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Background: Approximately 1-2% of pregnant women undergo non-obstetric surgery under anaesthesia during their pregnancy. This review specifically targets anaesthesia management for pregnant women undergoing non-obstetric surgery in resource-limited settings. Methods: Following the delineation of primary questions, scope, and inclusion criteria, a comprehensive search strategy utilizing advanced techniques was implemented across electronic sources, databases, and websites to identify relevant articles. A rigorous screening process was applied during the literature evaluation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement guided the conduct of this review, ensuring adherence to standardized reporting practices. Results: A total of 240 articles were initially identified from databases and websites. After screening titles and abstracts, 85 papers were excluded, and an additional 43 were removed due to duplication. Subsequently, 68 items were subjected to eligibility screening. Finally, 30 papers that specifically addressed anaesthetic considerations for pregnant women undergoing non-obstetric operations were reviewed. Conclusion: Thorough preoperative evaluation is essential for all patients, with particular attention to modifications in anaesthetic management to accommodate physiological changes during pregnancy. Urgent and emergent surgeries should proceed promptly during pregnancy to optimize outcomes for both the mother and foetus. Maintaining uteroplacental perfusion generally involves avoiding maternal hypoxaemia, hypotension, hyper- and hypocapnia, temperature extremes, and stress. When deemed safe, regional anaesthesia may offer favourable outcomes for both the mother and foetus.
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Background: Caesarean section is one of the most common procedures and clinician faces dual challenges with feto-maternal morbidity and mortality after caesarean delivery. Enhanced recovery after caesarean delivery protocols might effectively reduce postoperative feto-maternal morbidity and mortality. Therefore, this study aimed to assess practice of enhanced recovery after caesarean delivery among parturients who underwent elective caesarean delivery. Methods: A cross-sectional study design was conducted from March to June 2021 on 225 consecutive parturients scheduled for elective caesarean delivery. A semi-structured questionnaire which developed from Society of Obstetric Anesthesia and Perinatology, evidence-based recommendations regarding enhanced recovery after a caesarean (2020) to collect data. Data was collected through direct observation, reviewing the chart, and patient's interview. Data were entered and analyzed in SPSS version 20. Result: Preoperative pathway; limit fasting interval (91%), haemoglobin screen and optimization (82%), and patient education (100%) found good Areas of practice Intraoperative pathway; administering postoperative nausea and vomiting prophylaxis (100%), fluid optimization (88%), neuraxial anaesthesia with a neuraxial opioid (91%), initiating multimodal analgesia (88%), optimal uterotonic administration (88%), delayed umbilical cord clamping (85%), and prophylactic antibiotic (100%) found areas with good areas of practice. Postoperative pathways; initiation of multimodal analgesia (74%) and early removal of the urinary catheter (62%) were found areas good areas of practice. Conclusion and recommendation: The overall practice of enhanced recovery after caesarean delivery was below the target. The authors recommend that this comprehensive and specialized hospital administrator implement enhanced recovery after caesarean delivery protocol and give short-term training for health professionals' about the protocol.
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BACKGROUND: The present study aimed to assess variables associated to ICU-mortality among patients admitted to surgical intensive care unit in Ethiopia. METHODS: A Hospital-based retrospective follow-up study was conducted on all patients who were admitted to the surgical intensive care unit. Data were extracted from patients' charts with a pretested data extraction tool, entered into Epi-data 4.6.0, and analyzed with STATA- 14. Bivariate and multivariate Cox proportional hazards regression models were fitted. RESULTS: Of the total study participants (388), 148 (38.1%) patients admitted to the surgical intensive care unit died during the follow-up period with a median survival time of 11 days. Potassium level < 3.5 mmol/L (adjusted hazard ratio ( AHR): 3.46, 95% CI (1.83 6.55), potassium level > 5.0 mmol/L (AHR:2.41, 95% CI (1.29-4.51), hypoxia (AHR:1.66, 95% CI (1.10-2.48), Glasgow Coma Scale (GCS) score < 9 (AHR: 4.06, 95% CI (1.51-10.89), mechanical ventilation (AHR:12, 95%CI (3-45), absence of thromboprophylaxis (AHR:10.8,95% CI (6.04-19.29), absence of enteral feeding (AHR:3.56, 95% CI (2.20-5.78) were variables associated with ICU-mortality among patients admitted to surgical intensive care unit. CONCLUSIONS: The overall ICU-mortality of patients admitted to our surgical intensive care unit was higher compared to patients admitted to similar intensive care unit in developed countries. The variables associated to ICU-mortality among patients admitted to surgical intensive care unit were abnormal serum potassium level, lower GCS score, mechanical support, hypoxia, absence of thromboprophylaxis, and enteral feeding.
Subject(s)
Anticoagulants , Venous Thromboembolism , Humans , Ethiopia/epidemiology , Follow-Up Studies , Retrospective Studies , Intensive Care Units , Hypoxia , Critical CareABSTRACT
The mode of delivery influences breastfeeding practice. Moreover, cesarean deliveries under anesthesia-related risk factors affect the timing of breastfeeding initiation compared to vaginal deliveries. In addition, high rates of cesarean section (CS) deliveries and low breastfeeding rates are important public health concerns for all developing countries. Objective: This study aimed to determine the timely initiation of breastfeeding and its factors among women delivered via CS under spinal anesthesia. Methods: Institutional-based cross-sectional study was employed among 422 systematically selected mothers from April to June 2021. Data were collected by a structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Binary logistic regressions were computed to identify factors. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare statistical significance. Results: Delayed initiation of breastfeeding (DIBF) was 41.8%. Mothers who had an emergency CS (AOR =2.13, 95% CI [1.21-3.75]), had less than four antenatal care (ANC) follow-ups (AOR=1.77, 95% CI [1.02-3.13]), had moderate to severe pain during the perioperative period (AOR=2.65, 95% CI [1.24-5.54]), primipara (AOR=1.89; 95% CI [1.20-3.25]), used intraoperative opioid medications (AOR=1.86; 95% CI [1.01-3.30]), and had no skin-to-skin contact (AOR=2.1, 95% CI [1.27-3.51]) were associated with DIBF. Conclusion and recommendation: DIBF after cesarean delivery was high. Emergency CS, less than four ANC visits, immediate postoperative pain, and lack of skin-to-skin contact were factors associated with delayed breastfeeding. Health care providers, especially anesthetists, in the operation theater, should implement multimodal analgesics and minimize opioid consumption. Moreover, they should keep the newborn in skin-to-skin contact to initiate breastfeeding in the operation theater soon after birth.
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Background: Airway management outside the theatre is performed either to resuscitate a physiologically unstable critically ill patients or to secure an emergency airway in the absence of essential equipments. It is a life saving procedure for critically ill and injured patients. Delaying in securing airway or awaking the patient is not an option in case of difficult airway in intensive care unit. Therefore, developing and implementation of an evidence-based airway management protocol is important. Objective: This review was conducted to develop a clear airway management protocol for a critical ill patient in medical intensive care unit. Methods: After formulating the key questions, scope, and eligibility criteria for the evidences to be included, a comprehensive search strategy of electronic sources was conducted. The literatures were searched using advanced searching methods from data bases and websites to get evidences on airway management of a critical ill patient. Duplication of literatures was avoided by endnote. Screening of literatures was conducted based on the level of significance with proper appraisal. This review was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement. Results: A total of 626 articles were identified from data bases and websites using an electronic search. Of these articles, 95 were removed for duplication and 305 studies were excluded after reviewing their titles and abstracts. At the screening stage, 79 articles were retrieved and evaluated for the eligibility. Finally, 40 studies related to airway management of a critical ill patient in medical ICU were included in this systematic review. Conclusion: A critical ill patient needs oxygenation and ventilation support. A focused and rapid assessment, with special attention of the airway and hemodynamic status of the critical ill patient is paramount. An appropriate airway management option should be employed to resuscitate or to control an emergency airway of a critical ill patent. This could be non invasive ventilation or invasive airway intervention.
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BACKGROUND: The main goals of paediatric sedation/general anesthesia vary according to the specific imaging procedure, but generally includes anxiety relief, pain control and control of excessive movement. The quality of magnetic resonance imaging (MRI) and computed tomography (CT) depends largely on immobility of the patient during the procedure, which is often difficult to achieve without sedation in children. Sedation is the depression of the central nervous system and reflexes by the administration of drugs. Brain imaging is routinely used to identify stroke, hemorrhage, and structural abnormalities. All patients undergoing procedural sedation and those receiving general anesthesia should be evaluated equally. AIM: The study aimed to perform a clinical audit of sedation and analgesia practices for magnetic resonance imaging and computed tomography compared against the guidelines/standards to determine if practice meets the standards and identify areas of non-compliance at a teaching Referral Hospital in Ethiopia. METHODS: This clinical audit was conducted from January 1 to May 30/2020 for 5 months at a teaching Referral Hospital in Ethiopia. All children below the age of 6 years underwent MRI and CT imaging procedures under sedation during a study period were included. Data were collected through direct observation using checklists of standards by a trained data collector. Descriptive statistics were presented with tables, graphs of sums and percentages of items using SPSS version 20. RESULTS: A total of 40 children underwent MRI and CT imaging were observed at the Hospital imaging sites. Among the 20 standards, 6 of them had 100% compliance rate, 3 of the standards had 0% complaince rate and 11 of the standards had the compliance rate of between 0 and 100%. CONCLUSIONS AND RECOMMENDATIONS: In general, even though the practice guidelines of procedural sedation for MRI and CT recommend to practice procedures based on the standards, this study showed there were a number of standards that had <100% compliance rate. Therefore, it is recommended that staff should adopt standards or locally prepared protocols for their day-to-day practice.
