Adverse events during anaesthesia at an Ethiopian referral hospital: a prospective observational study.

INTRODUCTION: incident reporting systems are widely utilised within healthcare to analyse adverse events and have been shown to reduce patient harm. With data to suggest high anaesthetic-related mortality in low and middle-income countries (LMICs), such systems could allow more accurate determination of rates and types of incidents and could improve patient safety. METHODS: this prospective observational study carried out over six-weeks in March to April 2019 in an Ethiopian tertiary referral hospital, included direct observations in the operating room and recording of any anaesthesia-related adverse events occurring during the perioperative period. RESULTS: fifty surgical cases were observed during weekday daytime hours. Sixteen anaesthesia-related adverse events were observed in 12 patients, including six elective cases and six emergencies, an adverse event rate of 32% (n=16), affecting 24% (n=12) of patients. Most incidents occurred in infants less than one-year-old and those between 11-20 years (31.3%; n=5 each) and those undergoing general anaesthesia (66.7%; n=8), particularly during the induction phase (50%; n=8), the most common event being prolonged desaturation (31.3%; n=5). Most events were considered to contribute a low level of harm (56.3%; n=9). There were no intra-operative mortalities. CONCLUSION: this study presents evidence of a higher rate of adverse events during anaesthesia at a tertiary referral hospital in Ethiopia, than reported in current literature from LMICs. There is potential for large volume data to be produced and learnt from with a reporting system in place in this setting. The most common event was desaturation detected by pulse oximetry, particularly in paediatric surgery.

Anaesthesia practices for Caesarean section amongst non-physician anaesthesia providers at an Ethiopian referral hospital.

Sub-Saharan Africa faces high rates of maternal mortality and there is an urgent need to reduce this. Shortfalls in access to safe surgery and anaesthetic care result in avoidable maternal death. Providing quality training to anaesthesia providers is of key importance to reduce mortality. This mixed-methods prospective study incorporated workplace observations of anaesthesia for Caesarean section, a paper-based questionnaire and semi-structured, face-to-face interviews in Felege Hiwot Referral Hospital in Ethiopia.A total of 67 Caesarean section cases under spinal anaesthesia provided by 12 non-physician anaesthetists were observed and a 92% (n = 11) response rate to questionnaires obtained. Deficiencies were observed in communication, pre-operative assessment, spinal height evaluation and application of lateral tilt, while interviews revealed anaesthesia provider perceptions of hierarchy within the surgical team and deficiency in anticipation of potential complications. This study suggests that focusing on communication and anticipation of complications could aid providers in preventing and preparing for complications.

A case of total spinal anesthesia.

INTRODUCTION: In situations where the time to delivery is urgent, but not critical within minutes, and otherwise contraindicated spinal anesthesia is the safer option of avoiding the risks and complications of general anesthesia, mainly difficult airway and risks of pulmonary aspiration. CASE PRESENTATION: A 35 years old woman (Gravida-7, para 6) having an emergency cesarean section under spinal anesthesia for the indication of cephalopulvic disproportion (CPD). Spinal anesthesia given at L3/L4, with a sensory block of T-4, the fetus delivered uneventfully. Meanwhile, the mother complains difficulty of breathing, developed hypotension, bradycardia, hypoxia, and loss of consciousness. Immediate maternal resuciation done with vasopressor support, endotracheal intubation, and mechanical ventilation. Over a week, the patient progressively regained motor and sensory functions and discharged without any neurological or clinical sequelae. DISCUSSION: Total spinal anesthesia is an uncommon incident that can happen during epidural anesthesia, caudal anesthesia, spinal anesthesia, lumbar plexus block, paravertebral block, stellate ganglion block, interscalene brachial blocks, and other regional anesthesia techniques performed at or near to the vertebral column. Often characterized by a sudden decrease in blood pressure, rapidly increasing motor block, difficulty of breathing, loss of consciousness, dilated pupils, apnea, and even cardiac arrest. CONCLUSION: Unexpected total spinal anesthesia during neuraxial anesthesia can produce devastating consequences. Precautionary measures should be made during the conduct of regional anesthesia for high-risk patients and early identification and immediate intervention should be applied.

The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study.

SummaryReducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia.We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018.Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline (n = 101, 69% response rate). Pre- and post-course MCQs (n = 121, n = 123 respectively) and pre- and post-course skills tests (n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up (n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training (P < 0.0001) and skills test scores improved from 56.5% to 83.2% (P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3-11 months post-training compared to baseline (P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up.This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.

Determinants of blood transfusion for elective surgical procedures at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2017.

BACKGROUND: Till date 80% of the world's population has access to only 20% of the world's safe blood that is properly collected and tested. Paradoxically, despite a severely inadequate supply, blood is often transfused unnecessarily and it will expose patients to complications. Despite lots of publication and investigation on the efficiency of blood usage, there is no clear demarcation which patients really need blood transfusion. OBJECTIVES: To determine factors associated with blood transfusion in elective surgical procedures in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2017 G.C. METHODS: Hospital based cross sectional study was conducted from February 1, 2017 to September 30, 2017 G.C at Tikur Anbessa specialized Hospital. Data was collected by using convenient sampling technique and structured checklist. 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 387 elective surgical patients 88 (22.7%) of patients were transfused with prepared blood. The independent predictors of perioperative blood transfusion were neurosurgery (craniotomy) (p = 0.017), hemoglobin level < 11.0 g/dl (p < 0.001) and intraoperative blood loss ≥ 15% (P < 0 0.001). CONCLUSION: neurosurgery, hemoglobin <11.0 g/dl and intraoperative blood loss ≥15% were the major determinants of blood transfusion.