Anaesthesia and Anaesthesiology

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Acceptability of COVID 19 Vaccines among Health Care Workers and its Determinants in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2021G.C.
(Addis Abeba University, 2021-11) Abraham, Yisehak; Dr. Tilahun, Rahel(Senior Anesthesiologist); Dr.Birhanu. Tseganesh (Senior Anesthesiologist)
Background: Healthcare workers who have negative attitudes, are averted, or are hesitant about vaccinations share these unfavorable attitudes and tend to recommend vaccination to their patients infrequently(1). Despite the huge efforts made to achieve successful COVID-19 vaccines, a major hindrance can be related to vaccine hesitancy towards the approved and prospective COVID-19 vaccination(2). The willingness to accept the vaccine among health care workers range from 28% lowest in Congo to 77% in France(3,4). Objective: To assess the acceptability of a COVID-19 vaccine among healthcare workers in Tikur Anbessa specialized hospital, Addis Ababa 2020G.C. Method: Institutional based descriptive cross sectional study was conducted among health care workers of Tikur Anbessa specialized hospital. Which is one of the tertiary hospital in the country. The source population was health care worker of Tikur Anbessa specialized hospital. Stratified random sampling was used with a final sample size of 384. The data was collected using an online questionnaire. Data was checked for completeness and imported to SPSS 20 software for analysis. Descriptive analysis was done for Socio-demographic and clinical characteristics of the participants. Bivariate logistic regression was done for each predictor variable and outcome variable. Multiple logistic regressions were done and statistical significance p-value less than 0.05 was taken as a determinant factor. Result: Of the total 390 health care worker who started the online questionnaire 384 completed it a (98.4% completion rate). Among the 384 participants 256(66.7%) respondents were willing to have the COVID 19 vaccine, 50.8 % were willing to be vaccinated as soon as the vaccine becomes available while 49.2% would delay vaccination until the vaccine's safety is confirmed. Having a high risk of contracting COVID and believing that the COVID-19 vaccine should be compulsory for all increased probability of getting vaccinated Conclusion and recommendation: Healthcare workers are at great risk of contracting and spreading the disease and, unless wide-acceptance of the vaccine is achieved. One of the crucial method is to alleviate fear of side effects.
Adherence to pre-operative fasting guidelines and associated factors among pediatric surgical patients in selected government referral hospitals, Addis Ababa, Ethiopia, 2020.
(Addis Abeba University, 2020-06) Yimer, Aragaw Hamza; Haddis, Lidya(B.Sc. M.Sc.); Abrar, Meron(B.Sc. M.Sc.)
Background: Fasting of children before anesthesia is mandatory with the aim of to reduce the complications of due to regurgitation, vomiting, aspiration during anesthesia and surgery. Prolonged fasting times have several negative implications in children due to high ﬂuid turnover quickly leads to dehydration, perioperative hypotension, metabolic disturbances and hypoglycemia which leads to poor anesthetic outcomes. Objective: The aim of this study was to assess adherence to preoperative fasting guidelines and associated factors among pediatrics patients undergoing elective surgery in Addis Ababa selected government Hospitals, Ethiopia, 2020. Method: A cross-sectional survey was conducted in Addis Ababa selected government hospitals, Ethiopia in 2020. A total sample of 279 pediatric patients with age up 17 years scheduled for elective surgery included in the data collection. The data analysis was done with SPSS V.21 and the value of the variables and its associated factors was checked its association with logistic regression. Significance was determined at P -value <0.05. The result was presented by using text, tables, charts, and graphs. Results: A total of 279 pediatrics patients were responded in the analysis with a 98.6% response rate. Majority of the participants 251(89.96%) were not followed the guidelines of preoperative fasting. The mean fasting time for clear liquids was 10±4.03 (2-18 hrs.), for breast milk 7.18±2.26 (3.5-12 hrs.), and for solid foods 13.5±2.76 (8-19 hrs.). The reasons for which the preoperative fasting delayed was due to incorrect order 35.1% , prior cases procedures took longer times 34.1% changing sequence of schedule was 20.8%. Conclusion: The majority of children were still having prolonged fasting practice. The staff’s instructions and sequences of schedules are challenged to follow the international fasting guidelines protocol.
Admission Pattern and Treatment Outcomes among Patients Admitted to Pediatric Intensive Care unit in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia ,2020/21:A Cross-sectional Study
(Addis Ababa University, 2021-06) Eshetu, Oliyad; Tafessa, Dawit (BSc MSc; Seifu, Ashenafi (BSc MSc
ABSTRACT BACKGROUND: The knowledge of the pattern of admission and treatment outcome of critically diseased pediatric patients admitted to pediatric intensive care units in developing countries where the resource is scarce may help for the identification of priorities and resources to make the facility better. The prevalence of pediatric intensive care unit mortality often varies globally, depending on the facilities of the intensive care unit, the availability of workers, and admission patterns. OBJECTIVE: The objective of this study was to assess admission pattern and treatment outcome of children admitted to a pediatric intensive care unit (PICU), at Tikur Anbessa specialized hospital, Addis Ababa Ethiopia, from October 2018 to October 2020 METHODS: The study was a cross-sectional study design among 361 pediatrics patients admitted to the pediatric intensive care unit of Tikur Anbessa Specialized Hospital Addis Ababa Ethiopia from October 2018-October 2020 by using a systematic random sampling technique. Descriptive statistics were summarized with data, tables, and figures for display results. The distribution of the data was checked with a normality curve. Bivariate and multivariate analyses were used to see the association of an independent variable on the outcome variable. Factors with a p-value of less than 0.2 in bivariate analysis were exported to multivariate analysis to see if they are independent factors for the outcome variable. The adjusted odds ratio was used to show the strength of association with a 95% confidence interval and the p-value of less than 0.05 was taken as statistical significance in multivariate analysis. RESULTS: A total of 361(100%) charts were sampled for data collection; 197 (54.6%) were male and 164(45.4) were female. The most common cause of admission was, septic shock (27.14%), whereas the least cause of admission was Asthma 9(2.50%). The mean age at admission was 39.44±44.87 months. The overall mortality rate of our pediatric intensive care unit was 43.8%. From multivariate regression analysis need for mechanical ventilation (AOR= 11.08, 4.25-28.87, 95%CI, P=0.001), need for inotropic (AOR = 10.67, 4.09-27.81, 95%CI P<0.001), comorbidity (AOR=8.38, 3.5-20.5 , 95%CI P<0.001), length of PICU stay from 2-7 days (AOR =7.27, 1.7330.55, 95%CI P=0.007) and severe GCS (<8) with (AOR =10.51, 3.81-29.05, 95%CI P<0.001) were independent determinant of mortality. CONCLUSION: The mortality rate at our PICU was 43.8%. Septic shock and meningitis were the common cause of death and the largest death has happened in less than 7 days of admission.
Analgesic Effect of Intrathecal Neostigmine + Bupivacaine,Morphine+Bupivacaine and Bupivacaine Alone among Postoperative Patient Who Undergone Lower Extremities Orthopedics Procedure at Asella Referral and Teaching Hospital,South West Ethiopia,2019.
(Addis Ababa University, 2019-05) Bekele, Ayele; Aregawi, Adunga(Assistant professor); Getachew, Lemlem(MSc in Anesthesia)
Background: Spinal anaesthesia is a commonly used regional technique for lower abdominal and lower limb surgeries. Bupivacaine is the most commonly employed local anaesthetic for sub arachnoid block. Perioperative hemodynamic status and post-operative pain relief are important issues with Bupivacaine. Different studies have been conducted to establish best adjuvants to overcome these demerits and so as to enhance bupivacaine induced post-operative analgesia and provide a stable intraoperative condition. Objective: To compare analgesic effectiveness of intrathecal morphine + bupivacaine + neostigmine bupivacaine and bupivacaine alone for a patient who undergone lower extremities orthopedics procedure Methodology: In this institutional based prospective cohort study, 102 patients with American Society of Anesthesiologists (ASA) class I or II status, age≥18 who undergone lower extremities orthopedics were grouped into bupivacaine 12.5 with morphine(0.2mg) n=34, bupivacaine 12.5mg with Neostigmine (50mcg), n=34 and Bupivacaine alone group (15mg) based on the decision of responsible anesthetist. Data collection method includes preoperative chart review, intraoperative observation and postoperatively patient interview and chart review. Postoperatively duration & consumption of analgesia, first analgesia request as well as severity of pain using 10cm NRS score were assessed over 24hrs. The data were entered into EPI INFO and transport to SPSS version 22 for analysis of variable using one-way ANOVA, kuruska-walih H rank test, and chi square. Results: There was significant difference in maximal level of sensory block, time to maximum sensory and motor block among the three groups. The morphine group had longer time to first rescue analgesics than the neostigmine and bupivacaine group (P <0.05). Overall 24-hr NRS pain scores were significantly higher in the bupivacaine group v/s the morphine and neostigmine groups (P <0.05) Conclusion and recommendation: Morphine 0.2mg produce prolonged postoperative analgesia with few side effects than neostigmine and bupivacaine alone.
Analgesic effect of intravenous Dexamethasone prior to Spinal Anesthesia among parturient undergo cesarean section at Gandhi Memorial Hospital, ADDIS ABABA, ETHITIOPIA, Prospective Cohort Study, 2018/19
(Addis Ababa University, 2019-06) Tesfaye, Adamu; M, Eyayalem(B.Sc. M.Sc.); D, Tinbet(B.Sc. M.Sc.)
Background: By prolonging the duration of spinal anesthesia sensory block co-administration of adjuvant has the potential to improve efficacy of regional blocks. However this technique has its own complications. Hence, drugs having minimal side effects and prolonged analgesia is always looked for. This is because postoperative pain in obstetric patients is left untreated and it’s the main cause of chronic pain among women. Objective: to determine the effect of preoperative dexamethasone on prolongation of the analgesic effect of spinal anesthesia after elective cesarean section. Methods: Observational prospective cohort study was conducted at Gandhi Memorial in 64 patients scheduled for elective Cesarean Section under spinal anesthesia and systematic random sampling was used to randomly select patients. Data was checked manually for completeness and then it was coded and entered, cleaned and analyzed with SPSS version 20 computer program. Normality of the data was checked by Shapiro wilk test. Chi square test was used for categorical variables and Manny Whitney test used for comparing numerical variables of skewed data or student's t-test used for comparing numerical variables normally distributed data of two groups. P-value less than 0.05 considered as statistically significant. Result: The demographic and clinical characteristics were comparable between groups. Groups’ comparison indicated significant difference in terms of severity of postoperative pain, in which the dexamethasone group were lower with p value < 0.015. Similarly, time to the requirement of first rescue analgesia was prolonged in dexamethasone group with median (interquartile range) score of 6.5(2.4) as compared to non-dexamethasone group 4.1(1.8). The median score for total consumption of Tramadol in 24hrs post operatively has been lower in dexamethasone group with p value < 0.0001. There is no statistically significant difference in median score of total diclofenac consumption between the two groups with p value of 0.2. Conclusion: we concluded that preoperative administration of dexamethasone 0.1mg/kg intravenously before administrating spinal anesthesia for cesarean section is efficient in reducing postoperative pain, total Tramadol consumption on the first postoperative day and prolonging the time to the requirement of first rescue analgesia.
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(Bsc, Msc. In Anesthesia, Lecturer)
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.
Anesthetists Knowledge, Practices and Associated Factors towards Infection Prevention in Addis Ababa Public Hospitals, Ethiopia: A Cross-Sectional Study
(Addis Ababa University, 2021-06) Alemayehu Terefe; Tesfaye Biruk (Msc ; W/yohannes Misrak (Msc
Background Infection prevention is one of a central component of safe and quality service provide at the level of health organization. In health care system, globally hundreds of millions people are affected every year by avoidable infections. In sub-Saharan Africa, the rate of nosocomial infection ranges from 2.5 to 30.9% with surgical patients. Objective: The aim of this study is to assess anesthetists knowledge, practices and identify associated risk factors towards infection prevention in Addis Ababa public hospital Methodology: A cross-sectional survey study was conducted with structured pretested, and self administered questionnaires on 220 anesthetists working at hospitals in Addis Ababa. The collected data was checked for its completeness, consistency, and accuracy and entered in EPI INFO7 software and then exported to SPSS version 24 for analysis. The descriptive statistical analysis was used to summarize important independent variables and logistic regression model was fitted for bivariate and multivariable analysis. For the determination of the existence of an association between variables, a 95% confidence level and alpha of 0.05 was used. The odds ratio was used to estimate a measure of effect and to show the strength of association. Result: A total of 220 anesthetists have participated in this study with a response rate of 88%.Out of these 82.7 % (95% of CL: 77.7-87.7) and 48.2% (95% of CL: 41.4-55.4) of respondents were assessed as Knowledgeable and safe practices towards infection prevention respectively. Knowledge towards infection prevention is strongly associated with training on infection prevention, the presence of an infection prevention committee, and the availability of guidelines. Also, the presence of an infection prevention committee, personal protective equipment, and availability of guideline associated with safe practice toward infection prevention. Conclusion: The finding of this study showed that the majority of anesthetists have a good knowledge of infection prevention and nearly half of anesthetists had poor practice towards infection prevention. Hospitals and concerned stack holders should focus on training of infection prevention, and develop infection prevention guidelines related to anesthesia practice, adequate supply of personal protective equipment, and need continuous mentorship by the infection prevention committee.
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
Assessing the Anesthetist Involvement in Trauma Care Management at Trauma Set Ups and Emergency Rooms and Affecting Factors in Addis Ababa Public Hospitals
(Addis Abeba University, 2017-06) Tekleab, Teame; Akalu, Leulayehu (PhD)
Back Ground: Trauma care involves the entire spectrum of care from the first responder through rehabilitation. The original aim of the trauma team is to reduce the second peak of the trimodal distribution of death following trauma, by appropriately managing correctable disturbances to the airway, breathing and circulation, if well implemented, is predicted to reduce preventable deaths by 42%. The initial responsibility is airway management; securing a compromised airway with a definitive airway device may be a priority, usually requiring intubation with rapid sequence induction of anesthesia with manual in-line stabilization of the cervical spine, provision of analgesia and resuscitation both inside and outside the hospital. Anesthetists practice in a variety of settings and one of the most challenging is the trauma set ups and emergency rooms and the setting in which the anesthetists practice may influence the skills needed because of many factors. Objectives: -Assessing the anesthetists involvement in trauma care management at trauma set ups and emergency rooms and affecting factors at Public Hospitals in Addis Ababa. Methods-institutional based cross sectional study was conducted on all eligible Anesthetists working at six randomly selected Public Hospitals in Addis Ababa from Jan 1, to Mar 30, 2017 GC. Data was collected using structured questionnaire and data entry and analysis was done with SPSS version 20. Result- A total of 57 respondents were surveyed with response rate of 100%. Of the respondents (n = 57), 16 (28.1%) of were involved in trauma set ups and ER, 41 (71.9%) were not. Of the 16 respondents involved in trauma set ups and ER 7(43.8%) were involve daily, 6(37.5%) weekly and about 3 (18.8%) reported involved at least once per month. Among the 16 respondents involved 10(62.5%) were participating in airway management, 5(31.3%) were in sedation and 1(6.2%) in peripheral nerve block. Concerning those who were not involved (n=41), 14(34.1%) were due to inadequate resources supply in their setups,8(19.5%) poor teamwork communication and coordination between the staffs,8(19.5%) lack of knowledge , 7(17.1%) shortage of manpower and 4(9.8%) was because of administrative problems. Conclusion and recommendations- The results indicated that 71.9% of the anesthetists remain unable to involve in trauma care management at trauma set ups and emergency rooms. Inadequate resources supply (34.1%); poor teamwork communication and coordination between the staffs, shortage of manpower and to some extent administrative problems were among the most affecting factors for involvement in trauma set ups in this research finding. we suggest to the concerned bodies to fulfill necessary materials to the hospitals and open opportunity for educational development and refresher training for the anesthesia professionals.
Assessment knowledge, attitude and practice regarding personal protective equipment of COVID-19 among nurses working in Tikur Anbessa specialized hospital operation room and intensive care unit, Addis Ababa, Ethiopia.
(Addis Abeba University, 2020-12) Fitsum, Yemane; Dr. Tilahun, Rahel(Cardiothoracic Anesthesiologist)
Background: Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread between people through direct, indirect, or close contact with infected people via mouth and nose secretions. Facility cleaning, regular and proper handwashing, respiratory hygiene and etiquette, advice on national travel, emphasis on staying at home for infection containment, events and meeting arrangement rules, case notification and management, and proper use of face masks are the prevention methods of this pandemic. PPE is a physical barrier worn by HCWs to prevent spreading of a pathogen from either a suspected or confirmed case or a pathologic specimen. Objective: To assess level of knowledge, attitude and practices and associated factors of Intensive care unit and operation rooms nurse’s towards use of personal protective equipment to prevent COVID-19 in Tikur Anbesa Specialized hospital, Addis Ababa, Ethiopia. Method: A cross sectional study was conducted between September and November 2020 among 113 nurse professionals working in TASH OR and ICU department. Data was collected using self-administered structured questionnaire. Data entry, analysis and quality of data were maintained by SPSS version 25 software. Level of statistical significance was set at p<0.05. Result: Of 113 total respondents, 62(54.9%) were female and the age of participant’s lies between 20 - 55. Almost half of the participants does not gate training related to COVID-19. The overall mean knowledge score of participants was 63.8 (SD ± 19.8), mean attitude score was 64.68 (SD ± 16.1), and mean practice score was 64.7 (SD ± 22.8). There were strong association between work experience and training status on knowledge score (p=0.005 and 0.002 respectively). Similarly, work experience, training status and knowledge on PPE were association factors that affected nurses’ attitude towards PPE. In addition, educational status (p= 0.026) and knowledge on PPE (p=0.003) were significantly associated with practice score of nurses on PPE. Conclusion: One nurses out of three had good knowledge, and half of the participant had, favorable attitude and good practice. Work experience and training on PPE were factors that affects both knowledge and attitude of nurses towards PPE. knowledge on PPE affected both attitude and practice of nurses on personal protective equipment.
Assessment of intraoperative and immediate postoperative pain management in adult orthopedic surgical patients at the post anesthesia care unit of Tikur anbessa specialized hospital
(Addis Ababa Universty, 2017-11) Tsegaye, Dagmawi; Shimelis, Rediet (Md, Assistant Professor of Anesthesiology)
Background Despite the increased focus on pain management programs and the development of new standards for intraoperative and postoperative pain, assessment remains a concern for patients. Pain therapy is a central medical task and a legal duty and optimum pain control is a fundamental right for all patients. Objectives To evaluate the prevalence and intensity of pain in adult patients after orthopedic surgeries. To describe the practice of intraoperative and postoperative pain management in adult orthopedic surgical patients at Tikur Anbessa Specialized Hospital. Methodology Institutional based prospective cross-sectional study was conducted on 324 study participants to assess the immediate postoperative pain management in adult orthopedic surgical patients at the post anesthesia care unit. Visual Analogue Scale was used to assess the level of pain. Data was collected using a structured questionnaire and was be analyzed using Statistical Package for Social Sciences, version 20. Results The total number of participants was 384. The number of male participants was 264 (60.9%) and female participants 150 (39.1%). Upper limb surgeries constituted 67.7% of the cases and fracture was the commonest cause for orthopedic surgeries 70.3%. Among the study participants 191 (49.7%) had experienced moderate to severe post-operative pain. Open Reduction and Internal Fixation constituted 68.2% of the operations done. Regional anesthesia accounted for 51.3% and general anesthesia 48.2%. Among those patients who were operated under general anesthesia 53% of them received morphine via intravenous route, 20.5% received combination of weak opioid and NSAID, and 18.9% received intravenous tramadol for intraoperative analgesia. Among the study participants 28.9% of them stayed in the PACU for two hours and the rest stayed for an hour.
Assessment of awareness and attitude of pregnant women toward anesthesia techniques for cesarean section and associated factors at selected public Hospital of Addis Ababa Ethiopia,2021.
(Addis Abeba University, 2021-06) Teku, Gudeta; Tafesse, Dawit(Bsc,Msc in Anesthesia); Tesfaye, Siryet(Bsc,Msc in Anesthesia)
Background There is a lack of public awareness of anesthesia as a medical specialty. Obstetric women's decisions to have a cesarean section are influenced by a lack of awareness about anesthesia and anesthesia techniques. Objective: To assess awareness and attitude of pregnant women’s towards anesthesia techniques for cesarean section among women attending ANC at selected public Hospital of Addis Ababa, 2021 Method: Prospective cross-section study design was employed among 332 pregnant women who were attended ANC at selected public hospitals of Addis Ababa, Ethiopia. A systematic random sampling technique was used for selecting participants. The data was collected by using a pretest structured questionnaire and entered into Epi Data for cleaning. Then it was exported to SPSS version 26 for analysis. Both binary and multivariate logistic regressions were used to measure the association between the factors and outcomes at 95% CI and P-value <0.05 was considered as statistically significant Results: The finding of the study reflected that from total study participants, 206(62%) were heard about anesthesia. In this study, 116(56.3) of participants had a good awareness of anesthesia techniques .Level of education and number of parity were significantly associated with awareness of anesthesia techniques. Respondents who were completed secondary school had a good awareness of anesthesia techniques[AOR=6.785; 95% CI (1.01- 45.170)] and women with para three had good awareness than null parity [AOR=6.453; 95% CI (1.612-25.825)].The study found, 146(70.9%) of respondents had a positive attitude towards anesthesia techniques but the previous type of anesthesia and absence of anesthesia-related complication had no significant association with the parturient’s attitude towards anesthesia techniques. Among 43 respondents who previously received GA, 13 respondents preferred again GA whereas out of 66 respondents who received SA, 48 participants preferred spinal anesthesia. Conclusion: Overall our parturients' awareness about anesthesia and anesthesia techniques for cesarean section is low. Out of the total participant, 126(38%) were even not heard about 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.
Assessment of Confidence and Knowledge level of Perioperative fluid administration among post graduate surgical trainees in Tikur Anbesa Specialized Hospital.
(Addis Ababa University, 2019) Daniel, Selam; Dr.Hulala, Faiza(Assistant professor of anesthesiology)
Background: Intravenous fluid therapy is an integrated and lifesaving part of the treatment of patients undergoing surgery. It continues to be heavily relied upon in the modern management of general surgical patients, with nearly universal use in the perioperative period. Objective: The objective of this study was to determine the confidence level of surgical postgraduate residents in prescribing perioperative fluid for the management of patients, whether they feel like they have achieved adequate training in their undergraduate program and if they actually have adequate knowledge regarding this topic. Method: It was an institution based descriptive cross-sectional study using a self-administered questionnaire. The data was collected using pretested questionnaire, which was used in other researches. The collected data was entered and analyzed using SPSS version 24. Result: Even though the confidence level for the respondents were no satisfactory there seems to be a slightly elevated degree of confidence level despite a lower level of knowledge. There was a clear preference to use NS for resuscitation with higher level of confidence with less confidence to use potassium supplement. There was also a less than satisfactory knowledge regarding electrolyte requirements of the body and composition of body fluids by the respondents. Recommendation: A prospective studies about trends of practice would be helpful to have objective data for analysis of adverse outcomes which are attributed to inappropriate prescription of perioperative fluids. After this it would be wise to come up with local guidelines and educational interventions to address perioperative fluid management.
Assessment of dissatisfaction, refusal and associated factors after spinal anaesthesia for elective surgical procedures in public hospitals in Addis Ababa, Ethiopia, 2020/2021, A cross sectional study
(Addis Abeba University, 2021-06) Yimam, Ali; Seifu, Ashenafi (BSc, MSc)
Background: Spinal anaesthesia is the most common type of regional anaesthesia technique which helped for a wide range of surgical procedures. Patient satisfaction with anaesthesia care is important to monitor the quality of anaesthesia delivery system. It is important to identify the reasons and the risk factors for patients’ dissatisfaction and refusal after spinal anaesthesia for continuous improvement of quality of anaesthesia services. Objectives: The aim of this study was to assess the dissatisfaction, refusal and associated factors after spinal anaesthesia for elective surgical procedures in public hospitals in Addis Ababa, Ethiopia, 2020/2021. Methods: A multicentre cross-sectional study was conducted from December 30 to April 14, 2020/2021, in selected public hospitals in Addis Ababa, Ethiopia. A total of 227 patients older than 18 years old scheduled for elective surgery under spinal anaesthesia were incorporated in the study. A five point likert scale was used to assess patients preoperative, intraoperative, and postoperative satisfaction level of anaesthesia service. Both bivariate and multivariate logistic regressions were used to measure association of predictor and outcome variable at 95% CI using adjusted odds ratio. P value <0.05 was used to declare statistical significance. Results: A total of 227 patients included in this study and overall proportion of patients who were satisfied with spinal anaesthesia was 150 (66.1%). Risk factors of dissatisfaction were backache (AOR=4.73, 95%CI=1.97, 11.36), headache (AOR=3.68, 95%CI=1.54, 8.80), and intraoperative nausea &vomiting (AOR=3.33(1.43, 7.73). 188(83%) of patients would choose spinal anaesthesia again whereas 39(17%) would refuse to undergo spinal anaesthesia in the future and its risk factors were intraoperative pain, fear of awareness and backache. Conclusion and recommendation: Patients satisfaction towards spinal anaesthesia was very low in our setup compared to many other previous studies. Backache, headache and intraoperative nausea and vomiting were risk factors which results patients dissatisfaction. Explaining the benefits and risks of anaesthesia, and understanding the patient’s opinion is essential to increase satisfaction with anaesthesia service.
Assessment of Incidence of Adverse Events and Associated Factors in Pediatrics out of Operating Room Procedural Sedation at Tikur Anbesa SpecializedHospital, Addis Ababa In 2022/2023
(Addis Ababa University, 2023-06-18) Addisu Bekele; Faiza Hulala
Procedural sedation and analgesia (PSA) describe the use of agents, such as sedatives and analgesics, to alleviate anxiety, pain, and fear during diagnostic and therapeutic procedures. Pediatric out of OR (operating theatre) procedural sedation is expanding throughout the world as well as in our setup. Children require sedation more often than adults and they are at the greatest risk of adverse events due to their physiology. Complications include hypoxia, vomiting, laryngospasm, and cardiac arrest. There is no single ideal sedative agent without risk. Despite the magnitude, there is no single study done in Ethiopia. Objectives To assess the incidence of adverse events in pediatrics out of OR procedural sedation and associated risk factors in Tikur Anbessa specialized hospital. Methods Institutional-based cross-sectional study design was in TASH (Tikur Anbessa specialized hospital) conducted from December 2022 – March 2023. The final sample size was 269. Simple convenient sampling technique was used as a sampling technique. Data was checked for completeness and then entered in to SPSS 26 software for analysis. Descriptive analysis was done for socio-demographic, surgery and anesthesia related characteristics of the study participants. Bivariate logistic regression was done for each predictor variable and outcome variable. Multivariable logistic regression was done for variables with P- value less than 0.25 and statistical significance P- value less than 0.05 was taken as a determinant factor. Results Overall, the prevalence of adverse events in pediatrics out of OR procedural sedation was 9.2% (n=20). Respiratory adverse event was the most common adverse event occurring in 15 (6.9%) patients. the odds of developing respiratory adverse events is 10.27 times higher among patients who had moderate or severe malnutrition as compared to those who had normal nutritional status (AOR= 10.27;95%CI 3.21, 32.8; p<0.001. Conclusion and recommendation Malnutrition is associated with the occurrence of respiratory adverse events in pediatrics out of OR procedural sedation. Careful evaluation and optimization of pediatric patients with malnutrition is necessary.
Assessment of Knowledge and practice of Critical Care HCWs towards Ventilator Associated Pneumonia Bundles in TASH adult ICU
(Addis Abeba University, 2020-12) Kidanu, G/hans; Tlahun, Rahel (MD, Cardiothoracic Anesthesiologist)
BACKGROUND: Ventilator-associated pneumonia (VAP) continues to be a common and potentially fatal complication of ventilator care and often encountered within intensive care units (ICUs). Ventilated and intubated patients present critical care Health care workers the unique challenge to incorporate evidence-based practices surrounding the delivery of high-quality care. This study examined the Assessment of Knowledge and practice of Critical Care HCWs towards Ventilator Associated Pneumonia Bundles in TASH adult ICU OBJECTIVE: to Assess Knowledge and practice of Critical Care HCWs towards Ventilator Associated Pneumonia Bundles inTASH adult ICU METHODS: Cross-sectional study was conducted from September to November 2020 among 160 HCW Addis Ababa University TASH working in adult ICU who were selected by a stratified sampling technique. a structured questionnaire was used to collect data. Data were entered and analyzed using SPSS version 26 and the results was presented by tables, bar graphs and pie chart. Variables with p-value < 0.05 were used as significantly associated with the dependent variable. RESULTS: Most (67.5%) of the study participants were male and 70.6 % were ages 25-30 years. Most of the respondents were residents (69.4%) and had a work experience below 5 years (73.1%). The total mean knowledge score of the participants was 12.4312 out of 16 (Range 5-16, SD= 2.10606). 51.9 % of the participants had scores above the mean (i.e. good knowledge score) while the rest had below the mean score with only 155 (96.9%) of the study participants scoring above 8 out of 16. The mean practice score of the respondents was 14.9625 out of 25 (Range 7-23, SD = 3.48562). Fifty three point one percent (53.1 %) of the respondents had a mean practice score above the mean (good practice) while the rest had poor practice. 25 (15.6 %) respondents had total practice score below 12 out of 24 (i.e. below 50%). CONCLUSION: In this study, around half of HCWs have good knowledge (i.e. 51.9%) and around half of HCWs have good practice (i.e.53.1%). The percentage of HCWs who score good practice is higher than who score good knowledge. No significant association between age, gender, working department, years of working experience and knowledge. It was profession (job title) that had statistically significant impact on having good knowledge score. Practice of ICU HCWs on VAP prevention bundles was not statistically associated with age, gender, working department, years of working experience and profesion.but nurses had higher odds of having good practice. There was no correlation between knowledge and practice score.
Assessment of knowledge, attitude and practice of anesthesia providers towards post operative nausea and vomiting at tikur anbessa specialized hospital.
(Addis Abeba University, 2020-11) Getiye, Awoke; Dr. Abate, Ananya(MD, Assistant Professor Of Anesthesiology); Dr. Tilahun, Rahel(MD,Assistant Professor Of Cardiothoracic Anesthesiology)
Background: Evidence based knowledge, attitude and practice of anesthesia providers towards postoperative nausea and vomiting management is essential to improve hospital service as well as patient care. Objective: the objective of this study was to assess the knowledge, attitude and practice of anesthesia providers working at Tikur Anbessa Specialized Hospital towards postoperative nausea and vomiting. Method: Institutional based cross-sectional study was employed among anesthesia providers at TASH from September to October 2020. Single population proportion formula was utilized to calculate sample size of the study participants and the final sample size was 111. The study participants were selected after proportional allocation was done among the different anaesthesia providers based on their educational level. The data was collected by self-administered questionnaire and entered into Epi-data and exported to SPSS version 26 for analysis. Descriptive statistics, bi-variable and multivariable logistic regression analysis were done to identify factors associated with the knowledge, attitude and practice level of study participants. Result: A total of 111 study subjects were participated in the study of which 65.5 % (n =73) were male with male to female ratio of 1.921:1. The result showed that 58.6% (n= 65), 61.3% (n = 68) and 39.6% ( n = 44) of study participants had good knowledge, positive attitude and good practice towards PONV management respectively. Educational level of anesthesia providers was a factor significantly associated with knowledge, attitude and practice of anesthesia providers towards management of PONV. Conclusion and recommendation: Over all educational level of anesthesia providers was a factor significantly affecting the knowledge, attitude and practice of anesthesia providers towards management of PONV. Even though majority of anesthesia providers had good knowledge and positive attitude towards management of PONV practice was lacking. Anesthesiologists were having good knowledge, positive attitude and good practice than other level of anesthesia providers at TASH . We recommend department of anesthesia, critical care and pain medicine to prepare training , protocols and guidelines for effective management of PONV in the future.
Assessment of Knowledge, Attitude and Practice of Gynecology and Obstetrics Residents about Pain Management of First Trimester Surgical Abortion via Suction and Curettage in Tikur Anbesa Specialized Hospital, Ghandi Memorial Hospital and Zewditu Memorial Hospital Addis Ababa, Ethiopia, 2017
(Addis Ababa Universty, 2018-05) Tamrat, Lina; Alferid, Fetiya (MD, Assistant Professor of Anesthesiology)
Background: First Trimester Surgical Abortions (FTSA) especially cervical dilation and suction aspiration are associated with pain. Researchers estimated that in Ethiopia, in 2008, as many as 103,140 of induced abortions were performed in health facilities. Between 2008 and 2014, the proportion of abortions occurring in facilities rose from 27% to 53%.There is no available data or guideline to know the pain management practice during first trimester abortions In Ethiopia. There is also lack of available study done to assess the level of knowledge, attitude and practice of physicians toward pain management practice during First Trimester Surgical Abortion. Objectives: The aim of this research is to assess knowledge, attitude and practice of Gynecology and Obstetrics Residents in the management of pain during First Trimester Surgical Abortion via Suction and curettage in TASH, GMH and ZMH. Methods: Multi center cross-sectional study in three hospitals (TASH, GMH and ZMH) was conducted during the month of October 2 – November 6, 2017 to assess knowledge, attitude and practice of GOR in the management of FTSA. A total of 62 residents participated in this study from a total population of 76. Structured, self-administered questionnaire was used to collect the data. The collected data was analyzed through SPSS version 20 software. Results: The proportion of residents who had good knowledge regarding pain management during first trimester surgical abortion was found to be only 11%. The residents who had good practice of pain management were 6.5% and there were 83.5% of residents who had favorable attitude regarding pain management. There was significant association between the knowledge of the respondents and attaching in TASH with (n=7) and P value of 0.004. Attitude index of the respondents has also significant association with year of residency with a p value of 0.0329. Conclusion and Recommendations: There was very low measured knowledge and attitude level of the physicians. And also the physicians own assessment of the suboptimal pain management practice of their hospital leads us to recommend further training on pain management options suitable for our setup.
Assessment of knowledge, attitude and practice of labor analgesia among obstetric health care providers in Tikur Anbessa Specialized Hospital
(Addis Ababa University, 2018-11) Dr. Indris, Semira; Eshete, Manekulh (MD,Assistant Professor Of Anesthesiology)
Background Despite the increased focus on pain management programs and the development of new standards for pain, assessment and treatment of labor pain is mostly abandoned specially in low and middle income countries. In Ethiopia there are few studies done in some regional states to assess attitude towards labor pain and utilization of labor analgesia, thus this thesis is conducted in one of the biggest and tertiary hospital found in the capital city of Ethiopia,A.A. Objectives To evaluate the knowledge and attitude of labor pain analgesia and to describe the practice of labor analgesia among obstetric health care providers at Tikur Anbessa Specialized Hospital. Method: cross-sectional study was conducted from AUGUST 1 to OCTOBOR 1, 2018 at Tikur Anbessa Specialized Hospital. Data was collected using structured questionnaire distributed to obstetric residents , Ansthesiology residents and midwifes. The collected data was coded and entered into EPI info version 7and analyzed by using SPSS version 20. Descriptive analysis was used. Result: This study found that majority (91%) of ansthesia and more than half(67%) of obstetric residents have good attitude towards labor analgesia, while majority(74%) of the midwifes found to have poor attitude.Althogh 80% of Ans residents have good knowledge towards labor pain management, only 49% of midwifes & 47% of obs residents found to have good knowledge about labor analgesia .majority of HCPs i.e 82% of midwifes, 69% of obs residents, 83% of ans residents was found to have good practice of labor analgesia. Conclusion & recommendation: The majority of healthcare providers understand that women suffer significant pain during labor and majority believe that labor pain relief is necessary However, when we see the general knowledge of HCPs, except Ans residents half of obs residents & half of the midwifes have poor knowledge about labor analgesia thus emphasis should be given to train all obstetric health care providers regarding safe , efficient and affordable labor analgesia.

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