Preoperative investigation practices for elective surgical patients: clinical audit.

BACKGROUND: The findings of pre-operative investigations help to identify risk factors that may affect the course of surgery or post-operative recovery by contributing to informed consent conversations between the surgical team and the patient, as well as guiding surgical and anesthetic planning. Certainly, preoperative tests are valuable when they offer additional information beyond what can be gathered from a patient's history and physical examination alone. Preoperative testing practices differ significantly among hospitals, and even within the same hospital, clinicians may have varying approaches to requesting tests. This study aimed to investigate preoperative testing practices and compare them with the latest guidelines from the National Institute for Health and Care Excellence (NICE). METHODS: This three-month institutionally based study was carried out at the Debre Tabor Comprehensive Specialized Hospital from May 1 to July 30, 2023, including individuals aged 16 years and older who were not pregnant and had undergone elective surgery in the gynecological, orthopedic, and general units. Data on the sociodemographic characteristics, the existence of comorbidities, the invasiveness of surgery, and the tests taken into consideration by the guideline were gathered using a self-administered questionnaire. After rigorously analyzing and revising the results of preoperative investigation approaches, we compared them to the standard of recommendations. Moreover, the data was analyzed and graphically presented using Microsoft Excel 2013. RESULTS: During the data collection period, 247 elective patients underwent general, orthopedic, and gynecological operations. The majority of patients, 107 (43.32%), were between the ages of 16 and 40 and had an American Society of Anesthesiologists (ASA) class one (92.71%). 350 investigations were requested in total. Of these, 71 (20.28%) tests were ordered without a justified reason or in contravention of NICE recommendations. CONCLUSIONS: In our hospital's surgical clinical practice, unnecessary preoperative testing is still common, especially when it comes to organ function tests, electrocardiograms (ECGs), and complete blood counts (FBCs). When deciding whether preoperative studies are required, it is critical to consider aspects including a complete patient history, a physical examination, and the invasiveness of the surgery.

Incidence of unplanned intensive care unit admission following surgery and associated factors in Amhara regional state hospitals.

Unplanned postoperative critical care admission poses a potential risk to patients and places unanticipated pressure on clinical services and it has become an important parameter to assess patient safety in perioperative services. This study was aimed to determine the incidence of unplanned intensive care unit admission following surgery and the associated factors. A multi-center cross-sectional study was conducted on postoperative patients admitted to the ICU of three hospitals located in the Amhara region. Data were collected via a structured survey tool and analyzed using SPSS version 23 software with binary logistic regression analysis. The statistical significance to identify patient, anesthetic and surgical related factors in the preoperative, intraoperative, and postoperative period was < 0.05 for multivariable regression with a 95% confidence interval. Predominantly patients were admitted to the ICU in an unplanned manner. ASA status, preoperative hemoglobin (Hgb) level, intraoperative estimated blood loss, and adverse events occurring in the operating room were significantly associated with intensive care unit admission following surgery. Patients who had a low preoperative Hgb value were 35.1 times more likely to be admitted to the intensive care unit in an unplanned manner compared with their counterparts [(Adjust odds ratio (AOR) 35.16; CI 12.82, 96.44)]. Patients with ASA II and III were 19.4 and 16.2 times more likely to be admitted to ICU in an unplanned way compared to patients who had ASA I physical status [(AOR 51.79; CI 8.28, 323.94) (AOR 67.8 CI 14.68, 313.53)]. Unplanned ICU admission after surgery was high in this study, suggesting poor perioperative planning, risk stratification, and optimization of patients.

Preoperative anxiety and its associated factors among women undergoing elective caesarean delivery: a cross-sectional study.

BACKGROUND: Anxiety is a behavioral expression of tension and unpleasant emotion that arises from multifactorial dimensions that might increase the mortality of patients during anesthesia and surgery. This study aimed to verify the prevalence and associated factors of preoperative anxiety among women undergoing elective cesarean delivery. METHOD: A cross-sectional study design was conducted on a total of 392 patients who underwent elective cesarean delivery in Debre Tabor Comprehensive Specialized Hospital, in North Central Ethiopia from October 15, 2020, to September 15, 2021. Data was collected using a validated Amsterdam questionnaire, after translating to the local language (Amharic). Descriptive statistics were expressed in percentages and presented in tables. Bivariable and multivariable logistic analyses were done to identify factors associated with preoperative anxiety. The statistical significance level was set at P < 0.05 with 95% CI. RESULTS: The overall prevalence of preoperative anxiety in women undergoing elective cesarean delivery was 67.9 [95% CI = (63.0-72.7)]. Participants who came from rural areas [AOR = 2.65; 95%CI: 1.27-5.53], farmers [AOR = 2.35; 95%CI: 1.02-5.40], participants with no previous surgical and anesthesia history [AOR = 2.91; 95%CI: 1.69-5.01], and primiparous women [AOR = 1.69; 95%CI: 1.01-2.83] were more significantly associated with preoperative anxiety. CONCLUSION: The prevalence of preoperative anxiety among elective cesarean deliveries was found to be high. So, preoperative maternal counseling and anxiety reduction services should therefore be given top priority, particularly for those women who came from rural areas, are farmers, have no prior surgical or anesthetic experience, and are primiparous.

Factors associated with knowledge towards postoperative nausea and vomiting management among health professionals in referral Hospitals of Northwest Ethiopia. A multi-center cross-sectional study.

BACKGROUND: Knowledge of health care professionals on postoperative nausea and vomiting (PONV) and antiemetic prescription trends affects patient's outcome after surgery and anesthesia and also patient and family satisfaction. Hence, knowing the knowledge status of health professionals towards PONV management is vital for the optimal care of surgical patients. Therefore, the study aimed to assess the knowledge and factors associated with PONV management among health professionals in referral hospitals of Northwest Ethiopia. METHODS: An institutional based cross-sectional study was conducted on 407 health care professionals from March 1 to 30, 2019. A Simple random sampling technique was used to select the study participants. Both bivariable and multivariable logistic regression analysis were used to identify factors associated with the knowledge level of health professionals on PONV management. In the multivariable analysis, variables with a p-value <0.05 were considered statistically significant. RESULTS: In this study, about 52.8% (95% CI: 47.9, 57.2) of the participants had good knowledge of PONV management. Being male (AOR = 1.95; 95% CI: 1.20, 3.17), Physician (AOR = 5.36; 95% CI: 2.20, 13.5), Anesthetist (AOR = 3.88; 95% CI: 1.66, 9.08), and taking training on PONV management (AOR = 5.32; 95%CI: 1.58, 17.89) were positively associated with good knowledgeable of health professionals about PONV management. CONCLUSION: and recommendation: More than half of health care professionals who are working in the perioperative sites of the referral hospitals had good knowledge about the PONV management. Being male, Physician, Anesthetist and taking in-service training on PONV management were significantly affecting the knowledge level of health professionals on PONV management. Thus, providing regular in-service training on PONV management, especially for physician and anesthetist is highly recommended.

The prevalence of burnout syndrome and its association with adherence to safety and practice standards among anesthetists working in Ethiopia.

BACKGROUND: Burnout amongst healthcare professionals is a serious challenge affecting health care practice and quality of care. The ongoing pandemic has highlighted this on a global level. This study aimed to determine the prevalence of burnout syndrome and its association with adherence to safety and practice standards among non-physician anesthetists in Ethiopia. METHODS: A cross-sectional survey was conducted amongst non-physician anesthetists throughout Ethiopia in January 2020 utilizing an online validated questionnaire containing sociodemographic characteristics, symptoms of burnout using the 22 items of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale, 10 questions designed to evaluate the best practice of providers, and 7 questions evaluating self-reported errors. The MBI-HSS questions assessed depersonalization, emotional exhaustion, and personal accomplishment. A high level of burnout was defined as a respondent with an emotional exhaustion score ≥27, a depersonalization score ≥10, and a personal accomplishment score ≤33 in the MBI-HSS subscales. Bi-variable and multivariable logistic regression were used to identify factors associated with burnout. RESULTS: Out of a total of 650 anesthetists approached, 400 responded, a response rate of 61.5%. High levels of burnout were identified in 17.3% of Ethiopian anesthesia providers. Significant burnout scores were found in academic anesthetists (p = 0.01), and were associated with less years of anesthesia experience (p < 0.001), consuming >5 alcoholic drinks per week (p = 0.02), and parenthood (p = 0.01). CONCLUSION: We found that non physician anesthetists working in Ethiopia is suffering by high levels of burnout. The problem is alarming in those working at academic environments and less experienced.

The efficacy of TAP block versus ilioinguinal block for post-cesarean section pain management: A systematic review and meta-analysis.

BACKGROUND: Controversy still exists regarding the analgesic efficacy of transverse abdominis plane (TAP) block versus ilioinguinal or iliohypogastric (IL/IH) nerve block for postoperative pain management following cesarean section. This meta-analysis aimed to perform relatively credible pooled results on the efficacy of the TAP versus IL/IH nerve block for postoperative pain management after cesarean section. METHODS: Databases such as: PubMed/MEDLINE, Google scholar, and google were systematically searched. studies compared the analgesic efficacy of TAP versus IL/IH nerve block for postoperative pain management following cesarean section were included. Data were extracted by three reviewers independently by using Microsoft Excel and then exported to STATA™ 16 version statistical software for analysis. We used a random-effects model meta-analysis and the mean difference of analgesic efficacy with a 95 â€‹% confidence interval was reported based on Preferred Reporting Items for systematic reviews and meta-analysis (PRISMA). RESULTS: Five studies with a total of 390 (196 in TAP and 194 in IL/IH) study participants were included in this meta-analysis. No statistically significant difference was observed between the TAP and IL/IH groups in time to first rescue analgesic request, total postoperative analgesic consumption in milligrams of intravenous tramadol equivalence, and post pain severity score at different points of time both rest and movement. CONCLUSION: This meta-analysis revealed that both approaches have similar postoperative analgesic efficacy following cesarean section. we recommend that the clinician may consider either approach for post-cesarean section pain management.

Prevalence and associated factors of post dural puncture headache among parturients who underwent cesarean section with spinal anesthesia: A systemic review and meta-analysis, 2021.

INTRODUCTION: PDPH is a headache that develops after dural puncture which worsens in an upright position, and improves with lying down. It could affect maternal satisfaction and health care quality. The prevalence and factors of PDPH vary based on different literature and there is no previous meta-analysis done. METHODS: This study was done by searching studies from databases PubMed/MEDLINE, Google scholar, and google. Data were extracted by three reviewers independently by using Microsoft Excel and then exported to STATA™ 16 version statistical software for analysis. Heterogeneity assessed using the I2 statistic. With a random model meta-analysis, the pooled prevalence of post-dural puncture headache and its associated factors (POR) with a 95% confidence interval was estimated. RESULT: Eight studies with a total of 175, 652 study participants were included to estimate the pooled prevalence of PDPH following cesarean section under spinal anesthesia. The pooled prevalence of PDPH in this meta-analysis was found to be 23.47% with 95% CI (10.53, 36.42). Having normal BMI, multiple attempts of spinal injection and spinal injection with a needle size of less than or equal to 22 gauge were positively associated with the PDPH with AOR and 95% CI of 1.22 (1.09, 1.35), 3.50 (1.55, 5.44) and 7.36 (4.93, 9.80) respectively. CONCLUSION: The pooled prevalence of PDPH among parturients who gave birth with the cesarean section under spinal anesthesia is estimated to be 23.47%. Having normal BMI, multiple attempts of spinal injection, and spinal injection with a needle size of less than or equal to 22 gauge were positively associated with the PDPH.

Educational Resources for Preservice Anesthesia Training Programs in Amhara Region, Ethiopia.

BACKGROUND: Across low and middle-income countries, shortages of essential equipment, supplies, and human resources in health training institutions pose a problem to educational program delivery. With the rapid expansion of anesthesia training programs to address the shortages in anesthesia workforce, the need for educational resources has also grown. This study sought to evaluate the availability of educational resources within anesthesia degree programs in Ethiopia. METHODS: Utilizing the Higher Education Relevance and Quality Agency of Ethiopia standards, a questionnaire survey was designed and distributed to schools of anesthesia in the Amhara region. A total of 96 standard indicators were used to assess the attainment of preservice educational resources for non-physician anesthesia degree programs, of which 71 (74%) were basic standards and 25 (26%) were standards for quality improvement. RESULTS: Two of the six institutions delivering anesthesia training in the Amhara region responded to the questionnaire. Neither the basic nor the quality improvement standard requirements for educational resources were completely achieved in any category of classrooms, offices, skills laboratory, clinical practice site, information technology facilities, library, student amenities, or financial resource. The target achievement rate was 50% or below in all but one category (clinical practice site). CONCLUSION: Educational resources for responding preservice anesthesia training programs in the Amhara region of Ethiopia are inadequate and below the required national standards. Expansion of anesthesia training programs should be accompanied by the necessary resources for high quality program delivery and to ensure quantity does not compromise on quality.

A cross-sectional survey of COVID-19 preparedness in governmental hospitals of North-West Ethiopia.

INTRODUCTION: The novel coronavirus was first reported in December 2019, from Wuhan, China, and it has been declared as a pandemic by World Health Organization on 7 January 2020, and from that time till now the disease transmitted across the world. Hospitals need to be prepared for the overwhelming COVID-19 cases in their respective hospitals. OBJECTIVES: The objective of this study was to assess the level of hospital preparedness for COVID-19 in South Gondar Zone Governmental Hospitals, 2020. METHODS: The institutionally based survey was conducted in South Gondar Zone Hospitals from 20 July to 25 July 2020. We used the World Health Organization preparedness checklist for COVID-19, and the checklist has three options for eight hospitals (not started, in progress, and started), so each hospital evaluated out of 208 points (104 items × 2) to assess each hospital their preparedness based on the checklist. Statistical Package for the Social Sciences, Version 21, is used for the analysis of the data. We used descriptive statistics and explained by using text and tables. RESULTS: We evaluated all eight hospitals in these zone hospitals and only one hospital was in an acceptable level of preparation (>146 points), three hospitals were in an insufficient level of preparation (73-145 points), and the other four hospitals were grouped under the unacceptable level of preparation (<72 points) for COVID-19. And in all hospitals, there was no laboratory diagnostic method and treatment center for the COVID-19 virus. CONCLUSION: From the level of COVID-19 pandemic preparation from eight hospitals, only one hospital reaches the level of an acceptable level of preparedness. Mobilizing the community and other stakeholders to equip the hospital with resources and prioritization is recommended to mitigate the impact of COVID-19.

Frequency of ABO and Rh Blood Group Distribution at Debre Tabor Blood Bank, Amhara Region, North-Central Ethiopia. A Six-Year Retrospective Survey.

INTRODUCTION: Blood is arranged into four groups based on their surface antigen (A, B, AB, and O). In addition to this classification based on the Rhesus factor, each blood group clustered into RH positive and RH negative. This study was done to identify the distribution of blood group and rhesus factors on the local blood bank. OBJECTIVE: To identify the frequency of ABO blood group and RH factors distribution on voluntary blood donator at Debre Tabor blood bank from May 2014 to May 2020. METHODS: A retrospective cross-sectional survey was conducted to identify the frequency of ABO and Rh factor distribution on voluntary blood donors at Debre Tabor town blood bank. The data was collected at Debre Tabor blood bank. A six-year data and a total of 19,901 bags collected blood samples were used for summarization of the data. The data was analysed by using SPSS version 21. RESULTS: Blood group "O" was the dominated one with 39.6% followed by blood group "A", "B" and "AB" with 29.48%, 24.06%, and 6.7%, respectively. When we see the RH classifications, RH positive accounts the highest percentage 92.77% and the remaining 7.23% was Rh negatives. CONCLUSION: In this survey, the majority of blood groups were found "O" followed by "A", "B", and "AB". Among the collected blood unities, 92.77% was RH positive. The leading blood donators were male.

Magnitude and Associated Factors of Awareness with Recall under General Anesthesia in Amhara Regional State Referral Hospitals, 2018.

INTRODUCTION: Awareness with recall of intraoperative events is an infrequent but potentially devastating complication of general anesthesia, with a reported incidence of 0.1-0.2% in low-risk patients. Higher incidence is expected in resource-limited operation room setups and in high-risk patients. Awareness can result in significant distress to patients and long-term psychological consequences, including symptoms associated with posttraumatic stress disorder, anxiety, night mares, night terror, dissatisfaction with surgical service, and sometimes even suicide. OBJECTIVE: To assess the magnitude and associated factors of awareness with recall under general anesthesia in Amhara regional state referral hospitals. METHOD: An institution-based cross-sectional study was conducted on 1065 patients who underwent surgery under general anesthesia from January 1 to June 30, 2018. The study participants were selected by systematic random sampling from 4 referral hospitals. The modified Brice questionnaire was used to detect awareness under general anesthesia. Interviewer-administered structured questionnaire and chart review were employed. Data with complete information were entered in to SPSS version 20 computer software. Descriptive statics and bivariate and multivariable analysis were computed. A P-value less than 0.2 was used to select candidate variables for multivariable logistic regression. A P-value less than 0.05 was used to declare statistical significance. RESULT: 1065 patients were included in the study which makes the response rate of 90.7%. The magnitude of awareness with recall under general anesthesia was found to be 8.2% of which 4.9%, 2.6%, and 0.7% of patients reported hearing voice, pain, and sensation of breathing tube, respectively. Lack of premedication was the only significantly associated factor for awareness with recall under general anesthesia (AOR = 3.014, 95% CI (1.201 to 7.565)). CONCLUSION AND RECOMMENDATION: Our study showed higher magnitude of awareness with recall under general anesthesia. Lack of premedication was the only associated factor with awareness with recall under general anesthesia. Anesthetists should give emphasis to prevent the possibility of awareness under general anesthesia by providing premedication. Cohort studies should be done including the consequences of awareness with recall under general anesthesia.