Incidence and Associated Factors of Failed Spinal Anesthesia on Adults Undergoing Elective Surgery in Selected Public Hospitals at Addis Ababa, Ethiopia : A Cross Sectional Study
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Date
2021-06
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Addis Ababa University
Abstract
Background: Spinal anesthesia is the preferred anesthesia technique employed in a variety of surgical procedures. Even though it is safe and reliable technique, the occurrence of failed spinal anesthesia (FSA) may not possibly avoided. Sometimes the failure may have a serious consequence. Study reports on incidence of failed spinal anesthesia vary among countries .Some practitioners assert that an incidence rate of less than one present is attainable. In Ethiopia,
although spinal anesthesia is widely used in a variety of surgical procedure, and failure is observedin a day to day practice, the incidence and associated factors of failed spinal anesthesia is not yet known. In order to minimize the risk of failure, the incidence and the associated factors have to be identified.
Objective: To investigate the incidence and associated factors of failed spinal anesthesia in adults who underwent elective surgery in public hospitals at Addis Ababa, Ethiopia.
Methods: An institutional based cross sectional survey was conducted on 266 eligible adult elective surgical patients from January 31st to April 30th 2021 at selected public hospitals, Addis Ababa, Ethiopia. Systematic random sampling method was employed for selecting samples. Data was entered and analyzed with SPSS version 24. Binary and multivariable logistic regression analysis was done to access significance of factors associated with failed spinal anesthesia. At 95% confidence interval a p-value of less than 0.05 was considered as statistically significant.
Both crude and adjusted odds ratio were calculated to show strength of association.
Results The incidence of FSA among the adult who underwent elective surgery under SA was 21.01% (54/257). In multivariable analysis experience of anesthesia provider of service years less than two (AOR=3.556; 95% CI=1.832-6.905), Bloody CSF (AOR=2.738; 95% CI=1.365-5.491) and
number of spinal attempt greater than two, (AOR=2.919, 95% CI =1.458 –5.846) were significantly associated with failed spinal anesthesia.
Conclusion and Recommendation: The results of this study reveal that the incidence of failed spinal anesthesia at Addis Ababa public hospitals, Ethiopia, is high compared to the results of studies done in other countries. Associated factors identified as significant predictors for failed spinal anesthesia in this study were more of avoidable factors. Hence, first, the anesthesia providers needs to be aware of the high incidence and then they should make the best possible effort to minimize failure by giving due attention to detail at each steps of the technique during procedures. Furthermore, the findings of this study and developments, if any, need to be reviewed with subsequent similar studies.
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Keywords
Failed spinal anesthesia, neuraxial block, Spinal anesthesia, subarachnoid block, intrathecal block