Anaesthesia and Anaesthesiology

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Patterns of Admission and Mortality of Patients Admitted to Surgical Intensiv Care of Tikur Anbesssa Specialized Teaching Hospital
(Addis Abeba University, 2014-08) Alferid, Fetiya; Assefu, Manekuleh (PhD)
Critical patient have been admitted to SICU throughout the year since its establishment in the yr. However there is no study up to date that was done to determine admission pattern and outcome of patients. With only six beds at hand and establishment of the new ICU, it’s essential to know which patients are being admitted and their outcomes. Thus the aim of this study is to describe type of patient admitted to SICU of TASTH and their outcome. Back Ground TASTH is one of the largest referral and teaching hospital in Ethiopia accommodating referred patients from all over the country. SICU of TASTH is one of the two public SICU in Addis Ababa and the only ICU for neurosurgical patients. SICU admits more than 200 patients per year with only six beds at hand. [1] Not many researches could be found about the characteristics and mortality of patients admitted to SICU. Objectives The main objective of the study these study is to describe the characteristics and mortality of patients admitted to SICU of TASTH. Methodology Retrospective Descriptive Observational study of all patients admitted to SICU of TASH from Meskerem 1, 2005 to Paqume 5, 2005.[September 11,2012 to September 10,2013] Result The highest percent of admission was postoperative followed by respiratory compromise and circulatory compromise. Patient admitted to SICU ranged from 1 to 89 years of age with the median age being 30 the average age at admission was 33.3. There were higher admission rate of male than female (40.1% and 59.1% respectively). Majority of patient were from AA with 43.8% then Oromia 30.3 the SNNP 12.6%. Highest admission was observed from patients in neurosurgical department accounting 32 %. Cardiothoracic also have high admission 29% but low mortality (3%) in the SICU. The mortality rate was 31.5% .The average SICU stay in our study was 5.76 days. Of 30.9% cases which were trauma related RTA accounted for 15.2% of the patient followed by assault 6.2% and fall down 4.5%. From these trauma patients 40% of RTA patient had concomitant pneumonia and 48% of RTA patients died (13 out of 27). Mechanical ventilator was used by 28.1 % of the patients’ during their SICU stay. Average da spent on mechanical ventilator by these patients was 1.9 with minimum 1 to maximum of 45 days .Ceftriaxone is the commonest antibiotic prescribed. CONCLUSION There is poor documentation and chart keeping with many cards missing. There is no proper guideline on admission criteria which should be organized and utilized. Mechanism like computerization of data records should be used to avoid missing or losing of charts. A person should be assigned on for making sure proper monitoring of documentation should be there. Many researches have to be done to improve the outcome of patients in ICU as well as to look for gaps in patient management. Much work has to be done in setting up new ICU in the other regions and even in Addis Ababa. There should be center for control of antibiotic resistance and much more study needs to address of antibiotic usage in TASTH Work Plan and Budget The study was conducted from August to October 2014. The total cost of the study will be 8,891.00birr
Assessment of Work Related Stress and Associated Factors among Anesthetists in Addis Ababa Governmental and Private Hospitals
(Addis Abeba University, 2014-08) Kolcha, Mitiku; Adimassu, Wossenyel( MSC Lecturer of AAU)
Background Anesthetists are prone to stress due to the nature of job and responsibility of patient situations in perioperative .High levels of stress are believed to affect anesthetists' health and performance. . If the stress is not dealt with effectively, feelings of loneliness, nervousness, sleeplessness and worrying may result .Stress is the main problems that impends to delivery quality anesthesia care in our set up, Stress is unavoidable but is not all bad. Too little stress leads to sleep, boredom and increase concentration, whereas too much stress gives us a sense of panic and tension. Acute and chronic stress is the most common form of stress in anesthetists their profession. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future, such as their job of providing anesthetics or attending patient perioperative. Objectives of this study to assesses the prevalence of stress and associated factors upon anesthetists in AA. Methods is cross-sectional quantitative was chosen in the duration of February to May 2014. PSS(perceived stress scale structured questionnaires was developed and primary data collected from AA anesthetists. Results Two hundred four anesthetists were participated in study . The response rate of the study was 97.3%, their age ranged from 20 to 59 years . The majority were male: 115(56.4%). Study participant of 51%( N=204) with 95%CI(0.44 to0.578%) become stressed Conclusion, More than half of the anesthetists in Addis Ababa governmental as well as private hospital have defined work related stress. Statistically significant associated factors such as:- Watching football games TV/DSTV(movies), greater than 15days night duty per month, automatic mechanical ventilation non function at all, excessive physical and mental workload, complexity of the task, responsibility of the patient with ethical decision and fear of harming patient, mostly dissatisfaction on profession .
Knowledge, Attitudes and Perceived Barriers on Postoperative Pain Management Among Anesthetists’ in Addis Ababa Government Hospitals, Addis Ababa- Ethiopia 2015
(Addis Abeba University, 2015-07) Tibebu, Yosef; Melese, Eyayalem (PhD)
Background: Postoperative pain (POP) is a common postoperative problem after surgical procedure worldwide. Despite advanced development and understanding of pain physiology and perception, many literature pointed out that patient are experiencing needless suffering of post surgical pain. Undertreated and uncontrolled postoperative pain reduce physical and social performance, impaired quality of life and patient dissatisfaction, delayed discharge, increase use of health care resources and its associated high cost during their stay in hospital. There are many potential barriers to adequate postoperative pain management have been cited by literatures includes lack of health professional knowledge, negative attitudes as a result of poor or absence of training and education system. Purpose: This study aimed to assess knowledge, attitude, and perceived barriers regarding postoperative pain management among anesthetists‟ in Addis Ababa Government Hospitals, Ethiopia 2015. Methods: A cross- sectional descriptive questionnaire survey was administered to anesthetists who were working in 11 AAGH. Questionnaire items covered knowledge, attitude, perceived barriers, and the participant‟s opinions on barriers to POPM. A total of 150 questionnaires were distributed and 102 participants were analyzed with response rate 68%. The statistical significant level was set at p< 0.05 statistical analysis were performed using SPSS version 20 software package. Results: The mean score of correctly answered questions by the participants were 4.9 with standard deviation ±2.3 out of 12 items ranging from a minimum of 1 to a maximum of 11. There was significant knowledge difference among anesthetists‟ in their academic level. The mean number of correct responses provided by Msc holders was higher than Bsc and diploma holders at 6.9, 4.7, and 4.4 respectively. Only 6.9% of participants were knowledgeable. Conclusion: The overall knowledge deficit of anesthetist‟ was found. An effective educational strategy for surgical pain management is needed in order to improve health professionals‟ knowledge and clinical practices
Maternal Satisfaction after Spinal Anesthesia for Cesarean Delivery
(Addis Abeba University, 2015-07) Belay, Dessalegn; w/yohannes, Misrak (PhD)
Background: Spinal anesthesia for caesarean section is an old and well established method. It was first used in obstetrics in 1901 for pain relief during vaginal delivery and also became popular for caesarean delivery because of its rapid onset and a high frequency of successful blockade. Even if spinal anesthesia for cesarean section has become increasingly popular and the recent decade has been the preferred technique for the majority of anesthetists, Patient satisfaction toward spinal anesthesia is vital monitor to the quality care in anesthesia. Objectives: To determine patients' perspective regarding spinal anesthesia, their level of satisfaction and the factors of dissatisfaction during caesarean deliveries at Gandhi Memorial hospital Addis Ababa , Ethiopia from March20 -May30, 2015. Methodology: Cross-sectional study of 175 patients who underwent caesarean section under spinal anesthesia at Gandhi Memorial hospital from March20- May 30,2015. post-operative survey of patients on the day after surgery(24hours) was conducted by collecting pre-operative , intra-operative and Post-operative data, on a constructed questionnaire ,data was transported to SPSS version 20 for further analysis. data was analyzed by binary regression; all factors to identify what factors and to what extent those factors influence overall satisfaction. Results: A total of 175 patients were incorporated in the study. The distribution of cases on the basis of age groups it was found that majority of the patients 113(64%) were aged between 25 and 34years. The overall satisfaction of spinal anesthesia divided into108 (62%) of patient was satisfied an 67(38 %) of the patient was dissatisfied. Furthermore, 143( 82 % ) patients would opt for spinal anesthesia in future for similar surgery, if required; 32( 18% )of patient would not. The reasons for refusal to receive spinal anesthesia were as follows: fear of complication like headache, backache and, awareness during operation and baby sound. Conclusion and recommendations: patient compliant(backache, nausea/vomiting, headache and pain), inadvertent mistakes and unskillful techniques, can negatively affect patient perspectives about spinal anesthesia. Some factors which can increase the satisfaction rate of patients who are undergoing a surgery with spinal anesthesia are as follows; a patient’s opinion is very important when deciding the anesthetic method ,the anesthetists must provide complete explanations regarding spinal anesthesia before surgery and the anesthetists should have good rapport with their patients. Finally, the anesthetist should manipulate the patient skillfully and sedate the patients if they wish. Keywords: spinal, anesthesia, patient satisfaction, caesarean section
Patients’ Knowledge and Attitude Towards Anesthesia in Tikur Anbesa Specialized Hospital in Addis Ababa, Ethiopia
(Addis Abeba University, 2015-07) Bulti, Naod; Admasu, Wosenyeleh (PhD)
Background: In Ethiopia, anesthesia as a discipline and anesthetist as a professional is not well recognized by the public. In studies done in around the world, the public knowledge of the anesthesia a discipline and is lower compared to other medical discipline. Objectives: The objective of this study was to determine patients‟ knowledge and attitude towards anesthesia in Tikur Anbesa specialized Hospitals, Addis Ababa, Ethiopia from March 30- June 11, 2015 G.C Method: The study was conducted in Tikur Anbesa Specialized Hospital. An analytic cross- sectional study design was followed from March 30- June 11, 2015 G.C. All adult elective patients in Tikur Anbesa Specilaized Hospital during the study period were used as a sample. Results: Ninety two percent (92%) of the patients believed that anesthesia is necessary for surgery and 79% of patients responded that a surgeon decides if a patient is fit for anesthesia. Sixty eight percent (68.2%) had poor knowledge & attitude towards anesthesia with a mean score of 9.98. Conclusion: Despite surveys on the overall knowledge & attitude of patients overseas also shows poor results, in our study it is much more significant number of patients who had poor knowledge & attitude.
Job Satisfaction and its Determinants Among Anesthetists at Government Hospitals of Addis Ababa, Ethiopia,2015
(Addis Abeba University, 2015-07) Kassahun, Blen; Akalu, Leulayehu (PhD)
Back ground: Job satisfaction is defined by how employees feel about their jobs and different aspects of their jobs. It is a crucial variable used to determine the quality of health-care systems. The work environment for Anesthetists has some unique and stressful ergonomic factors Thus to achieve a higher level of job satisfaction among Anesthetists, it is necessary to identify and improve some essential work climate characteristics. Objective: To determine the level of job satisfaction of anesthetists working in government hospitals of Addis Ababa and factors affecting their level of satisfaction. Methodology: Institutional based cross-sectional study design was conducted on 101 anesthetists working in Addis Ababa governmental hospitals from April 1 to May 1, 2015. Simple random sampling method was used to obtain the study participants. Data were collected using a structured questionnaire, and analyzed using SPSS, version 20. Descriptive and inferential statistical analyses were employed. Data were summarized using graphic presentations for the interpretation of findings. Associations for statistical significance were assessed using the ‘chi square’ test of association. P-values less than 0.05 were considered as statistically significant. Results: Out of 101 anesthetists who responded for the self administered questionnaire.57% are male and 43% are female. The majority of respondents are below the age of 30 years (58.4%) & more than half (59.4%) of the respondents were single. 53% of the respondents were satisfied and the highest dissatisfaction rate was in the age group of below thirty. There was no association between job satisfaction and socio demographic variables. However, satisfaction in helping others, responsibilities, and freedom to choose method of working were significantly associated with job satisfaction. Conclusion and recommendations: as the finding of this study 53% anesthetists were satisfied and the major reasons for dissatisfaction were lack of public awareness about the role of anesthetists and low salary.Therefore, improving satisaction level of anesthetist by solving major reasons of dissatisfaction are strongly recommended
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.
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
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
The Prevalence and Risk Factors of Post Spinal Hypotension Among Pregnant Mothers who Delivered by Elective Caeserean Section from January to February At Gandhi Memorial Hospital, Addis Ababa, Ethiopia. Cross Sectional Study Design.
(Addis Abeba University, 2016-06) Nigussie, Ashebir; Admasu, Wosenyeleh (PhD)
INTODUCTION: - Hypotension is a 20% to 30% reduction in systolic blood pressure, comparing it to initial values or absolute systolic blood pressure values between 100 mmHg and 90 mmHg. Hypotension during spinal anesthesia for cesarean section is one of the most common complication which decreases uteroplacental perfusion. OBJECTIVES: - To assess incidence and risk factors of post spinal hypotension among pregnant mothers who delivered by elective cesarean sections from January to February 2016 at Gandhi Memorial Hospital, Addis Ababa. METHODS: - Institution based cross sectional study design was conducted. All list of pregnant mothers who gave birth by elective cesarean section under spinal anesthesia at Gandhi Memorial Hospital were included. Training was given for data collectors and supervisors. Regular supervision and follow up made. Data was entered in to Epi info version 7 software and transported to SPSS version 20 for analysis. Odd ratio and 95% confidence interval was computed. Bivariate and Multivariate analysis used to identify factors associated with hypotension. RESULTS: - The study was conducted on 60 study participants. 24(40%) were equally found between 25-29 years and 30-34 years. The incidence of hypotension was 80% during five to fifteen minute and 83% during fifteen to twenty five minute. 70% of the study participants were preloaded with more than 500ml of crystalloid and 60% were took oxytocin for uterine contraction. Majority of them were positioned in supine position prior to spinal anesthesia. CONCLUSION AND RECCOMENDATION: -The incidence of hypotension was high so that vigorous fluid resuscitation and the use of prophylactic vasopressor were recommended. Keywords: hypotension, pre-loading, spinal anesthesia
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.
Assessments of the Magnitude of Post Dural Puncture Headache (PDPH) and Associated Risk Facrors with Pdph Among Patients Undergoing Spinal Anesthesia for Orthopedics and Urologic Procedures in Black Lion Specialized Referral Hospital, Addis Abeba, Ethiopia
(Addis Abeba University, 2016-06) Tafesse, Dawit; Akalu, Leulayehu (PhD)
BACKGROUND: Although modern anesthesiology has made great progress in the last decades, Neuraxial anesthesia (NA) is still the keynote of regional blockade. It is popular for its effectiveness in producing anesthesia and analgesia with neuromuscular paralysis. As the NA techniques are used popularly in clinic and Hospital, Post Dural Puncture Headache (PDPH), a common iatrogenic complication resulted from post-spinal taps or accidental Dural puncture subsequent to epidural block, is frequently reported and becomes a challenging to health caregivers. Although the problem has been widely reported verbally by the patients, its magnitude and associated factors are not well being studied in our country. The aims of the study were to assess the magnitude of Post Dural Puncture Headache (PDPH) and associated risk factors with PDPH among patient who underwent spinal anesthesia for orthopedic and urologic procedures in Black Lion Specialized Referral Hospital, Addis Ababa, Ethiopia. From February 15 to March 15, 2016 G.C METHODS AND MAERIALS: An institutional based Cross Sectional study, was conducted from February 15 to March 15, 2016 G.C in Black Lion Specialized Referral Hospital, Addis Ababa Ethiopia. And a total of 76 consecutive patients undergoing SA aged 17–75 was participated in the study. Those independent variable that were significant on binary logistic regression at P < 0.2, were analyzed on multivariate regression, and considered significant association with PDPH at P value < 0.05. RESULT: Out of 76 patients undergoing SA for orthopedic and Urologic Procedures; the prevalence of PDPH was 33%. Among patients who develop PDPH; 54% of the patients reported moderate pain while 44% experience mild PDPH. The number of spinal attempt was significantly related (P-value .000, AOR 0.002; 95%CI; 0.000 - 0.03) to PDPH while sex, BMI and Age of the patient was not found significantly related to PDPH with P-values of (0.618, 0.529 and 0.72) respectively. CONCLUSION AND RECOMMENDATION: The incidences of Post Dural Puncture Headache was found to be higher (33%) in Black Lion Hospital. The hospital management and the anesthetists in the hospital should minimize the magnitude of PDPH by avoiding use of big and traumatic needle (22G Q-needle) and repeated spinal attempt (> 2 attempt. Key Words: Post Dural Puncture Headache, Spinal Anesthesia, Quincke Needle
Magnitude and Predictive Values of Preoperative Tests for Difficult Laryngoscopy and Intubation Among Surgical Patients who Underwent Elective Surgery Under General Anesthesia in Tikur Anbessa Specialized Hospital From February1 to March 30, 2016
(Addis Abeba University, 2016-06) Tamire, Tadese; Admasu, Wosenyeleh (PhD)
Introduction: The significance of difficult or failed tracheal intubation following induction is well-recognized cause of morbidity and mortality in anesthetic practice. Nevertheless, the need to predict potentially difficult tracheal intubation has received a little attention. During routine anesthesia the incidence of difficult tracheal intubation has been estimated at 1.5% - 8% of general anesthetics. Difficulties in intubation have been associated with serious complications, such as brain damage or death, particularly when failed intubation has occurred. Occasionally in a patient with a difficult airway, the anesthetist is faced with the situation where mask ventilation proves difficult or impossible. This is one of the most critical emergencies that may be faced in the practice of anesthesia. If the anesthetist can predict which patients are likely to prove difficult to intubate, he/she may reduce the risks of anesthesia considerably. In Ethiopia there is no data on the magnitude of difficult laryngoscopic tracheal intubation and no standard guideline for preoperative tests.The main concern of this study was to provide information on the magnitude of difficult laryngoscopic intubation and to determine valuable preoperative tests to predict difficult laryngoscopy and intubation in patients with apparently normal airways which can help anesthetists to improve preoperative airway assessment and contribute to decrease anesthesia related morbidity and mortality. Objective:The main objective of this study was to assess the magnitude and predictive values of preoperative tests for difficult laryngoscopy and intubation, among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation in Tikur Anbessa Hospital from February 1- March 30, 2016. Study design: A facility based cross sectional study design was used. Result:In this study, we found the magnitude of difficult laryngoscopy and intubation as 13.6% and 5% respectively. 33.3% of Patients with difficult laryngoscopy were found to be difficult for intubation. Mallampatti test, interincisor distance and thyromental distance were identified to be good preoperative tests to predict difficult laryngoscopic intubation when used in combination. Recommendation: We recommend anesthesia professionals to use combination of MMC/TMD/IID for their routine preoperative airway assessmen
Magnitude of Case Cancellation and Associated Factors Among Elective Surgical Cases in Tikur Anbesa Specialized Hospitalhospital, Addis Ababa, Ethiopia, 2016
(Addis Abeba University, 2016-06) Shiferaw, Addis; Weldeyohannes, Misrak (PhD)
BACK GROUND: Elective surgical case cancellation refers to any elective surgical case that is booked into the operation theatre list on the day prior to surgery, but is not operated upon as scheduled. Elective surgical case cancellation is common and can have significant adverse effects. The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. Reasons for cancellations are complex because they are related to patients, organizational issues, and clinical staff. OBJECTIVE: To assess magnitude of case cancellation and reasons for case cancellation among elective surgical cases in Tikur Anbesa specialized hospital from February 1 to March 1, 2016 G.C. METHODS: A cross sectional study design was conducted. All elective surgical cases were included in the study. Data was collected by using pretested structured questionnaires and entered in to SPSS version 20 for analysis and cleaning up. P=0.05 value and/95% C.I was used to judge significant of association. The result of study was explained by narratives, tables and graphs. RESULTS: During the study 369 patients were scheduled for elective surgical operations, 244 (66.1%) patients were operated on their planned date and 125 (33.9%) operations were cancelled. The mean age was 27.9 ± 19.3 years, with male to female ratio of 1.67:1. The main reasons for cancellation were shortage of time related (39.2%), management related (21.48%) and patient related (20%) CONCLUSION: Cancellation of elective surgical procedures on the scheduled day of surgery was high during the study. Most of the reasons were shortage of time and management related and patient related were the least reason. Most of the reasons were avoidable. RECOMMENDATION: Implementation of patient preoperative assessment should be applied. A team approach ensuring presence of policies and procedures for improving and ensuring realistic scheduling of patient lists, reducing time spent preparing and cleaning the operating room and better handling resources should be applied
The practice of labor analgesia and its perceived Barriers Among Health Care providers Working in public Hospitals of Addis Ababa, Ethiopia
(Addis Abeba University, 2016-06) Mulugeta, Hailemariam; Weldeyohannes, Misrak (PhD)
Background: Almost all women experience moderate-to-severe pain during labor which adversely affects parturient and fetuses. Authorities in the fields of obstetrics and anaesthesia encourage use of labour analgesia. The practice of labor analgesia in Africa is not a well-established service, especially in the low- income countries like Ethiopia. The goal of this study was to assess the practice of labour analgesia and its perceived barriers among health care providers working in public hospitals of Addis Ababa, Ethiopia. Methods and materials: Institutional based cross sectional study was conducted in four public hospitals of Addis Ababa. Cluster sampling technique was used to select the public hospitals. All of the healthcare providers who are supposed to be involved in the management of labor pain in the clustered hospitals were included. Pretested structured questionnaires were used to collect data with regular supervision and follow up. Data was entered in to epi info-7 and analyzed with SPSS-20 statistical software. Results were presented using narratives, graphs, tables and charts. Conclusions were drawn by means of simple percentages and inferential statistics using binary logistic regression, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. Results: Of the 177 respondents, 81 (45.8 %) Anesthetists, 61 (34.5%) Midwives, 26 (14.7%) Obstetricians/gynecologists, and 9 (5.1%) Anesthesiologists were involved. About 54.2% practitioners offered any form of labor analgesia. Among these, only 1(0.6%) offered it routinely, 42 (23.7%) sometimes and 53 (29.9%)on maternal request. Eighty-one respondents (45.8%) never practiced labor analgesia. The commonest pharmacological labor analgesia used were opioids (35.6%). The major reasons adduced for not offering labor analgesia routinely or not at all were; non-availability of drugs and equipment (59.9%), lack of emphasis towards labor pain management by health service management system (44.1%), shortage of skilled man power (38.4%), and fear of fetal distress to administer systemic analgesics (33.3%). Conclusion and Recommendations: The routine practice of labor analgesia by healthcare providers was very low in the study facilities. There is need for team work by all the stakeholders in the health sector and the government to step up its use, and make childbirth a more fulfilling experience for laboring mothers. Key words: labor, pain, analgesia, practice, barriers
Magnitude and Associated Risk Factors of Post Operative Sore Throat Following Surgery by General Anesthesia with Endotracheal Intubation in Black Lion Hospital, Addis Ababa, Ethiopia
(Addis Abeba University, 2016-06) Mengistu, Birhanu; Akalu, Leulayehu (PhD)
Background: A complaint of postoperative pharyngeal discomfort is so prevalent that it is almost expected by patients and anesthetist alike as an unavoidable part of routine anesthesia. Complaints range from a minor throat irritation to debilitating pain, inability to swallow and temporary voice changes, and are a frequent observation on the postoperative visit. There is no data regarding the magnitude of post-operative airway complications and their associated risk factors in Ethiopia. Objective: The purpose of this study is to assess the magnitude and possible associated risk factors for postoperative sore throat following surgery by general anesthesia with endotracheal intubation. Methods and materials: Institutional based crossectional study design was conducted in Black Lion Hospital Addis Ababa, Ethiopia from February 1-30, 2016 in patients aged 18 years and above who underwent surgery under anesthesia with endotracheal intubation using structured questionnaire prepared on variables being measured. Bivariate analysis and binary logistic regression was used to measure association between dependent and independent variables. Pvalue 0.05 was used as cut off point. Results:Out of 114 patients who had elective surgery by anesthesia with endotracheal intubation, 52(45.6%) of the study participants complained of various forms of post-operative throat complaints. In this study it was found that size of ETT showed statistically significant association with the post-operative sore throat with p-value 0.001, (AOR- 0.214, 95% CI 0.090-0.512) and the duration of anesthesia/surgeryalso showed statistically significant association with POST with p-value 0.014, (AOR 0.14, 95% CI 0.029-0.676). Conclusion and recommendation:The findings of this study confirmed previous observations that the larger the ETT size, the higher the incidence of postoperative respiratory morbidities. Although tracheal intubation remains an absolute necessity for good airway protection for different surgical procedures, we recommendedto use the smaller ETT sizes (6.5, 7.0 mm ID) to minimize the pressure-induced trauma on the laryngeal and tracheal mucosae Key words: -Post operative sore throat, Endotracheal tube. surgery
Assessment of Patient Satisfaction with Preoperative Anesthetic Evaluation and Assosated Factors at Menelik Referal Hospital Addis Ababa, Ethiopia
(Addis Abeba University, 2016-06) Melekamayhu, Abateneh; Admasu, Woseneyeleh (PhD)
Background: Patient Satisfaction- refers to a state of pleasure or happiness with an action or service especially one that was earlier desired. Patient satisfaction is progressively appreciated measure of outcome for health care procedures and it was a measure of success in this hospitals. It was affected by anesthetist’s patient interaction, in the preoperative anesthetic evaluation. No prior study conducted in our setup. Objective: The purpose of this study was to evaluate inpatients’ satisfaction with preoperative anesthetic evaluation and associated factors at Menelik II Referral Hospital Addis Ababa Ethiopia. Methods- Institutional based cross sectional study was conducted at Menelik II Referral Hospital from Jan 6 to Feb 6, 2016, All patients who remained for elective surgery were included in the study period and interview 24 hours after operation. Data were collected using pretested standard questionnaires. All items in the structured questionnaire were scored on five point Likert scale. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Binary logistic regression was used to measure statistical significance between dependent and each independent variable. P-value 0.05 and 95% CI was used as cut off point. Results: Two hundred and seventy-five patients were operated upon under anesthesia during the study period. Of these, a total of 224 patients were included in this study with a response rate of 81.5 %, with the overall proportion of patients who said they were satisfied with anesthesia services was 72.3 %.the major factors that take patient dissatisfaction were 68.1% of patient explain anesthetist were not introduce him or herself to the patient, information on postoperative analgesia were 99.1% and postoperative nausea vomiting management were accounts 84.8%. Conclusion and recommendation: Patient satisfaction with anesthesia services was low 72.3 % in our setup compared with many previous studies, and females more dissatisfied 42.4 % than males 57.6 %. Factors that affected patient satisfaction negatively may be preventable or enhanced. Further study should be done and patient satisfaction give an emphasis
Assessment on Magnitude and Associated Factors of Post Anesthesia Shivering at Zewditu Memorial Hospital from February 01 – March 31, 2016
(Addis Abeba University, 2016-06) Muluken, Zemenu; Admasu, Wosenyeleh (PhD)
Background: Now on these days as quality of patient care has being given big concern in developing countries, which was not yet, it is necessary to conduct a study to know some procedural and treatment complication. Post anesthesia shivering is one of these complications, which has many deleterious effects on the patient outcome. The cause of shivering is incompletely understood. So, it is important to know the overall magnitude and major contributing factors for post anesthesia shivering for better health care. Objective: To assess the magnitude and associated factors of post anesthesia shivering in Zewditu Memorial Hospital, Addis Ababa, Ethiopia from February 01 – March 31, 2016. Methods: Institutional based cross-sectional study design was conducted from Feb 01- Mar 31, 2016. A systematic random sampling method was employed to select 179 study subjects. A pre-tested structured questionnaire was used to collect data. Perioperative tympanic temperature was recorded every 15 minutes interval. Results: The overall incidence of post-anesthesia shivering was 29.1%. From this majority of patients (60.8%) had grade 3 shivering. In multiple logistic regression analysis, being male patient (AOR= 3.273, 95% CI: 1.495, 7.165; p=0.003), older age (AOR= 0.123, 95% CI: 0.032, 0.469; P=0.002) and tympanic temperature less than 360C (AOR= 2.747, 95% CI: 1.248, 6.049; p=0.012) were considered associated factors of PAS. Conclusion and Recommendation: The incidence of shivering was (29.1%); we also conclude that prophylaxis for shivering is necessary in those high risk patients. Age of the patient was the variable with the most predictive power by far. If surgery is planned on patients who are Male, low core body temperature, children and adult age group every precautions and care should be considered to make core body temperature in the normal range post operatively. For pain management alternative, it may be better to use opioids which have known protective effect for shivering.
Effects of General Versus Spinal Anesthesia over Apgar Score of Newborns Delivered by Cesarean Sections and Factors Associated with Apgar Score from January to March 2016 at Gandhi Memorial Hospital, Addis Ababa
(Addis Abeba University, 2016-06) Suleiman, Mohammed; w/yohannes, Misrak (PhD)
Introduction: The Apgar score is a practical method of systemically assessing newborn baby immediately after birth to identify those requiring resuscitation and to predict survival in neonatal period. In spite of the growing number of newborns that are delivered via Cesarean section, the decrease in Apgar score of babies delivered under cesarean has become one of the concerning issues. Objective: To assess the effects of general versus spinal anesthesia over Apgar score of newborns delivered by cesarean sections and factors associated with Apgar score from January to March 2016 at Gandhi Memorial Hospital, Addis Ababa. Method: Institutional based comparative cross sectional study design was conducted. Systematic random sampling technique was used to select study participants. Training was given for data collectors and supervisors. Regular supervision and follow up was made. Data was entered into Epi info version 7 computer software by investigators and was transported to SPSS version 20 computer program for analysis. Bivariate and multivariate analysis was used to identify factors associated with Apgar score. Result: A total of 86 study subjects were included. Majority of baby had low Apgar score at one minute and high Apgar score at five minute. Out of 43 mothers, who received spinal anesthesia, 15 patients (34.88%) gave birth to neonates having Apgar score >7 at one minute. On the other hand, out of 43 mothers who received general anesthesia, 7(16.3%) mothers gave birth to neonate having Apgar score ≥7 at one minute. It had been found that those neonates who were born under general anesthesia were three folds more likely to have low Apgar score than those who born under spinal anesthesia (AOR 2.768 (95% CI ((.876-8.745). Conclusion and recommendation: There was relatively a low Apgar score among newborn babies delivered under general anesthesia. Therefore, the use of spinal anesthesia was recommended.
Magnitude of Interaoperative and Postoperative Hypothermia and Associated Factors, Among Pediatric Patients That were Operated In Tikur Anbessa Specialized Hospital
(Addis Abeba University, 2016-07) Mossie, Mulat; Admassu, Wesenyeleh (PhD)
BACKGROUND: -Humans maintain constant body temperature within a wide range of changes in external environment. Perioperative hypothermia is one of the major problems during surgery that can affect operated pediatric patients. OBJECTIVE: - The objective of this study was to determine magnitude of intraoperative and postoperative hypothermia and determinant factors among pediatric patients operated in Tikur Anbessa Specialized Hospital from January to February, 2016. METHODS: - Study was conducted with Cross sectional study design. All selected elective surgical pediatric patients, between 1 January 2016 and 30 March2016 were eligible to the study. Data was entered into Epi info version 7 and exported to SPSS version 20 for analysis. Binary Logistic regression was used to test each factor with the dependent variable, and variables with P value of <0.2 were carried to multi variant analysis. 95% C.I. and P value of <0.05 was used as a cutoff point to test for significance of associations. RESULTS: -A total number of 90 pediatric patients were enrolled to the study of whom 26 females and 64 males. The ages of patients varied from 26 days to 14 years (mean 5.63 ±4.40). Hypothermia incidence was calculated after induction, an hour and two hours of induction was 72.2%, 64.4%, 83.8% respectively. After third hours there were three cases but all had been hypothermic. And postoperative incidence of hypothermia was 78.9% of all pediatric patients. Conclusion: -Intraoperative and Postoperative hypothermia is a common problem in this Hospital. Therefore, we suggest that temperature monitoring, patient warming and OR temperature managing should be a routine procedure during anesthesia management and PACU

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