected by systematic random sampling technique. Numerical rating scale pain score, time to request first analgesia and total analgesia consumptions were recorded in first 24 hours.Independent sample t- test, Mann–Whitney U-test and a chi-square was used for analysis based on distribution of data. Result- Numerical rating scale pain score at 1st and 2nd hour after surgery was significantly different between the groups with p≤ 0.05. But pain score at 6th, 12th, 18th and 24 insignificant.Time to request first analgesia was significantly longer in exposed than Non-exposed group with p< .0001.The median(range) of tramadol consumption in 24 hour was 100(100_100) for exposed and 150(100_150) for non-exposed which was significant difference between both groups with (p- value ˂ .0001). But, diclofenac consumption was not significantly different (p =.576).
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    Incidence and Associated Factors of Acute Postoperative Pain in Women Undergoing Cesarean Section at Gandi Memorial Women and Child care Hospital, Addis Ababa,Ethiopia,2019/2020.
    (Addis Abeba University, 2020-06) Bimrew Dagim; Samuel Hirbo ; Daniel Tenbit
    Background: Pain is a sensory and emotional experience associated with actual or potential tissue damage,or described in terms of such damage according to Association of the Study of Pain. Although advances in medical science, poor post-operative pain management exists in developed as well as developing countries including Ethiopia. Several preoperative, intra-operative and postoperative factors are realized to cause enhancement of postoperative pain. Therefore in resource shortage settings to take appropriate plan of treatment and proper use of multimodal analgesia, it is obliged to identify the problem and its factors. Objective: The aim of this study is to assess the incidence and associated factors of post-operative acute pain after cesarean section in the first 24 post-operative hours in Gandhi memorial Hospital, Ethiopia, 2020. Methods: An institutional based prospective follow up study was conducted in parturient undergone cesarean section in Gandhi memorial hospital from December 1-2019 to February 30-2020, data was collected by through interview and reviewing the patients chart after taking consent. Numerical rating scale was used to evaluate incidence of acute postoperative pain. Data was analyzed using SPSS version 20.Logistic regression was applied to point out independent risk factors for post-operative acute pain. Variables with a p-value of < 0.05 were taken as significant association with dependent variables. Result: A two hundred ninety parturient were participated in the study with a response rate of 98%.Moderate –severe acute postoperative pain after cesarean section was 76.2 %( 95% CI: 71%, 81%)in the first 24 hours postoperatively. On multivariable analysis, history of previous cesarean section (AOR: 2.8095% CI: 1.40, 5.55), preoperative anxiety (AOR: 2.70, 95%CI: 1.45, 5.05), transverse incision type (AOR: 3.35, 95% CI: 1.67, 6.72), incision length (AOR: 2.46, 95% CI: 1.24, 4.85)were identified as associated factors of postoperative moderate-severe acute pain after cesarean section. Conclusion: The study confirmed that moderate-severe acute postoperative pain after cesarean section is enormous in proportion and also undertreated. Previous cesarean section, preoperative anxiety, incision type and incision length were determinants of post operative acute pain after cesarean section. Evaluate and document the pain rating scale, communicate with other integrative departments for a better management and organize a master plan to lessen the pain occurrence problem must be required
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    Survival Status and Predictors Of Postoperative Mortality in Patients Who Underwent Esophageal Surgeries for Esophageal Malignancies at Selected Governmental Hospitals Ethiopia, Addis Ababa: A Retrospective Cohort Study
    (Addis Ababa University, 2024-06) Birhanu Mintesinot; Abiy Sileshi ; Samuel Hirbo
    Introduction: Cancer is still the leading cause of death worldwide, and esophageal canceris the sixth leading cause of cancer-related deaths. For individuals with esophageal cancer,esophagectomy is the only treatment option available and it has a high risk of both death andmorbidity. Moreover, despite advances in preoperative optimization, surgery, and anesthesia techniques, as well as the introduction of neoadjuvant therapy, the mortality and morbidity associated with esophagectomy persist to be high. Objective: To assess the Survival status and predictors of postoperative mortality in patients who underwent esophageal surgeries for esophageal malignancies at selected governmental hospitals from 2018-2023 GC Ethiopia, Addis Ababa Methods: A Retrospective Cohort study was conducted. After the acquisition of data from the chart review, Data was analyzed using R version 4.3.3. Descriptive statistics for categorical variables were reported as frequency and percentages. Kaplan Meier curve and log-rank test were used to estimate the survival curve and the difference in survival among groups within each covariate respectively. After esophageal surgery, the impact of each covariate on the time to death was assessed using the Cox proportional hazard model. Results: 246 patients who underwent esophageal surgeries for esophageal malignancy at 4governmental hospitals in Addis Ababa were included over 5 years. The mean age of the patients was 52.1 years. 127(51.6%) had a T4 stage Cancer, 166(67.5%) had a tumor size <3.3cm, and Squamous cell carcinoma accounted for 207(84.1%) cases, Epidural Analgesia was the most commonly used analgesic technique 45(18.3%). 30-day mortality was 8.5%, The overall 1,2,3,4and 5-year survival rate were 49.8%, 30.2%, 15.4%, 15.4%, and 10.3% respectively. The median Survival time was 12 months. ASA score of > III. (AHR = 1.93, 95%CI 1.10-3.38), Hospital Acquired Pneumonia (AHR = 1.95, 95%CI: 1.06-3.59). Hypertension (AHR = 2.22, 95%CI: 1.04-4.73), Cervical anastomotic Leak (AHR = 2.17, 95%CI: 1.00-4.67), and sepsis (AHR = 3.69,95%CI: 1.49– 9.11). were identified as an independent predictor of postoperative mortality in the multivariate Cox regression model. Conclusion: In Ethiopia, patients who underwent esophageal surgeries for esophageal malignancy have a low 5-year survival rate. Patients who develop complications in the postoperative period are more likely to die compared to their counterparts Thus screening, prevention, and early management of postoperative complications is recommended to improve survival rate.