Anaesthesia and Anaesthesiology
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Item Comparing Effect of Lateral Versus Sitting Position on Hemodynamics and on set of Sensory Block During Induction Time of Spinal Anesthesia in Patients Undergoing Elective Cesarean Section, at Ghandi Memorial Hospital Addis Ababa; Ethiopia: A Prospective Cohort Study,2022/2023(Addis Ababa University, 2023-06-19) Nuru Yimam; Lidya Haddis(Msc); Fisiha Fente (Msc)Spinal anesthesia is the preferred anesthetic technique for cesarean sections. It can be given in a lateral or sitting position. But maternal positioning affects hemodynamics and the spread of local anesthetic drugs that also affect the onset of sensory block. Post-spinal hypotension is the major problem that occurs after spinal anesthesia. It is defined as a decrease in systolic blood pressure greater than 20% of the baseline measurement. Even though precautionary measures have been taken to alleviate post-spinal hypotension, it still occurs at a rate of 30–90% after spinal anesthesia, and it needs research to indicate at what position it will be pronounced. Objective: The main objective of this study was to compare the effect of sitting versus lateral position on hemodynamics and the onset of sensory block during the induction time of spinal anesthesia in patients undergoing cesarean section at Gandhi Memorial Hospital in Addis Ababa, Ethiopia, from December 30, 2022, to April 30, 2023. Methods: A prospective cohort study was applied to 170 parturients who had undergone elective cesarean delivery under spinal anesthesia. Data was analyzed using SPSS version 27, after checking the normality of the data distribution. An independent t-test was used to analyze parametric data, and a Mann-Whitney u-test was used for the analysis of non-parametric data. A chi-square test was employed to compare categorical variables. A statistical significance is determined when P <0.05. Result: There was no statistically significant difference between the two groups in terms of socio-demographic data (P > 0.05). The incidence of hypotension in the lateral and sitting groups was 25% and 75%, respectively (P = 0.036). The lowest recorded median systolic blood pressure was 95 mm Hg in the lateral group and 87 mm Hg in the sitting group. The onset of sensory block was also faster in the lateral position than the sitting position (P <0.05). Conclusion and Recommendation: The changes in maternal hemodynamics were better maintained in lateral position than sitting position, and adequate sensory level for cesarean section is attained quicker in lateral position as compared to sitting position in patients undergoing spinal anesthesia for cesarean section. We recommend using the lateral position as the sole induction position during spinal anesthesia.Item Magnitude and Predictors of Difficult Tracheal Intubation in Patients who Underwent Elective Thyroid Surgery at Selected Addis Ababa Public Hospitals, Ethiopia(Addis Ababa University, 2023-08-27) Henok Yeshitila; Senait AwekeThyroid surgery has got variety of anesthesia concerns. One of the anesthetic concerns is airway related problems which is difficult tracheal intubations that lead to devastating complications or may increase morbidity and mortality of the patients. Airway assessment can have significant importance to anticipate a difficult airway before anesthetic administration and help us to prepare for treating difficulty and to avoid life-threatening complications related to difficulty in tracheal intubation. Objective: To assess the magnitude and predictors of difficult tracheal intubations in patients who underwent elective thyroid surgery at selected Addis Ababa public hospitals, Ethiopia, From Dec, 2022 to Mar, 2023. Methods: A hospital-based multicenter cross-sectional study design was used. The study comprised 196 ASA I and II thyroid patients aged 18 to 65 were included. Descriptive statistics were done on socio-demographic variables to obtain frequency distributions. The analysis was done by using binary logistic regression while data in univariate analysis with p-value < 0.2 was entered into multivariate logistic regression. Finally, variable with p value < 0.05 in multivariate logistic regression is considered statistically significant association with difficult tracheal intubations. Result: A total of 196 patients were included in the study. From which 26(13.3%) patients had DTI. In addition to these the presence of tracheal deviation on chest x-Ray and increase in mass duration from 161 to 240 month was found to be a strong association with DTI on multivariate logistic regression analysis with (p 0.001, OR=14.4, and p 0.001, OR= 16.4) respectively. Conclusion and recommendations: We conclude that patients with increased duration of mass and presence of tracheal deviation on chest X-ray have a strong association with difficult tracheal intubation. So that such patients with goiter need thorough pre-operative evaluation as considering duration of the mass and tracheal deviation. We recommend anesthesia professionals to give due attention for thyroid patient with long duration of mass and tracheal deviation to do x-ray as a preoperative test modality for thyroid patients. KEY WORDS: Difficult tracheal intubation, Intubation difficulty score and Thyroid surgeryItem Incidence and Associated Factors of Anemia in Elective Surgical Patients Admitted to a Surgical Intensive Care Unit at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2023(Addis Ababa University, 2023-06-13) Habtie Bantider; Wosenyeleh Admasu; Lidya HaddisAnemia is a frequently reported and commonly documented issue in intensive care units. In surgical intensive care units, more than 90 % of patients were found to be anemic. It is a hematologic factor that contributes to extended mechanical ventilation, sepsis, organ failure, longer hospitalizations in critical care units, and higher mortality. So, screening and identifying associated factors for the initiation of early treatment are recommended before intensive care unit discharge. Objective: To assess the incidence and associated factors of anemia in elective surgical patients admitted to a surgical intensive care unit at Tikur-Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from November 2022 to December 2022. Method: A retrospective cohort involving 422 patients hospitalized to ICU after elective surgery at TASH, Addis Ababa, Ethiopia, was carried out between December 2019 and December 2022.Data was gathered from the patients' charts and study participants were chosen using methods of systematic random sampling. SPSS 26 (the statistical software for social science, version 26) was used to analyze the data. The binary logistic regression was used to examine associations between variables. Finally, variables are significant when their p-value is less than 0.05. Result: The incidence of anemia in elective surgical patients admitted to the ICU was 69.9% (95% CI: 65.4% to 74.5%). ASA class III [AOR: 8.53, 95% CI: 1.92–13.8], renal failure [AOR: 2.53, 95% CI: (1.91, 5.81)], malignancy [AOR: 2.59, 95% CI: (1.31, 5.09)], thoracic surgery [AOR: 4.07, 95% CI: (2.11, 7.87)], urologic surgery [AOR: 6.22, 95% CI: (2.80, 13.80)], and neurosurgery [AOR: 4.51, 95% CI: (2.53, 8.03)] were significantly associated with anemia in ICU admitted surgical patients. Conclusion and recommendation: More than 2/3rds of ICU-admitted surgical patients were anemic. ASA III, renal failure, malignancy, thoracic surgery, urologic surgery, and neurosurgery were significantly associated with it. Early identification helps to institute preventive and therapeutic measures. Anemia is a frequently reported and commonly documented issue in intensive care units. In surgical intensive care units, more than 90 % of patients were found to be anemic. It is a hematologic factor that contributes to extended mechanical ventilation, sepsis, organ failure, longer hospitalizations in critical care units, and higher mortality. So, screening and identifying associated factors for the initiation of early treatment are recommended before intensive care unit discharge. Objective: To assess the incidence and associated factors of anemia in elective surgical patients admitted to a surgical intensive care unit at Tikur-Anbessa Specialized Hospital, Addis Ababa,Ethiopia, from November 2022 to December 2022. Method: A retrospective cohort involving 422 patients hospitalized to ICU after elective surgery at TASH, Addis Ababa, Ethiopia, was carried out between December 2019 and December 2022. Data was gathered from the patients' charts and study participants were chosen using methods of systematic random sampling. SPSS 26 (the statistical software for social science, version 26) was used to analyze the data. The binary logistic regression was used to examine associations between variables. Finally, variables are significant when their p-value is less than 0.05. Result: The incidence of anemia in elective surgical patients admitted to the ICU was 69.9% (95% CI: 65.4% to 74.5%). ASA class III [AOR: 8.53, 95% CI: 1.92–13.8], renal failure [AOR: 2.53, 95% CI: (1.91, 5.81)], malignancy [AOR: 2.59, 95% CI: (1.31, 5.09)], thoracic surgery [AOR: 4.07, 95% CI: (2.11, 7.87)], urologic surgery [AOR: 6.22, 95% CI: (2.80, 13.80)], and neurosurgery [AOR: 4.51, 95% CI: (2.53, 8.03)] were significantly associated with anemia in ICU admitted surgical patients. Conclusion and recommendation: More than 2/3rds of ICU-admitted surgical patients were anemic. ASA III, renal failure, malignancy, thoracic surgery, urologic surgery, and neurosurgery were significantly associated with it. Early identification helps to institute preventive and therapeutic measures.Item Severity of Pain and its Associated Factors Among Trauma Patient at Emergency Department in Selected Public Hospitals: An Institution Based Multi Center Cross-Sectional Study in Addis Ababa Ethiopia, 2023.(Addis Ababa University, 2023-06-11) Yeabtsega Alemayehu; Fissiha FentieTraumatic pain is very high in African countries such as Ethiopia due to the fact that they have no acute traumatic pain management guidelines and are the most neglected. Thus, the current study aimed to describe factors associated with severe trauma pain and to support healthcare professionals in planning actions and programs that prioritize the evaluation and control of trauma victims' pain in emergency units. Objectives: To assess the severity of pain and its associated factors among trauma patients at the emergency department in selected Addis Ababa public hospitals, Ethiopia, 2023. Method: A multi-center cross-sectional study was conducted in selected Addis Ababa public hospitals from February 1 to April 30; 2023.The pain intensity was evaluated at the time of admission to the emergency department within 20 minutes prior to analgesic administration by the data collectors. A numerical rating scale (NRS) was used to assess the pain intensity. The collected data were coded, entered into EpiData version 3.1 and analyzed by SPSS version 26 statistical software. A bi-variable analysis was performed to determine each of the independent variables, and only variables with a P-value < 0.2 were entered into the multivariable analysis. The strength of the association was determined by the odds ratio and its 95% confidence interval. Result: The prevalence of moderate-to-severe traumatic pain in patients who sustained trauma at triage in the ED was 82.3%. Being female(AOR=5.601, 95%CI 1.723-18.2), alcohol consumption (AOR=4.212, 95%CI 1.22–14.4), ambulance transport (AOR=5.763, 95%CI 1.72-19.3), road traffic accident (AOR=7.286,95%CI1.004-52.8), fracture (AOR=5.239,95%CI 1.077-25.4), trauma site (AOR=7.642,95%CI 1.499-38.9) were significantly associated with severe trauma pain in multivariable logistic regression. Conclusion: The current study shows that the prevalence of trauma pain was high in the emergency ward. Therefore, the assessment of moderate to severe trauma pain in the ED could be improved by increasing the use of pain rating scales and identifying factors that are associated with severe traumaItem The Magnitude and Associated Factors of Intra Operative Hemodynamic Change in Patients Undergoing Elective Thoracic Surgery in Selected Government Hospitals: The Institutions-Based Multi-Centre Cross-Sectional Study in Ethiopia, 2023(Addis Ababa University, 2023-06-12) Yisehak Wolde; Hirbo SamuelBackground: Hemodynamic instability, which is an independent predictor of long-term patient morbidity and duration of stay in the hospital. Multiple factors contribute to the development of intraoperative hemodynamic instability. Prevention and treatment of hese factors may reduce patients’ hemodynamic change,and its associated morbidity and mortality.associated factors were blood lose ,co -existing disease ,type of procedure, age and duration of surgery. Objectives: This study aims to assess the magnitude and associated factors of intra-operative hemodynamic change in patients undergoing elective thoracic surgery in TASH, Menilik II referral hospital, and SPSH 2023. Methods: The Institutions-based multicenter cross-sectional study was conducted from 1/2/2023/ to April 30/2023, using -pre-tested, Interviewer questionnaires for 185 patients. This study used a systematic random sampling technique to select the appropriate participant which Selects the sample the regular intervals based on sampling fraction (K). The data was entered into Info 7.2.1 and analysed by SPSS version 26 software performed descriptive statistics and, bivariate and multivariate logistic regression. Result: According to this study, there is a higher magnitude of Intra-operative hypotension which was found to be 40.8% (95%CI: 33.8%-48.2%). Intra-operative blood loss, type of procedure, and pre-existing co-morbidity were positively associated with intra-operative hypotension.The pre-existing co-morbidity like hypertension associated with intra-operative hypertension,the magnitude was found to be 14.4%(95%CI: 8.9%-19.1%).The age and the duration of surgery were associated with intra-operative tachycardia. Overall, the prevalence was 16.6%( 95%CI:10.67%-21.33%).The type of procedure were strongly associated with intra-operative bradycardia. Overall, the magnitude was found to be 14.4%(95%CI:8.9%-19.1%). Conclusion and recommendation:The magnitude of intrao-perative hypotension is high. Some of the identified factors were Blood loss > ABL and the type of diagnosis. Therefore early anticipation and preparation for intraoperative hypotension especially for patient undergoing lung resection and risk of increased blood loss can improve patientItem Comparison of Severity of Lower Back Pain Among Parturient Who Deliver by Cesarean Section Under Spinal Anesthesia Versus General Anesthesia at Gandhi Memorial Hospital Addis Ababa, Ethiopia, 2022/23(Addis Ababa University, 2023-05-22) Mihret Zerefu; Sileshi AbiyLower back pain is a pain at lumbar region, above the sacrum. It is characterized as a dull aching pain which is associated with restriction in spine movement. Globally it is a common complaint during pregnancy and also after delivery. It is still controversial whether spinal or general anesthesia for cesarean section is associated with lower back pain. Considering the increase in cesarean section rates in recent years and the negative impact of this kind of pain on a mother, assessing lower back pain with types of anesthesia delivered will enable to fill the gap in awareness and creates better clinical management strategies. OBJECTIVES: To compare severity of lower back pain among parturient who deliver by cesarean section under spinal anesthesia versus general anesthesia at Gandhi memorial specialized hospital Addis Ababa, Ethiopia, 2022/23. METHOD: An institutional based prospective follow up study was conducted in 80 parturient who deliver with cesarean section under spinal or general anesthesia at Gandhi memorial hospital from December 30 2022, to April 30, 2023. Consecutive sampling technique was used. Data was collected by a pretested questionnaire started from 1st 24 hours postoperative delivery by direct contact and through telephonic communication every week for 1 month. Numeric rating score was used to evaluate the severity of lower back pain. Proportion (incidence) of lower back pain was calculated. Normal distributed variable was compared by using the independent t test. Mann Whitney U test was used for non-normal distributed data. Chi-square test was used to compare the categorical data. A P value of less than 0.05 is considered to indicate statistical significance. RESULT: The overall incidence of lower back pain was 81.25%. Out of 40 parturient under spinal anesthesia group, 34(85%) develop lower back pain whereas under general anesthesia, 31(77.25%) develop lower back pain. Mann Whitney U test show median pain score difference between groups at 24 hour and 1st week after delivery with P value (0.034,0.005) respectively. Age was associated with lower back pain in spinal groups (p value 0.031). Parity and lower back pain during pregnancy were associated with lower back pain in general groups (p value 0.037,0.016). CONCLUSION: The incidence of lower back pain was high both in parturient with spinal and general anesthesia groups. There was significant difference in pain score among the two groups at 24 hour and first week. Age, parity and history of lower back pain during pregnancy were associated with the incidence of lower backItem Effect of Low Dose Intrathecal Pethidine (0.2mg/Kg) Added to Bupivacaine on Prevention Intraoperative Shivering Among Geriatric Patients Undergoing Elective Surgery Under Spinal Anesthesia an Institution Based Prospective Cohort Study 2022/23(Addis Ababa University, 2023-05-30) Abraham Addis; Selamawit AdugnaShivering is one of the most common unpleasant problems associated with spinal anesthesia, causing dissatisfaction and undesirable complications in patients undergoing elective surgery under spinal anesthesia. However, the prevention of shivering has not been thoroughly investigated. This study aims to assess the effect of low-dose intrathecal pethidine on the prevention of intraoperative shivering among geriatric patients undergoing elective surgery under spinal anesthesia. Objective : The objective of this study is to compare the effect of low-dose intrathecal pethidine (0.2mg/kg) added to bupivacaine and bupivacaine alone on the prevention of intraoperative shivering among geriatric patients undergoing elective surgery under spinal anesthesia at St Peter Specialized Hospital from January 1/23 to April 30/23. Methods: A Prospective cohort study was conducted. The study participants were allocated into two groups: those given low-dose (0.2mg/kg) intrathecal pethidine with bupivacaine and those given bupivacaine alone, based on the medication administered by the responsible anesthetist. The data were analyzed using student’s t-test or Mann–Whitney U test, based on the normality of distribution, and the results were presented as mean ± SD. The categorical data were analyzed using the chi-square test, and the results were presented as frequency and percentage. A p-value of less than 0.05 was considered statistically significant. Results: The incidence of shivering was observed to be 72.4% in the non-exposed group and 24.14% in the exposed group, which is statistically significant with a p-value <0.05 (0.0000…). Additionally, there was a stastiscally significant difference the intensity of shivering between the two groups, with p- value of <0.05 (0.003). Conclusion: Administering a low dose (0.2mg/kg) of intrathecal pethidine with bupivacaine is effective in reducing the incidence and intensity of intraoperative shivering among geriatric patients undergoing elective surgery under spinal anesthesia, although it may cause mild pruritus.Item Magnitude of Maternal Satisfaction with Labor Epidural Analgesia Andfactors Associated with it in Selected Health Care Facilities (Black Lionhospital, Korean General Hospital And Grace Maternity and Childrenhospital) in Addis Ababa, Ethiopia, 2023(Addis Ababa University, 2023-06-06) Misgana Tadesse; Getachew JiregnaMaternal satisfaction with childbirth is a complex measure that is influenced by several factors. Among these labor pain management is one factor. There are different methods of labor pain management. Labor epidural analgesia is one method of analgesia. Currently labour epidural analgesia is widely practiced all over the world, and today in many developed countries labour epidural analgesia reflects standard obstetric care. In Ethiopia, over the past few years. labour epidural analgesia is practiced in some health facilities but there is paucity of study regarding magnitude of maternal satisfaction with LEA. Objective: the aim of this study was to determine the magnitude of parturient who are satisfied with labor epidural analgesia and factors associated with it. Methods: A retrospective cross sectional study was conducted between the period of September 2022 to march 2023 among 260 parturient who received labor epidural analgesia in selected health facilities located in Addis Ababa, Ethiopia. Data were collected using an intervie werad ministered structured questionnaire. Demographic, obstetric and anesthetic data were collected. The patient was interviewed by phone call within 6 months of postpartum period. Satisfaction was measured using Likert scale and categorized into satisfied(likert scale 4 and 5) and dissatisfied(likert scale 1upto 3). All demographic and clinical variables presented as categorical variables and summarized in Frequency tables, graph and piechart.Binary Logistic Regression model were applied to do the analysis. Results: 260 parturient were included into the study, of which the magnitude of parturient who are satisfied with Labor epidural analgesia was about 83 percent. High satisfaction was positively associated with on timing of LEA initiation (p-value 0.01, AOR=15.08; 95% CI: 4.97, 25.71), spontaneous vaginal delivery (p- value 0.04, AOR=3.54; 95% CI: 1.25, 10.17) and absence of complication associated with LEA (p-value 0.02, AOR=6.48; 95% CI: 1.75, 12.62). Being housewife (p-value 0.007, AOR= 0.19; 95% CI: 0.10, 0.74) and primipar aous (p-value 0.004 AOR= 0.30; 95% CI: 0.12, 0.822) were associated with patient dissatisfaction.Item 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 HulalaProcedural 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.Item Comparison of The Effectiveness of Neck Circumference to Thyromental Distance Ratio, the Ratio of Height to Thyromental Distance, Upper Lip Bite, and Modified Mallampati Tests to Predict Difficult Laryngoscopy Among Elective Adult Surgical Patients at Addis Ababa Referral Hospitals, Ethiopia Cross-Sectional Study, 2023(Addis Ababa University, 2023-04-29) Alebachew Asmro; Betelihem GirmaThe preoperative assessment determines anatomical features that contribute to difficult laryngoscopy. The magnitude of difficult laryngoscopy ranged from 6% to 27%. Poor patient evaluation can cause unanticipated difficult intubation and severe adverse effects. A variety of tests were used both separately and together, with varying degrees of success. However, it is unclear which of these bedside tests is best at predicting difficult laryngoscopies. Objective: - To compare the effectiveness of neck circumference, neck circumference to thyromental distance ratio, the ratio of height to thyromental distance, upper lip bite, and modified mallampati tests to predict difficult laryngoscopy among elective adult surgical patients at Addis Ababa Referral Hospitals, Ethiopia from February 1 to April 30, 2023 Methods: - The multicentered cross-sectional study was carried out on 190 study participants from February 1 to April 30, 2023. Statistical analysis was done using a chi-square test and a student t-test. A P value of < 0.05 was considered statistically significant. The receiver-operating characteristic (ROC) curves were used to diagnose the significance of predictors of difficult laryngoscopy and the cut-off points. The Diagnostic parameters like sensitivity, specificity, Positive predictive value, and negative predictive value were carried out using crosstabs on SPSS, whereas the positive likelihood ratio, negative likelihood ratio, and accuracy were calculated manually from the descriptive statistics. Result: - The magnitude of difficult laryngoscopy in this study was 13.2%. The cutoff values of Neck circumference, Neck circumference to thyromental distance ratio, and the ratio of height and thyromental distance were >37cm, >4.66 cm, and >22 cm, respectively. The upper lip bit test and the ratio of height and thyromental distance were the most sensitive, specific, high Positive predictive value, and diagnostic accuracy tests (76%, 98.2%, 86.4%, 96.4%, and 95.2%) and (72%, 95.8%, 72%, and 92.6%), respectively. Neck circumference was the least sensitive single test, with a sensitivity of 60%. Conclusion: - The upper lip bit test was the most accurate single test, and neck circumference had the least screening ability for predicting difficult laryngoscopy in the study population.Item Awareness of Labor Analgesia and its Associatedfactors Among Pregnant Women who Had Antenatalcare Follow up at Tikur Anbessa Specialized Hospital,Addis Ababa Ethiopia(Addis Ababa University, 2023-06-22) Henoke Mulu; Bonsa HabuluLabor pain is one of the most severe forms of pain that women experience throughout their lifetime. Many pregnant women in our country don’t ask analgesia for labor pain. This is due to women awareness about the presence of labor pain analgesics is low. Objective: To asses awareness of labor analgesia and associated factors among pregnant women who had ANC follow up at TASH. Methods: An Institutional based cross-sectional study design was conducted among 382 women attending ANC in TASH. Structured, pretested and interview administered questionnaire was used to collect related data. Data were coded and entered in to Epi-Info version 7 and exported to SPSS version 25 for analyses. Bivariate and multivariate binary logistic regression analyses were used to identify independent predictors of awareness of labour analgesia. Odds ratio with 95 % Confidence interval was estimated to identify the predictors of the outcome variables. Statistical significance was affirmed at a p-value ≤ 0.05. Results: A total of 375 women attending ANC TASH were participated in this study making a response rate of 98.1%. A total of 116 (30.9%) 95% CI: (27.5-36.3) women had awareness about labour analgesics. Factors associated with awareness of labour analgesics were; Higher education level (high school education [AOR=3.1, 95%CI: 1.4-7.1], college or university [AOR=9.8, 95%CI: 3.6-26.6]), Urban resident [AOR=5.9, 95%CI: 2.1-17.3], and Information during ANC [AOR= 5. 2, 95%CI: 1.5- 17.1]. Conclusion and Recommendations: We found that the practice of giving information on labor analgesia were low on the ANC clinic and it’s highly associated with women awareness. Therefore, health care providers should practice provision of adequate information about labour pain management to enable women's right of informed decisioItem Incidence and Associated Factors of Early Postoperative hypoxia Among Patients Undergoing Elective Surgery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia(Addis Ababa University, 2023-04-23) Zelalem Getnet; Birhane TesfayHypoxia refers to insufficient oxygen in the blood. Any cause that influences the rate, volume of air entering the lungs (ventilation) or any cause that influences the transfer of air from the lungs to the blood may cause hypoxia. Hypoxia is a major complication in the post-anesthesia care unit (PACU) which is also the leading cause of anesthesia-associated mortality and morbidity. And there are few studies done to determine incidence and associated factors of early postoperative hypoxa in our country for which this study will be additional input in understanding the burden of the problem and its associated factors. Objectives: To assess the incidence of early postoperative hypoxia and associated risk factors. Methods: Institutional-based prospective observational study design was conducted from January 2022 – March 2023. A single population formula was used to estimate the sample size .Data was collected by anesthesiology residents and anesthetists preoperative and intraoperatively and by PACU nurses postoperatively. The collected data was verified, entered coded cleaned and analyzed using SPSS version 25 software. Multiple regression was applied to identify the determinant factors and association declared at p value<0.05. Result: The incidence of early postoperative hypoxia is found to be 32%. Participant whose age ≥50 years (AOR=2.4, 95%CI=1.22, 4.83), BMI 25-24.9 and 30-39.9 (AOR=7.5, AOR=1.78, 31.29 & AOR=15.8, 95%CI=2.90, 86.31 respectively), anesthesia duration taking more than 2 hrs ( AOR=4.3, 95%CI=2.04, 9.24) and estimated blood loss >500ml (AOR=5.2, 9%CI=2.04, 13.46) likely of develop early postoperative hypoxia. Conclusion and recommendation: The incidence of early postoperative hypoxia is significant and knowing the magnitude and paying attention to relevant predictive factors will help the clinician make better clinical decisions to ensure patient safety and postoperative recoveryItem Incidence and Risk Factors of Mortality Among Thoracic Surgical Patients Admitted to Intensive Care Units of Governmental Hospitals in Addis Ababa, Ethiopia: A Multi-Center Retrospective Follow up Study(Addis Ababa University, 2023-06-04) Shitalem Tadesse; Leulayehu AkaluThoracic surgery is a branch of medicine concerned with the diagnosis and surgical treatment of conditions caused by illness or injury to the thoracic cavity. Intensive care unit gives the intense care and life support for critically ill and injured patients. Patients in a thoracic surgery intensive care unit have severe respiratory and hemodynamic instability. The intensive care unit had a high mortality rate. Objectives: To assess the incidence and risk factors of mortality among thoracic surgical patients admitted to the intensive care units of Governmental Hospitals in Addis Ababa from December 2020 to December 2022 G.C. Methods: Multi-center Retrospective follow up study was employed. Two years of patients chart were reviewed from December 2020 to December 2022 in Addis Ababa Hospitals in Tikur Anbessa, Menelik II, and Saint Peter Hospital. All thoracic surgical patients admitted to the intensive care units in the study period were included. 230 patients in the intensive care unit were included. Purposive sampling and simple random sampling technique was used to select the three hospitals and collect the data respectively. The data was collected by using the mobile phone kobo tool box version 2022.3.6. Data were cleaned, checked, and exported into SPSS version 26 for analysis. Bivariate and multivariate logistic regression analysis was done. Finally, a p-value of less than 0.05 in the multivariate logistic regression model was identified. Result: 230 patients' charts were reviewed in the study with giving a response rate of 100%. The mortality rate was 12.61% with a 95% confidence interval of (0.08, 0.17). Duration of ICU stay >7 days (AOR:4.921,95% CI:1.513,16.002), patients who were not managed by thoracic epidural analgesia (AOR:4.338,95% CI:1.439,13.072), low ICU platelet count (AOR:21.289,95% CI:1.347,336.549) and increased blood transfusion requirements (AOR:3.124,95% CI:1.025,9.519) were identified as a risk factor for ICU mortality. Conclusion: The study confirmed that the mortality rates were high. Duration of ICU stay greater than 7 days, patients who were not managed by thoracic epidural analgesia, low ICU platelet count, and increased blood transfusion requirements were risk factors for intensive care unit mortality. Therefore health professionals should be cautious for patients who had prolonged stays in the ICU, apply and trend thoracic epidural analgesia for pain management during thoracic surgery, treat the underlying cause of low platelet count, and apply blood conservation strategies and quantify the amount of blood loss perioperatively.Item Effectiveness of Prophylactic Intravenous Dex-Amethasone for the Prevention of Intraopera-Tive Shivering Following Spinal Anesthesia for Cesarean Section at Gandhi Memorial Hospital, Addis Ababa. Ethiopia 2022/2023 Prospective Cohort Study(Addis Ababa University, 2023-06-12) Moges Kefale; Meron Abrarintraoperative shivering is a commonly seen side effect of spinal anesthesia during cesarean section. Different types of medications like; opioids, non opioid agonists, ketamine were for the prevention and treatment of shivering of shivering but it have serious side effects and ex-pensive. Some studies showed dexamethasone had preventive effect with minimal side effects; however there was a limited study about its efficacy in cesarean section. Objective: to assess the effectiveness of prophylactic intravenous dexamethasone for the preven-tion of intraoperative shivering following spinal anesthesia for cesarean section. Methods: institutional based prospective cohort study was conducted at Gandhi memorial hospital from February 07 to April 08/2023. Ninety eight ASA II parturients undergoing cesarean section under spinal anesthesia were involved in the study. Systematic random sampling technique was used to select study participants from scheduled for cesarean section. Parturients premedicated with 0.1mg/kg dexamethasone before 10 minutes of spinal anesthesia and non dexamethasone groups were followed for 50minutes intraoperatively. The incidence of intraoperative shivering was compared between groups. The data was entered into Epi data v4.6 and analyzed using SPSS version 26 software. Continuous data was checked for normality distribution and analyzed using independent samples t-test. Non-normally distributed data was analyzed using Mann Whitney U test. Chi square and fisher’s exact test were used to analyze categorical data. Descriptive data were displayed using tables and figures. P value < 0.05 was considered as statistically significant. Result: the incidence of intraoperative shivering was 32.1% in dexamethasone group and 67.8% in non dexamethasone group (p value =.000084). There was statistically significant difference in grade of shivering (p value=.044); the result showed; 48.1% had grade 1, 19.2% had grade 2, 0% had grade 3 shivering in dexamethasone group. Whereas, 15.8% had grade 1, 80.7% had grade 2, 1% had grade 3 shivering in non dexamethasone group. Conclusion and recommendation: this study concluded that prophylaxis intravenous dexame-thasone 0.1 mg /kg before 10minutes of spinal anesthesia had effective prevention of intraoperative shivering during cesarean section. We recommend premedication of prophylaxis intravenous dex-amethasone (0.1mg/kg) to prevent intraoperative shivering during cesarean section under spinal anesthesia.Item Comparing the Effectiveness of Dexamethasone, Fentanyl and Morphine as Adjuvants to Intrathecal Bupivacaine for Postoperative Pain in Elective Lower Limb Orthopaedics Surgery at Addis Ababa Public Hospital 2022/2023. Prospective Cohort Study(Addis Ababa University, 2023-06-12) Ali Dimma; Selamawit ShiferawPostoperative pain management during lower limb surgery remained a serious issue despite advances in surgical approach, anesthetic modality, and pain therapy. Spinal anesthesia is the most commonly used anesthetic technique for pain control during orthopedic surgery. The main drawback of spinal anesthesia with bupivacaine is that it only provides analgesia for a brief period of time. Opioids like fentanyl and morphine are commonly used as adjuvants with local anesthetics, while steroids like dexamethasone have lately been studied as an intrathecal adjuvant to lessen disadvantages of spinal anesthesia. Objectives: The main aim of this study was to compare analgesic effectiveness intrathecal morphine versus intrathecal dexamethasone, and intrathecal fentanyl as adjuvant to heavy bupivacaine for management of post orthopedic surgery pain in Addis Ababa hospitals from Dec 1, 2022 to Feb 28, 2023. Methodology: A hospital based multicenter prospective cohort study was employed on 87 patients who undergone elective lower limb orthopedics surgery under SA fulfilling the inclusion criteria. Those who had received bupivacaine with dexamethasone were grouped as (BD-group), those who received bupivacaine with fentanyl were grouped as (BF- group) and those who received bupivacaine with morphine were grouped as (BM- group). The participants in the study were selected by systematic random sampling technique. Data was collected by preoperative chart review, intraoperative observation and postoperative patient interview. The data was entered into SPSS version 20 and analysis of variable was undertaken by using one-way ANOVA, Kruskal- Wallis H- rank test, and ᵡ2 test. Result: The median numerical rating scale score was significantly lower in BD group during early 8 hours after surgery compared to BF group and BM group. The average duration for the first analgesic request was substantially shorter in the BF group compared to the BD and BM groups.; (367.9±65.64), (702.1±72.09), and (667.07±75.3) minutes respectively (p < 0.001). The total tramadol consumption was significantly lower in BD group 50(45-80) compared to BF group 75(55-100) and BM group 70(55-80) with (p<0.05). Conclusion and Recommendation: Use of dexamethasone and Morphine as adjuvant with intrathecal bupivacaine are effective analgesic techniques for lower limb orthopedic surgery for prolonging analgesic period, reducing postoperative pain score and analgesic consumption. We recommend the use of intrathecal dexamethasone with heavy bupivacaine as an alternative to morphine for managing postoperative pain during lower limb surgery in resource limited area.Item Effects of Intravenous Lidocaine and Dexamethasone on the Incidence and Severity of Postoperative Sore Throat in Adult Surgical Patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2023; a Prospective Cohort Study(Addis Ababa University, 2023-08-11) Samuel Belay; Hirbo SamuelSore throat is the common postoperative complaint and uncomfortable side effect in patients receiving general anesthesia with endotracheal intubation. Drugs with analgesic and anti-inflammatory properties, like steroids and local anesthetics, are the best options for postoperative sore throat prophylaxis. Objective: The objective of this study was to compare the effects of intravenous lidocaine and dexamethasone on the incidence and severity of postoperative sore throat following endotracheal extubation in adult surgical patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, from January 1 to March 30, 2023 G.C. Methods: A prospective cohort study was carried out at TASH. Data from 50 patients in the lidocaine, 50 in the dexamethasone, and 49 in the control groups were analyzed. The data were collected using observation based on structured questionnaires. A systematic random sampling technique was applied to select respondents. The data were entered into EpiData version 4.6.0.6 and transferred to STATA version 17 statistical software for analysis. A Comparison of continuous data among the groups were performed using a one-way ANOVA test for parametric data. The Kruskal-Wallis rank test was used for non-parametric data. Associations between variables were tested using chi-squared test, Fisher’s exact test, and binary logistic regression. Bivariable and multivariable logistic regression was used to determine degree of association. Result: The incidence of POST was 40%, 32%, and 57.1% in the lidocaine, dexamethasone, and control groups, respectively (P = .0356). Dexamethasone reduced the incidence of POST (AOR: 0.374, 95% CI: 0.149–0.939). However, no difference was observed in the severity of POST at 3 hours (p =0.130), 6 hours (p= 0.096), 12 hours (p =0.313), and 24 hours (p =.0.525 ) of the post-extubation period among the three groups. IV lidocaine did not effectively reduce the incidence and severity of POST at different time intervals. Conclusion and recommendation: Intravenous dexamethasone is more effective than intravenous lidocaine in reducing the incidence of POST among the groups. Based on these findings, intravenous dexamethasone is recommended to decrease the incidence of POST.Item Comparison of Postoperative Analgesic Effect of Dexamethasone with Bupivacaine versus Tramadol with Bupivacaine in Caudal Anesthesia for Children Undergoing Lower Abdominal Surgeries at Tikur Anbesa Specialized Hospital Addis Ababa, Ethiopia 2022/2023. a prospective cohort study design(Addis Ababa University, 2023-10-16) Hajji Ahmed; Wubayehu AmarePain is a stressful condition that is regarded as a global health issue, with children being the most vulnerable and underserved population. one of the most commonly used regional anesthesia techniques in children is Caudal analgesia despite its limitations.Many adjuvants are used to increase the effectiveness of this block. Currently, tramadol and dexamethasone are commonly used caudal adjuvants that increased the effectiveness postoperative analgesia. Objectives: To compare the postoperative analgesic effect of tramadol with bupivacaine and dexamethasone with bupivacaine for caudal analgesia in elective pediatrics patients undergoing lower abdominal surgery at Tikur Anbessa specialized hospital in Addis Ababa Ethiopia. Material and methods: from February 1 to April 30, 2023 an institutional-based prospective cohort study design was employed at Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia. Comparison of two mean with equal sample size formula for two indepndent cohort studies was used to get a sample size of 64 children age 1-8 years underwent elective lower abdominal surgery. Intraoperative information was gathered by trained anesthetists, whereas postoperative data were gathered by trained nurses. The data were analyzed by independent t-test, Mann-Whitney U test , chi-square & fisher exact test were used to analyzed outcome variable as needed.p-value < 0.05 was considered as statistically significant. Results: Significant differences were observed in terms of time to first analgesic request time which was 15.63±2.22 and 14.14±2.12 in Bupivacaine-Tramadol and Bupivacaine-Dexamethasone group respectively (p=0.02).There also Significant differences in median total analgesia consumption(p=0.005).there was no difference in FLACC score between groups at the 3rd,6th, and 24th postoperative hours(p>0.05). However there was a significant difference in the FLACC score(p=0.002) at the 12th hour between groups. Base line vital sign, PACU hemodynamic parameters were comparable between groups. Conclusion:The patients receiving the combination of Bupivacaine-Tramadol had the lowest dose of Acetamnphon and the longest time until their first analgesic request compared to the Bupivacaine-Dexamethasone groups. combination of bupivacaine-tramadol provides longer analgesia duration and decreases the severity of postoperative pain than bupivacaine-Dexamethasone in a pediatric patient.Item Effect of Priming Principle on the Induction Dose Requirement of Propofol, and its Effect on Hemodynamic Parameter and Pain at Injection Site in Patient Undergoing Electives Surgeries Under General Anesthesia Public Hospital Addis Ababa Ethiopia from February 1 to April 30, 2022/2023,a Prospective Cohort Study(Addis Ababa University, 2023-06-09) Geberehana Gebre; Sulaiman JemalPriming techniques often referred to as auto co-induction is the procedure of delivering a pre-calculated amount of an induction agent prior to administering the full dose of the same agent. The process of inducing of anesthesia is regarded as among the greatest significant instances in the administration of IV agent because it has been linked with a wide range of hemodynamic variations. Several induction agents have been used to induce anesthesia, with propofol gaining popularity due to its pharmacokinetic profile, but its primary drawback was its wide hemodynamic variability, which was mostly dose dependent. In order to preserve the hemodynamic balance during propofol induction, different strategies were used. including concurrent use of N2O, administration of opioids, administration of sedative, and the use of benzodiazepines such as Midazolam, the addition of local anesthetics or magnesium sulphate, and the application of the priming principle).Item Magnitude and Associated Factors of Delayed First Case Starts of Elective Surgeries in Tikur Anbesa Specialized Hospital at Addis Ababa, Ethiopia, 2022/23: a Hospital-Based Cross-Sectional Study(Addis Ababa University, 2023-05-12) Denekew Azene; Geresu GebeyehuBackground: Delayed first-case start in elective surgeries is a frequent occurrence in the operation theatre compared to the official start time. It has a major effect on a healthcare system with a magnitude of 24.8% to 99.3% contributed by a wide range of factors. Identifying the reasons for the delay indicates how to give solutions for delayed first-case surgeriesItem The Effectiveness of Dexamethasone vs Pethidine as Adjuvant with Bupivacaine VS Bupivacaine Alone for Prevention of Post-Spinal Anesthesia Shivering During Cystourethroscopy Surgery in Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia 2022/2023gc Prospective Cohort Study(Addis Ababa University, 2023-05-15) Amana Deko; Misrak W/yohannesShivering is a common complication after spinal anesthesia, particularly in patients undergoing urological surgery under SA. Another study showed that it can also lead to hemodynamic instability, impairing monitoring and worsening patients' conditions by increasing cardiopulmonary workload and lengthening hospital stays, straining the country's economy and putting patients and their families at risk. Intrathecally administered dexamethasone and pethidine are believed to prevent shivering when used as adjuvants with bupivacaine. Objective: To compare the effects of dexamethasone versus pethidine adjuvanted with bupivacaine versus bupivacaine alone on the prevention of shivering after spinal anesthesia and the hemodynamic effect in patients undergoing TURP and TURBT surgery at TASH, Addis Ababa, Ethiopia.