Browsing by Author "Sitot Mulualem"

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    Analgesic Effectiveness of Intrathecal Tramadol Added to Bupivacaine Compared with Bupivacaine Alone for Spinal Anesthesia For Mothers Delivered by Cesarean Section at Empress Zewditu Memorial Hospital, Addis Ababa, Ethiopia.
    (Addis Ababa Universty, 2018-06) Abera Abebe; Sitot Mulualem
    Background: Spinal Anesthesia has become more widely practiced anesthetic technique. It is simple to institute, rapid in its effect and produces excellent operating conditions. Postoperative pain after cesarean section is common and more intense compared to post vaginal delivery pain. Therefore, intrathecal adjuvants play an important role in maternal analgesia in the postoperative time. It has been shown in clinical studies that using tramadol intrathecal can provide longer duration of analgesia, without the common side effects of opioids. Objective: To compare analgesic effectiveness of intrathecal tramadol as an adjuvant with bupivacaine in comparison with bupivacaine alone for mother delivered by cesarean section at Empress Zewditu Memorial Hospital from January 1 to March 30, 2018. Methods: Hospital based observational prospective cohort study was employed for 62 laboring mothers who fulfilled inclusion and deliver by cesarean section under spinal anesthesia selected with systematic random sampling from schedule list. Data was collected immediately after SA administration at 5, 10, 15, 20, 30, 40 minutes. Starting from the immediate postoperative time, an assessment was done at 1, 2, 3, 4, 5, 6 and 12 hours for numerical rating scale (NRS). Based on normality assumption, analysis was done by independent t test, Mann –Whitney U test, χ2 or Fisher’s exact test as appropriate. P-value <0.05 was consider as statistically significant. Result: Hemodynamic change was comparable and there was no adverse effect between the groups. The median pain scores were lower in exposed (BT) group at the 2nd, 3rd, 4th and 5th hours postoperatively and there was statistical significant difference at 2nd, 3rd, 4th and 5th hours postoperatively between exposed (BT) and non-exposed (BA) groups (p<0.001). The duration of anesthesia was effectively prolonged in group BT (245.33 ± 22.854 minutes) compared to group BA (135.00 ± 21.735 minute) (p<0.001). Conclusion and Recommendation: This study showed that intrathecal tramadol (20 mg) can safely be used along with bupivacaine in subarachnoid blockade to prolong the duration of analgesia. We recommend the use of intrathecal tramadol additive for effective post-operative analgesia for cesarean section.
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    Assessment of Predictors for Difficult Intubation and Laryngoscopy in Adult Elective Surgical Patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2019
    (Addis Ababa University, 2019-06) AlemayehuTamirat; Sitot Mulualem; Tesfaye Siryet
    Background: General anesthesia is not without Morbidity. One of the well-known life threatening events associated with general anesthesia is difficult airway which can happen during induction of anesthesia while attempting to insert the endotracheal tube with the aid of laryngoscope. Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation Objective: The main objective of this study was to assess predicators for difficult laryngoscopy and intubation, among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation in Tikur Anbessa Hospital from February 4 to March 29, 2019 Materials &methods: After the Ethical Committee approval, Institutional based cross sectional study was be conduct from February 1 to March 30, 2019 on patients submitted to TASH major operation room undergoing surgery under general anesthesia with endotracheal intubation (ETT). Patients were evaluated during preanesthetic bed side tests on the Mallampati classification, and the American Society of Anesthesiologists (ASA) difficult airway algorithm .Data on socio demographic characteristics, preanesthetic airway assessment & laryngoscopic view was collected. Data were analyzed by SPSS Version 20.0 window. In the study population. Descriptive as well as analytic statistics was used for variables and data presented by tables, graphs, charts, and texts. Independent variables with the dependent variable; was analyzed by using chi- square test, , binary logistic regression, and ROC curve were performed and p value less than 0.05 was taken as strong association Results; The magnitude of difficult laryngoscopy, difficult intubation, and failed intubation are 15.2%, 6.1%, and 0.07%, respectively. IID < 30mm and Mallampati classes III and IV are the most sensitive tests and to predict difficult intubation and laryngoscopy (value < 0.001).Unrestricted multiple attempt increases further difficulty of airway management ( value < 0.001) Conclusion and recommendation: In spite of various airway assessment tests, no single test was 100% accurate. We would like to recommend anesthesia professionals to use the combination of as their routine preoperative tests to predict difficult laryngoscopy and intubation.
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    Comparison of Intravenous Magnesium Sulphate and Lidocaine for Attenuation of Cardiovascular Response to Laryngoscopy and Endotracheal Intubation in Elective Surgical Patients at Zewditu Memorial Hospital Addis Abeba ,Ethiopia2018/2019.
    (Addis Ababa University, 2019-06) Misganaw Abebaw; Sitot Mulualem; Jemal Suliman
    Background: Laryngoscopy and endotracheal intubation are essential components of general anesthesia. But it is always associated with side effects called reflex cardiovascular responses. Many methods have been identified to attenuate these responses like intravenous lidocaine, deep inhalational anesthesia, vasodilators, intravenous magnesium sulphate even though therapeutic superiority remains understudied Objective: To compare the effectiveness of intravenous lidocaine and magnesium sulphate for attenuation of cardiovascular responses after laryngoscopy and endotracheal intubation in elective surgical patients at Zewditu memorial hospital. Methods: An institutional based cohort study on 112 adult patient age between 18-60 years was applied. 37 patients in non-exposed group (Group N), 37 in lidocaine group (Group L) and 38 in magnesium sulphate (Group M) were included. The hemodynamic parameters like HR, SBP, DBP, and MAP at various time points up to 7 minutes post-intubation were recorded and effect of both drugs to reduce hemodynamic responses was compared. Parametric data were analyzed using (ANOVA) and nonparametric data using Kuruska-Wallis H rank test. Results: In all three groups, there was statistically significant rise in heart rate and blood pressure from baseline. There was statistically significant difference in mean heart rate throughout study minutes among the groups (p<0.001). However there was no statistically significant difference in mean heart rate between Groups M and L at all post intubation time intervals.In blood pressure at all three parameters there was statistically significant difference among groups at all-time points except no difference at 7th minutes in DBP. There was significantly lower blood pressure in group M compared to both groups. Conclusion and Recommendation: In conclusion prophylactic administration of magnesium sulphate and lidocaine were effective in attenuating haemodynamic responses to the stress effect of laryngoscopy and intubation but magnesium sulphate is better than lignocaine. We recommend that magnesium sulphate as alternative of lidocaine in attenuating hemodynamic response to laryngoscopy and intubation
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    Magnitude and Associated Factors of Failed Spinal Anesthesia in Cesarean Section at Addis Ababa Governmental Hospitals, Ethiopia.
    (Addis Abeba University, 2019-06) Bekele Zenebe; Sitot Mulualem; Tesfaye Siryet
    Background: Nowadays use of spinal anesthesia is the preferred anesthesia technique for cesarean section because it avoids air way related complication. But sometimes failed spinal anesthesia occurred and expose patient for pain and discomfort. Objective: To assess magnitude and associated factors of failed spinal anesthesia in a mother underwent cesarean section at Addis Ababa governmental hospitals, Ethiopia from December 2018- May 2019. Methods: An institutional based cross sectional study was conducted on 794 mothers who fulfilled inclusion criteria for elective and emergency cesarean section under spinal anesthesia at selected Addis Ababa governmental hospitals, Ethiopia from December 2018 – May 2019. Data collection methods include patient interview, chart review and observation of spinal anesthesia procedure were employed for data collection. Collected data were entered in Epi info version 7 and analyzed using SPSS version 20. Independent variables with the dependent variable were analyzed using logistic regression. A p-value of <0.05 was considered as cutoff point to test for statistically significant. Result: Magnitude of failed spinal anesthesia in this study was 15.2% (121/794). Experience of the anesthetist <1 (AOR 4.12, 95%CI, 2.47-6.90), patient position (AOR=14.43,95%CL; 2.6578.61)number of attempt > 1 (AOR;=9.26 , 95% CI; 5.69-15.01), bloody CSF (AOR=6.37,95%CI; 2.90-13.96), BMI ≥30kgm2 (AOR=2.03, 95%CI; 1.12-3.68) and dose of bupivacaine <10mg (AOR; 2.72, 95% CI; 1.33-5.53) were significantly contributed for failed spinal anesthesia in this study. Conclusion and recommendation: Magnitude of failed spinal anesthesia in Addis Ababa governmental hospitals was high. Anesthesia professionals should know all possible factors and develop strategy to overcome the problem, and use of adjuvants should be a daily practice for anesthetist.
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    Magnitude and Associated Factors of Postoperative Hyperglycemia among Adult Patients who Underwent Elective Surgery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2020.
    (Addis Abeba University, 2020-06) Desalegn Mitiku; Sitot Mulualem; Getachew Lemlem
    Background: Patients with post-operative hyperglycemia develop complications like surgical site infection, delayed wound healing and increased length of hospital stay. However, hyperglycemia in postoperative period remains high in surgical patients. This study assessed the magnitude andassociated factors of hyperglycemia in postoperative period among adult patients who underwent elective surgery at Tikur Anbessa specialized hospital, Addis Abeba. Method: Institutional based cross-sectional study was conducted among 282 adult patients that underwent elective surgery at Tikur Anbessa specialized hospital from January 1 to March 30, 2020. Systematic random sampling technique was used and quantitative data were collected by pre tested questionnaire through interview and data retrieval from chart. Both bivariate and multivariable logistic regression analysis were done to evaluate the association between independent and dependent variable. Level of statistical significance was declared at p-value less than 0.05. Result: This study revealed that 126(44.7%) of patients developed postoperative hyperglycemia.Age group of 41-60 AOR=11.2.; 95%CI :( 2-24.5) and age group >60 AOR=12.3; 95%CI :(4.5-33.3), ASA class III AOR=6.3; 95%CI :( 1.4-27), General anesthesia AOR=5.6; 95%CI :(1.3-24), History of hypertension AOR=8.4; 95%CI :( 1.26-47) showed statistical association with post-operative hyperglycemia. Conclusion and recommendation: Magnitude of hyperglycemia is higher in postoperative period. Age, ASA class, type of anesthesia and history of hypertension were identified predictive factors. Anesthesia and surgical staffs must develop local protocol or adopt protocol to treat postoperativehyperglycemia and factors associated with post-operative hyperglycemia should be identified a head of surgery.
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    Magnitude of Perioperative Hypothermia and Associated Factors of Intraoperative Hypothermia in Patients 18 years and above who Undergo Elective Operation at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2017
    (Addis Abeba University, 2017-06) Sitot Mulualem; Admasu Wosenyeleh
    Background: Body temperature is a vital sign and 37°C is the mean core body temperature of a healthy human. Core body temperature is normally tightly regulated and maintained within narrow range. Perioperative hypothermia is one of the major problems during surgery and anesthesia that can affect operated patients. Objective: to assess the magnitude of perioperative hypothermia and associated factors of intraoperative hypothermia in patients undergoing elective anesthesia and surgery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from March 6 - May 12, 2017. Methods: institutional based cross sectional study was conducted on 265 patients 18 years and above who undergo operation at Tikur Anbessa Specialized Hospital, Addis Ababa,Ethiopia from March 6 - May 12, 2017.Patient interview, chart review and temperature measurement was employed for data collection. Collected data was analyzed using SPSS version 20 window. All Independent variables with the dependent variable, hypothermia, were analyzed using binary logistic regression. A p-value of <0.05 was considered as cutoff point to test for statistically significant. Result: The overall magnitude of preoperative, intra and post operative hypothermia in this study was 16.2%, 53.2% and 31.3%, respectively. Age >65 years (AOR=7.15, 95% CI,1.16, 43.99), coexisting illness (AOR, 3.32, 95% CI, 1.06; 10.36), preoperative hypothermia(AOR; 57; 95% CI; 7.1, 455.4), operation room temperature <23 oc (AOR=1.91; 95 % CI,1.04; 3.5) and >2 liter cold crystalloid fluids administered (AOR; 2.3; 95% CI, 1.07, 4.9)were found to be factors associated with intraoperative hypothermia. Conclusion and recommendation: The magnitude of intraoperative hypothermia is high in Tikur Anbessa Specialized Hospital. Anesthesiaprofessionals should warm crystalloid fluids before administering and the operation room temperature should be kept at least aboveo23 c.For Administrators and other stakeholders of Tikur Anbessa Specialized Hospital, we recommend to consider ways to make OR and PACU temperature controlled rooms for better health care.
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    Prophylactic Effect of Sub Hypnotic dose of Propofol in the Prevention of Intraoperative Post-Delivery N ausea and Vomiting in Mothers Undergoing Elective Caesarean Section Under Spinal Anaesthesia at ALERT Referral Hospital, Addis Ababa, Ethiopia, 2020,a Prospective Cohort Study.
    (Addis Abeba University, 2020-06) Bayisa Adane; Seifu Ashenafi ; Sitot Mulualem ; Tesfaye Siryet
    Background: Post-delivery Nausea and vomiting is one of the most common and unpleasant events affecting parturients undergoing caesarean delivery under spinal anaesthesia. It causes Parturient discomfort, it interferes with surgery, elevates the risk of bleeding as well asincreasing the risk of pulmonary aspiration. Objective: To assess the prophylactic effects of sub hypnotic dose of propofol in preventing the occurrence and severity of post-delivery nausea and vomiting in parturients who underwent elective Caesarean Section under Spinal Anaesthesia Methods: A prospective cohort study was done at Alert Referral hospital on 62 Parturients who came for elective caesarean section under spinal anaesthesia by using systematic random sampling method. Incidence of nausea and vomiting, severity of nausea and use ofrescue anti emetic were assessed. Distribution of numerical data analysed using Shapiro Wilk test. Independent t-test and Mann Whitney U test were used to compare symmetric and asymmetric data, respectively. Categorical variable between two groups were analysed using Chi Square or fisher exact test as appropriate. P value <0.05 was considered as statistically significant. Result: The incidence of PDNV was significantly lower in the propofol group when compared to non-propofol group the first 10 minutes post-delivery period (41.9% vs.74.2%) (P =0.01). The severity of nausea was statistically greater in the non propofol group compared to propofol group (32.3% in non propofol group experienced moderate nausea versus 3.2%) in the propofol group (p=0.006) and severe nausea was (0% Vs 22.7%, p=0.11)Less Intraoperative rescue antiemetic metoclopramide consumption was observed in sub hypnotic propofol group compared to non-propofol group. The median rescue ant emetic consumption was 10 mg in non-propofol group and 0 mg in propofol group (p<0.001). Conclusion and recommendations: Administration of prophylactic sub hypnotic dose of propofol (20 mg IV bolus) after delivery of the baby and clamping of the umbilical cord was effective in the prevention and immediate treatment of post-delivery nausea and vomiting and reduce need for Intraoperative rescue antiemetic for parturients undergoing elective caesarean section under spinal anaesthesia. The researcher recommend the use of prophylactic intravenous sub hypnotic dose of propofol(20 mg) for parturients undergoing elective caesarean section under spinal anaesthesia for the prevention of Intraoperative post-delivery nausea and vomiting.
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    The Prevalence of Frailty and its Associated Factors among Preoperative Elective Elderly Surgical Patients in Selected Referral Hospitals, Addis Ababa, Ethiopia, 2023/2024: A multi-center cross sectional study.
    (Addis Ababa University, 2024-06) Akanie Semalign; Sitot Mulualem ; Fentie Fissiha
    Background: Frailty is a phenotype that identifies people with reduced physiological reserve in multiple organ systems. The prevalence of frailty in surgical patients ranges from 4.1% to 50.3%.Frailty can leads to infection, increase healthcare intervention and hospitalization in elderly surgical patients. Thus preoperative identification of factors causing frailty is critical for determining patient suitability for surgery. Objectives: To assess the prevalence of frailty and its associated factor in preoperative elderly surgical patient at Addis Ababa referral hospitals, Ethiopia from February –April 2024. Method: A multi-center cross sectional study was conducted on 422 elderly surgical patients in selected referral hospitals in Addis Ababa, Ethiopia from February-April 2024. The data was collected after obtaining consent, and the study participants were chosen using a method of systematic random sampling. Data was checked, coded, entered, and analyzed by using Statistical Package for Social Science version 26. Multinomial logistic regression analyses were performed to identify a statistically significant association between the independent and dependent variables. Finally, variables are significant when their p-value is less than 0.05. Result: The prevalence of frailty and pre-frailty in elective elderly surgical patients was 23.7%(95% CI: 19.7% to 28%) and 35.1% (95% CI: 30.5% to 39.8%), respectively. Sex (AOR: 2.326,95%CI: 1.112–4.863), age (AOR:2.308, 95%CI:1.120–4.574), depression (AOR:2.747,95%CI:1.295–5.826), presence of more than two coexisting disease (AOR:9.049, 95%CI:1.633–50.147) and use of more than two medications (AOR:7.320, 95%CI:1.884–28.450) were found to be significantly associated with frail and sex(AOR:1.733, 95%CI 1.034-2.906)and residence(AOR:1.996, 95%CI:1.162–3.429) were found to be significantly associated with pre-frail Conclusion and recommendation: More than 1/5th of surgical patients were frail, and more than 1/3rd of surgical patients were pre-frail. Patient age, sex, depression, the presence of co-existing disease, and medication usage were identified factors of frailty. Pre-frailty, on the other hand, was linked to patient sex and residence status. Early assessment and pre-rehabilitation of elective elderly surgical patients with depression, coexisting disease and those who uses more than two medications, before surgery is recommended and may lead to a good surgical outcome.