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Belete Muluadam Admassie, Biruk Adie Admass, Debas Yaregal Melesse Department of Anesthesia, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, EthiopiaCorrespondence: Biruk Adie Admass, Email birukadie@yahoo.comBackground: Patients undergoing surgery frequently experience unfavorable anesthetic outcomes. They may have an impact on body systems and result in more serious postoperative morbidities. This study was conducted to determine the incidence of postoperative undesirable anesthetic outcomes among surgical patients at referral hospitals in Amhara region, Ethiopia.Methods: A total of 412 patients, who underwent surgical procedures between August 1 and October 30 of 2022, were included in this study. The Leiden Perioperative Care Patient Satisfaction Questionnaire’s (LPPSq) dimension “discomfort and needs” was used to collect data on the first postoperative day. Data entry and analysis were performed using SPSS version 20. To assess how risk factors affected the outcome variable, logistic regression analysis was utilized. In multivariable logistic regression analysis, a variable with a P-value of less than 0.05 was statistically considered as significant.Results: The proportion of those who had “at least a little bit” of unfavorable outcomes was calculated to estimate their overall prevalence, and the prevalence of those who had “more than moderate” levels of unfavorable outcomes was determined to appreciate how severe these outcomes were. The percentages of postoperative pain, the most common undesired result, for “at least a little bit” and “more than moderate” were 87.7% and 32.3%, respectively. In this study, postoperative cold was the least prevalent (51.4%) undesirable anesthetic outcome. The remaining undesirable postoperative outcomes were reported less frequently.Conclusion and Recommendation: Undesirable postoperative anesthetic outcomes were still common. The most frequent unfavorable result was postoperative pain. Adequate postoperative patient follow-up and quality service are paramount.Keywords: undesired anesthetic outcome, postoperative complication, postoperative outcome, surgery, anesthesia

Background. Patient satisfaction is a crucial component in determining the quality of healthcare in anesthesia services. This study aimed to assess patient satisfaction and associated factors on perioperative anesthesia services. Methods. Institutional-based cross-sectional study was conducted from May 16 to June 22, 2021, at the University of Gondar Comprehensive Specialized Hospital. Data were entered into Epi-data version 3.1 and exported to STATA version 14.1. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval, and a p value

Emergence delirium is a poorly understood incident in elderly patients in PACU. The aim of this study was to determine the incidence of emergence delirium and its predictors in elderly patients after general or spinal anesthesia for both elective and emergency surgery.In this prospective observational study, 172 consecutive patients were included. The study was performed in the post-anesthesia care unit for three months in 2020. We included elderly patients in both elective and emergency surgery. Patient interviews, chart reviews, and direct observation were among the data collection methods. The Nursing Delirium Screening Scale was the assessment tool. The outcome variable and independent variables' association was determined by bivariate and multivariate logistic regression analysis.The incidence of emergence delirium at the post-anesthesia care unit was 40.7% (95% CI = 32-48).Postoperative pain (AOR = 3.9:95%CI = 1.13-13.60), preoperative anxiety (AOR = 7:95% CI = 1.76-28.55), perioperative narcotics (AOR = 5.1:95% CI = 1.27-20.57) and excessive blood loss (AOR = 6.5:95% CI = 2.47-17.02) were predictors of emergence delirium.Delirium in the post-anesthesia care unit is common. Anxiety, perioperative narcotics, and intraoperative blood loss were predictors of emergence delirium.

Background One of the challenge to manage long bone fracture is the risk of infection. Intramedullary nailing is the standard treatment of long bone shaft fractures. Infection from the surgical site during orthopedic management is posing postoperative burdens in different perspectives like patient perspectives and healthcare facilities. However, there is limited information on the magnitude of infection in Ethiopia after surgical implant generation network (SIGN) nailing in the treatment of long bone shaft fractures. Therefore, the current study aimed to assess the prevalence of infection in patients with long bone shaft fractures treated with surgical implant generation network (SIGN) nailing. Objective To assess prevalence of infection in patients with long bone shaft fractures treated with SIGN nailing at Felege Hiwot Referral Hospital from January 1, 2015, to December 31, 2018, Bahir Dar, Northwest, Ethiopia. Methods This was a retrospective study over a period of 4 years. SIGN surgical-related data, presence or absence of infection from the documented information were collected from the chart/the source. The types of infection were also collected with the standard classification as superficial, deep and deep with osteomyelitis. Age, sex, fracture pattern, nature of fracture, mechanism of injury, prophylaxis antibiotics, nail type, follow-up in weeks and other factors were also extracted from the patients’ charts with structured checklist. Data were analyzed with statistical package for social sciences (SPSS) version 23. The analyzed data were presented with texts, tables and a graph. Results Three hundred and eighty-two long bone fractures were treated by locked SIGN intramedullary nailing during the study period. After screening the inclusion criteria, a total of 311 cases were included in this study. A total of 13 (4.2%) patients who treated with SIGN intramedullary nailing developed infection. Conclusions We conclude that the overall prevalence of infection with SIGN intramedullary nailing is almost similar with the surgeries done in the developed countries.

Background Clubfoot is a common congenital deformity affecting mobility of children. It leads to pain and disability. The Ponseti treatment method is non-surgical method for the correction of clubfoot. There is variation from country to country in how the result of clubfoot management is measured and reported. This study aimed to assess the 5-years results of the Ponseti method in the treatment of congenital clubfoot which was performed for children aged under 2 years in western Amhara, Ethiopia. Objectives The objective of this study was to assess a 5-years results of the Ponseti method in the treatment of congenital clubfoot among under 2-years old children in Felege Hiwot Referral Hospital, Bahir-Dar, Ethiopia, from 2015 to 2019 G.C. Methods A facility-based retrospective cross-sectional study was conducted. After receiving letter of ethical clearance from the University, IRB board, the data were collected from medical record/charts of patients’ who received Ponseti treatment, and the collected data were entered and analyzed with Statistical Package for Social Sciences version 21. The results were presented with texts and tables. Results A total of 200 children with 256 congenital clubfeet involved in the study. Among the total study subjects, 143 (71.5%) had unilateral clubfeet. The 5-years results of the Ponseti method in the treatment of congenital clubfoot conducted in 200 children with clubfeet were 187 (93.5%) with 95% (CI 90–99.5). Among the study participants, males were 66.5% (almost two times from females). Conclusions and recommendations According to the results from a 5-years data showed that the Ponseti method in the treatment of congenital clubfoot was successful with a success rate of 93.5%. We recommend that children with congenital clubfeet should be managed with Ponseti treatment method timely.

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.This review was conducted to develop a clear airway management protocol for a critical ill patient in medical intensive care unit.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.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 reviewA 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.

Thyrotoxicosis is a clinical syndrome produced by a multitude of disorders. Thyrotoxicosis is a serious medical condition that, if left untreated, can lead to a fatal illness. This review of recent evidences give additional input for perioperative management of thyrotoxic patients.The literatures were found with Boolean operators in the form of thyrotoxicosis AND anesthesia, antithyroid medications AND perioperative optimization AND beta blockers OR calcium channel blockers in electronic data base sources such as the Cochrane library, PubMed, and Google scholar. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement.and recommendations: Before surgery and anesthesia, manifestation of thyrotoxicosis including palpitation, irritability etc should be ruled out.

Muleta Teshome Assefa, Wubie Birlie Chekol, Debas Yaregal Melesse, Yonas Addisu Nigatu Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Northwest Ethiopia, EthiopiaCorrespondence: Wubie Birlie Chekol Email birliewubie@gmail.comIntroduction: Emergence delirium is a common incidental trouble in elderly patients that may interfere with patient recovery and will challenge the attending staff. So, we aimed to determine the incidence and risk factors of emergence delirium after anesthesia in elderly patients at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), Post Anesthesia Care Unit (PACU).Methods: A prospective observational study was conducted from February 20 to May 20, 2020 among elective and emergency procedures in patients aged 60 years and over at UOGCSH, PACU. Data were analyzed by SPSS version 20. The association between outcome variables and independent variables was determined by binary logistic regression analysis. The strength of association of variables was determined by calculating crude and adjusted odds ratio with 95%CI. A P-value of < 0.05 was used to determine the significance of the variable.Results: A total of 172 patients were included with a 97.7% response rate. The incidence of emergence delirium at PACU was 40.7% (95%CI: 32– 48). Perioperative intravenous narcotic used (AOR: 5.1, 95%CI: 1.265– 20.565), intraoperative excessive blood loss (AOR: 6.5, 95%CI: 2.47– 17.02), and preoperative anxiety (AOR: 7, 95%CI: 1.757– 28.549) were significantly associated with emergence delirium.Conclusion: Perioperative intravenous narcotic, intraoperative blood loss, and preoperative anxiety were significantly associated with emergence delirium. Reassuring patients preoperatively, giving full information about anesthesia and adequate postoperative pain management may decrease the magnitude of emergence delirium.Keywords: delirium, emergence delirium, incidence and associated factors, postanesthesia care

Administering oxygen therapy has an essential role in preventing and managing hypoxemia in both acute and chronic conditions. The aim of this study was to assess knowledge, attitude and factors associated with oxygen therapy for critically ill patients among nurses.An institutional-based cross-sectional study was conducted from May 23 to June 07 at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, in 2021. A self-administered, structured and validated questionnaire was used. It has socio-demographic characteristics, multiple choice questions, items that measure the possible associated factors and items that were used to assess the level of knowledge and attitude. Epi Data ("The EpiData Association" Odense, Denmark) version 4.6 was used to enter data, and SPSS (IBM) version 20 was used to analyze it. Both bivariate and multivariate logistic regression analyses were used to identify associated factors. Variables with a p value 0.05 were considered statistically significant.The overall proportion of critically ill patients with good knowledge and a positive attitude toward oxygen therapy was 33% (95% CI: 25.8-37.8) and 53.8% (95% CI: 49-59), respectively. Age (AOR; 1.738, 95% CI: 1.034-2.921), level of education (AOR; 7.731, 95% CI: 2.507-23.846) and guideline (AOR; 4.338, 95% CI: 2.233-8.428) and good level of practice (AOR; 1.885, 95% CI: 1.173-3.030) were discovered to be significant factors associated with good knowledge towards oxygen therapy and the reading guideline was found to be a significant factor associated with a positive attitude toward oxygen therapy (AOR; 1.396, 95% CI: 0.830-2.348).and recommendations: The level of knowledge was low, whereas the attitude of nurses was positive towards oxygen therapy. Reading guidelines, older aged nurses, master holder nurses, and good practice were significant factors associated with good knowledge of oxygen therapy, and reading guidelines was statistically associated with a positive attitude toward oxygen therapy. Thus, nurses need to be aware and skillful regarding the updated oxygen therapy guidelines. They should improve their level of education.

Administering oxygen therapy plays an essential role in preventing and managing acute and chronic hypoxemia. This study assesses the level of practice of nurses on oxygen therapy in critically ill patients and associated factors.An institutional-based cross-sectional study was conducted from May 23 to June 07, 2021, at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A self-administered structured and validated questionnaire was used. It has a socio-demographic characteristics, multiple choice questions, items that measure the possible associated factors and items were used to assess level of knowledge. Data were entered using Epi-data version 4.6 and analyzed using SPSS version 20. Descriptive and inferential statistics were analyzed and presented. The Chi-Square test was used to measure the strength of associations between variables. Binary and multiple logistic regression were used, a p-value of0.2 and 0.05 were considered statistically significant, respectively.A total of 400 nurses participated in the study, with a response rate of 94.8%. The overall proportion of good practice on oxygen therapy for critically ill patients was 47% (95% CI: 43-51.8). Age39 years (AOR; 3.17, 95% CI: 1.42-7.08), nurses have good knowledge on oxygen therapy (AOR; 1.74, 95% CI: 1.11-2.74), labeling of the volume of the cylinder after use (AOR; 2.51, 95% CI: 1.36-4.63), were significantly associated with good practice on oxygen therapy in critically ill patients.We concluded that there was a gap in the practice of oxygen therapy among nurses. Therefore, regular educational and training programs about oxygen therapy are needed to increase the level of practice among nurses. In addition practical training sessions should be organized for nurses to update their practice on the latest guidelines on oxygen therapy for critical ill patients.

Background Lack of consensus on hemoglobin threshold and transfusion strategies have led to a wide variation in transfusion practices and inappropriate use of blood. This may result in over ordering of blood with minimal utilization or unnecessary allogenic blood transfusion. This may lead to financial crisis due to costs for blood handling, laboratory tests and blood administration. So, saving of blood and resources are required by rationalizing blood transfusion indications based on evidence-based hemoglobin threshold and clinical predictive factors in resource limiting setup. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was used to conduct this study. PubMed, Google Scholar and Cochrane Library search engines were used to find evidences that help to draw recommendations and conclusions. Discussion Half of clinical specialties used red blood cell transfusion with 7 g/dl threshold and the other half used 8 g/dl to 9 g/dl. Restrictive strategy of blood transfusion is as effective as liberal transfusion strategy in critically ill patients except in patients with cardiovascular diseases. Conclusions Transfusion is required at hemoglobin levels

Background Hypoxemia is defined as low level of oxygen in the blood. The early postoperative period is a critical time for developing hypoxemia. It is well known that the physiological response of the patient is not reversed immediately after anesthesia and surgery. Supplemental oxygen should be considered in patients who had operation under anesthesia at the potential time of post-operative period. Objective The objective of this study was to determine the incidence of early post-operative hypoxemia and its contributing factors among operated patients under anesthesia during transportation to recovery rooms and at recovery rooms. Methods A prospective observational study design was conducted to determine the incidence of early post-operative hypoxemia and to identify the contributing factors among operated patients who had undergone with anesthesia from March 1 to April 10, 2018. Data were checked on daily basis. Data were entered to Epi Info and analyzed by statistical package for social sciences (SPSS) version 20 software. Descriptive statistics were used to summarize patient's sociodemographic data. Bivariate and multivariate binary logistic regressions were conducted to see the existence of the association between dependent and independent variables. Results 424 operated patients were included. The overall incidence of early post-operative hypoxemia among the study subjects (424) was 113 (26.7%). The risk factors of early post-operative hypoxemia were preoperative oxygen saturation Conclusion The incidence of early postoperative hypoxemia was high and risk factors of early post-operative hypoxemia were preoperative oxygen saturation 120 min, muscular strength score 0 and hepato-biliary-pancreas surgeries. Therefore, oxygen administration should be commenced to all risky patients for hypoxemia during early post-operative period.

Background Nausea and vomiting is vested in two separate units in the medulla, the chemo receptor trigger zone and the vomiting center. Intra-operative nausea and vomiting during spinal anesthesia for caesarean section are very common and unpleasant event with an incidence of up to 80%. It causes significant distress to the patient and also interferes with the surgical procedure. Objective The study was conducted to assess the incidence and associated factors of intra-operative nausea and vomiting during caesarean section under spinal anesthesia. Method Observational study was conducted from March 20th to May30th 2019 on 373 pregnant mothers who delivered with caesarean section under spinal anesthesia. Statistical analysis was performed using statistical package for social science version 20. The Odds ratios and 95% confidence interval, bivariate and multivariate binary logistic regressions were used to assess the association between dependent and independent variables. Result Among 384 eligible participants, 373 women were involved in the study with the response rate of 97.14%. Out of the total respondents, 152 (40.8%) of them experienced intra-operative nausea and vomiting and 69 (18.5%) of them experienced both nausea and vomiting. Hypotension (AOR = 3.949, 95% CI = 2.098–7.432), intra-operative pain (AOR = 6.152, 95% CI = 2.970–12.745), body mass index >35 kg/m2 (AOR = 4.491, 95% CI = 1.010–19.962) and high risk pregnancy (AOR = 2.222 95% CI = 1.006–4.910) were significantly associated with the occurrence of intraoperative nausea and vomiting. Conclusion The incidence of intra-operative nausea and vomiting was 18.5%. This is a significant intraoperative morbidity that shouldn't be overlooked and needs appropriate intervention according to institutional protocols.

Background Postoperative pain is a major concern after midline abdominal surgeries. Rectus sheath block (RSB) has been indicated after midline laparatomy; however, the analgesic effect of landmark technique on postoperative pain was not well investigated. Objectives we tested the hypothesis that RSB reduces pain scores, decreased total analgesic consumption and prolong first analgesic request time after emergency midline laparatomy. Methods Prospective observational cohort study was done from February 1 to May 10, 2018. Eighty eight patients were observed in this study, 44 in the RSB group and 44 in the non-exposed group. Pain severity was assessed in first 24 h postoperative period in terms of total analgesic consumption, first analgesic request time and visual analogue scale (VAS) score at 1 h,2 h,4 h,6 h,8 h, 10 h, 12 h and 24 h. Results The RSB group had significantly reduced VAS score at rest and on movement at (1, 2, 4, 6 and 8 h), but not at (10, 12 and 24 h) point assessed. Patients in RSB group had reduced tramadol requirement compared to non-exposed group in 24 h (255.68 ± 80.13) VS (314.77 ± 97.40), P = 0.003). The 24 h diclofenac consumption was significantly lowered in RSB group (75(75–150) than non-exposed group (150(75–150), P = 0.031. Mean time to first analgesic request was significantly longer in RSB group (372.95 ± 131.41) than non-exposed group (50.34 ± 14.12), p ≤ 0.001). Conclusions The RSB group resulted in less pain scores, reduced total analgesic utilization and stayed for longer time for first analgesic request. Therefore we recommended RSB as part of multimodal analgesia after emergency midline laparatomy.

Background Thoracic epidural nerve block (TENB) is a technique in which analgesia is produced by injecting local anesthetic agent by itself or combined with additives or alone into the epidural space. This systematic review was designed to improve the quality of pain management and to form a common consensus for TENB based on the current evidences. Methods PubMed through HINARI was used to get access for current and updated evidences on TENB for cardio-thoracic and major abdominal surgeries. The flow diagram was used to show the filtration methods of suitable literature. Discussion TENB should be started after checking baseline vital signs and after preparation of emergent phenomenon. The prominent part of C7, T3 scapular spine and the inferior border of T7 are used to localize the intended segment during performing the procedures. Skin infiltration with aseptic technique of 2–3 ml of 2% lidocaine, test dose of 3 ml of lidocaine with 1:200,000 epinephrine, and loading dose of 3–5 ml of 0.25–0.5% bupivacaine are recommended for TENB. The maintenance dose is 3–5 ml of 0.1–0.25% of bupivacaine. The thoracic epidural catheter will not stay for more than 4 days. Post-procedural care and monitoring should be performed for patients on thoracic epidural catheter. Conclusion Generally, appropriate preoperative patient evaluation, pre-procedural preparation of the necessary materials, and consideration of the possible options should be mandatory. Anesthetists should be familiar with the landmark techniques, troubleshooting, administration of safe doses of the drug, and post-epidural catheter insertion care.

Background Spinal anesthesia is the method of choice for cesarean section as it is associated with low occurrence of intra-operative and post-operative morbidities. Despite this significant move towards spinal anesthesia, it has a risk of failure reported in the range of 1–17%. Failed spinal is a disgusting event for the mother and the anesthetist that may lead to decreased maternal satisfaction and may potentially impact fetal and maternal outcomes. Objective The study was designed to determine the incidence and factors associated with failed spinal anesthesia during cesarean section. Methods A prospective institution based observational study was conducted on 275 parturients from October 1st to December 31st, 2019. After collection, the data was data entered and analyzed by SPSS version 21. The main outcome measure was the incidence of failed spinal anesthesia and the chi-square test was used to compare failure rates and multivariable regression analysis was performed to investigate potential factors. Results The study involved 275 parturients and the overall incidence of failed spinal was 19.5%. Co-morbidity (OR = 9.615; CI = 1.255–7.368), emergency procedure (AOR = 2.191; CI = 1.087–4.417), needle size (2.3; CI = 0.92–0.615), anesthetist's experience (AOR = 4.23; CI = 2.14–8.34), surgeon's experience (AOR = 2.530; CI = 1.319–4.853), bloody CSF flow (AOR = 2.440; CI = 0.103–0.582), and volume of local anesthetics (AOR = 2.781; CI = 1.432–5.398) were significantly associated with failed spinal anesthesia. Conclusions and recommendations The incidence of failed spinal anesthesia was found to be high compared to previous studies. Since the study tried to identify risk factors for failure, we should act accordingly to minimize the failure rate.

Background Obstructive sleep apnea is a syndrome characterized by periodic, partial, or complete obstruction in the upper airway during sleep. This, in turn, causes repetitive arousal from sleep to restore airway patency, which may result in daytime hyper somnolence or other daytime manifestations of disrupted sleep such as aggressive or distractible behavior in children. Obstructive sleep apnea syndrome is a complex disorder with series physiological consequences. Patients with obstructive sleep apnea syndrome have an increased tendency for upper airway obstruction during sleep, which leads to repetitive apnea, excessive daytime sleepiness and increased cardiovascular morbidity. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database, Google Scholar to get access for current and updated evidences on perioperative anesthetic management for patients with obstructive sleep apnea. Discussion Patients with a diagnosis of obstructive sleep apnea should be considered to be at increased risk for perioperative complications. Patients who had obstructive sleep apnea and at risk for obstructive sleep apnea should be identified before Surgery. The most effective and widely used treatment for obstructive sleep apnea is continuous positive airway pressure, it treats apnea –hypopnea by providing air under positive pressure through a nasal or facial mask thus creating a pneumatic splint in the pharynx, which prevents collapse of the pharyngeal airway. Conclusion Patients with obstructive sleep apnea (OSA) who underwent procedures under anesthesia were at increased risk for perioperative complications compared with patients without the disease. The equipment for management of a difficult airway should be in place before induction of general anesthesia. Orotracheal tubes in various sizes, gum elastic bougie as well as a McCoy laryngoscope and a laryngeal mask airway were necessary.

Post-operative nausea and vomiting (PONV) are common and distressing to patients. This common anesthetic and surgical side effect has been reported to increase patient dissatisfaction and can be more distressing to patients than post-operative pain. It has multi-factorial causes: patient, anesthesia and surgery related risk factors have been identified. Prevention of PONV is important since it has psychological and physical effects, and it can also cause severe complications.To determine the level of practice of PONV prophylaxis usage for caesarean section.This clinical perspective study was conducted at all pregnant mothers scheduled for caesarean section under anesthesia from March 1 to March 30, 2021 consecutively. The standards were directly changed into question forms with two integral checking components, "Yes", and "No". Data were entered and analyzed by statistical package of social sciences (SPSS) version 20.A total of 100 parturients scheduled for caesarean section were included with a response rate of 100%. Based on the standards, Anti-emetic treatment to patients with post-operative nausea and vomiting (PONV), adherence of anesthetists to local evidence based guideline for PONV prevention and more importantly no prophylactic administration to patients at low risk for PONV were implemented with a percentage of 17%,47%, and 14% respectively.and recommendations: There was a significant performance gap in the clinical practice of prevention of post-operative nausea and vomiting. We strongly suggest that adherence to a Protocol to reduce baseline risk and the adoption of a multimodal approach will highly likely ensure success in the management of PONV. The usage of appropriate anti-emetic prophylaxis to the right patient is necessary to have a good outcome after surgery and anesthesia.

Liver disease is a multisystem condition that is classified as acute or chronic depending on the length of time. Cirrhosis patients are expected to undergo surgery in the last two years of their lives, according to estimates. In patients with elevated liver enzyme levels, anesthesia and surgery may deteriorate liver function. Preoperative identification, optimization and anesthetic management are essential for optimum outcomes in patients with liver disease undergoing surgery.The literatures are searched using medical search engines like Google scholar, PubMed, Cochrane library and HINARI to get access for current and update evidence on perioperative optimization of patients with liver disease. The key words for literature search were (liver disease OR liver failure) AND (liver disease OR perioperative management) AND (non-hepatic surgery OR anesthesia). After searching using these search engines then collected by filtering based on the level of significance to this guideline with proper appraisal and evaluation of study quality with different level of evidences.and recommendations: Patients with liver disease presenting with non-hepatic surgery might have postoperative complications that can lead to death. Efforts should be expended to favorably alter a patient's preoperative Child's class before undertaking an elective operation.

Asthma is one of the commonest respiratory illnesses among elderly patients undergoing surgery. Detailed preoperative assessment, pharmacotherapy and safe anaesthetic measures throughout perioperative period are the keys to decrease complications. Resistance to expiratory airflow results in positive alveolar pressures at the end of expiration, which causes air-trapping and hyperinflation of the lungs and thorax, increased work of breathing, and alteration of respiratory muscle function. This systematic review was conducted according to the Preferred Reporting Items for systematic review and metanalysis (PRISMA) statement. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find evidences. Low-dose IV ketamine, midazolam, IV lidocaine or combined with salbutamol are recommended to be used as premedication before induction. Propofol, ketamine, halothane, isoflurane and sevoflurane are best induction agents and maintenance for asthmatic surgical patients respectively. Among the muscle relaxants, vecuronium is safe for use in asthmatics. In addition, Succinylcholine and pancronium which releases low levels of histamine has been used safely in asthmatics with little morbidity., Highlights • Asthma is one of the commonest respiratory illnesses among patients undergoing surgery. • This systematic review was conducted according to PRISMA protocol. • Propofol, ketamine, halothane, isoflurane and sevoflurane are best pharmacologic agents for asthmatic surgical patients. • Vecuronium is safe for use in asthmatic surgical patients.

Background Patient safety during surgery is an important component for good outcome of operated patients. To discuss an important details about each surgical case; surgical safety checklist is an important patient safety tool that is used by the team of operating room professionals. This study aimed to identify the compliance of surgical safety checklist. Methods This clinical perspective study was conducted from February 20 to March 20; 2021 at a teaching referral hospital. All surgical procedures done at a Comprehensive Specialized Teaching Hospital operation theatres were included. Data were collected through direct observation using World Health Organization standard checklist. Descriptive statistics were performed using SPSS version 20. Results A total of 100 operations were observed in the main operation theatres of their surgical safety before induction of anaesthesia, before surgical incision and before any team member leave the operation room. From those 100 surgical procedures; patients’ identity, procedure and informed consent, anaesthesia machine checking and medication preparations were performed fully (100%) compliance with the standards. Conclusions some standards weren't compliant with the standards of WHO surgical safety checklists. We recommend preparing common discussion panel for the operation room team about the performance of the surgical safety checklists and act accordingly., Highlights • Patient safety during surgery is an important component. • Patients' identity, procedure, informed consent were compliant with the standards. • Some standards weren't compliant with the standards of surgical safety checklists. • Risk of bleeding documentation and essential imaging displayed had zero compliant.

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.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.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.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%.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 had100% compliance rate. Therefore, it is recommended that staff should adopt standards or locally prepared protocols for their day-to-day practice.

Background Novel Corona Virus is a pandemic infectious disease which affects all age groups with higher incidence in geriatric population and chronic diseases. Contact, droplet and airborne had a role for transmission of the disease during airway manoeuvres in infected patients. This study aimed to prepare the operation room and provide protection of both the patient and health care personnel. Method This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol. Search engines like Pub Med through HINARI, Cochrane database, Google Scholar to get access for current and updated evidences on operating room team safety and perioperative anesthetic management for patients with suspected or confirmed novel corona virus. Discussion High risk procedures for aerosolization including endotracheal intubation, open lung surgery and airway suctioning should be managed with vented masks. Conclusion All health care personnel should wear personal protective equipment based on the class of patients during surgery. Elective procedures should be postponed to save and mobilize resources for the protection and management of the pandemic disease. Emergency procedures including burn, Cesarean section, malignant neoplasia, perforated viscus and traumatic injury should be operated with wearing of personal protective equipment.

Background. Spinal anesthesia is the most common anesthetic technique for cesarean delivery. Patient satisfaction is a subjective and complicated concept, involving physical, emotional, psychological, social, and cultural factors. Regular evaluation of maternal satisfaction related to anesthesia service is an important parameter to the required changes and expansion of high-quality care services. We aimed to assess maternal satisfaction and associated factors among parturients who underwent cesarean delivery under spinal anesthesia. Methods. Institutional-based cross-sectional study was conducted from February to May 2019. A total of 383 parturients were enrolled to assess maternal satisfaction using a 5-point Likert scale. Both bivariable and multivariable logistic regression analyses were done. Variables of p value ≤0.2 in the bivariable analysis were a candidate for multivariable logistic regression. A p value

Background Hypotension is the common incidental complication after subarachnoid block in emergency cesarean section. This study aimed to identify incidence and factors associated with hypotension in emergency cesarean section that underwent spinal anaesthesia. Methods Prospective observational study was done with statistical analysis of SPSS version 20. Binary logistic regression analysis was performed to determine whether each of independent variables was associated or not with the outcome variables. Both Crude and Adjusted Odds Ratio were calculated to show strength of association. Variables with P-value of Results Incidence of hypotension in emergency cesarean section was 56.8% (95% CI; 50.2–63.4). Baseline systolic blood pressure Conclusion The incidence of hypotension was high. Baseline blood pressure, spinal additives, duration of crystalloid load and speed of injection were significantly associated with hypotension. So, we recommend considering spinal additives, fluid co-loading and slow injection of drugs to reduce incidence of hypotension.

Background: Poor attitudes and lack of knowledge about labour pain has long been demonstrated to burden the health professionals, as well as the women. In developing countries, labour analgesia practice is not well established and undermined. Therefore, the aim of this study was to explore final year midwifery students’ knowledge and attitudes towards pain relief during labour, at University of Gondar, Northwest Ethiopia.Methods: A cross-sectional study was conducted among final year undergraduate midwifery students using structured, and self-administered questionnaire(n=130). Descriptive statistics were performed. Results were presented using narrations, means and standard deviations, percentage, figure and tables. Univariate analysis was used to assess the association between demographic variables with poor knowledge and attitudes. P-value below 0.05 level of significance was used to identify the statistical significance of factors for knowledge and attitude about pain relief during labour.Results: Of 130 students participated, the majority, 88% of respondents understood that women can feel moderate to severe pain during labour. However, only less than half of the participants had knowledge of labour pain should be relieved. The majority, 70% of students did not have awareness about the methods of labour analgesia.Conclusion: Although the majority of final year midwifery students were agreed with women can feel moderate to severe labour pain, almost more than half of the students were not aware of the painless labour in hospital. Most of the students believed that pharmacologic methods of labour analgesia will affect the labour, baby, and mother. Therefore, considerable attention in preservice teaching and training about labour pain and analgesia for midwifery students is recommended.

Introduction. Laryngospasm is a glottis closure due to reflex constriction of the laryngeal muscles. It can occur at any phase of the anesthetic. Different studies have been done previously with various results and indicative values which initiated us to do this research. This study aimed to assess the incidence and associated factors of laryngospasm among pediatric patients who underwent surgery under general anesthesia (GA). Methods. Institution-based, cross-sectional study was conducted on pediatric patients from February to August, 2019, in University of Gondar Comprehensive Specialized Hospital (UOGCSH). Data were entered and analyzed with SPSS version 20. Variables with P value less than P value of Results. The incidence of laryngospasm among pediatric patients who underwent surgery under GA was 57 (18.4%). Of this, 34 (59.6%), 12 (21.1%), and 11 (19.3%) happened during emergence, maintenance, and induction phases of GA, respectively. In multivariable analysis, airway anomalies (AOR: 14.64, 95% CI: 1.71, 125.04), secretion (AOR: 2.45, 95% CI: 1.19, 5.06), attempts of airway devices (AOR: 2.47, 95% CI: 1.16, 5.22), upper respiratory tract infection (AOR: 2.91, 95% CI: 1.008, 8.41), and inadequate depth of anesthesia (AOR: 7.92, 95% CI: 2.7, 23.22) were significantly associated with incidence of laryngospasm. Conclusions. Laryngospasm can occur at any phase of the anesthetic. At UOGCSH, the overall rate of laryngospasm was 18.4%, with the vast majority of episodes occurring on emergence. Inadequate depth of anesthesia, URTI, airway anomalies, multiple attempts of airway devices, and oropharyngeal secretion were predictors of laryngospasm. So, added vigilance is needed in patients with URTI, airway anomalies, or those who require multiple attempts at airway device insertion. Prompt clearing of airway secretions and adequate depth of anesthesia may help to prevent laryngospasm. Since the majority of our patients received an IV induction, endotracheal intubation, and maintenance with halothane, caution must be taken in extrapolating these results to other patient populations.

Background : Pain is a stressful condition considered to be a global health problem, and children are the most vulnerable and under-served population. Moderate to severe postoperative pain in pediatric population is associated with physiological, psychological and emotional adverse effects. This study aimed to assess the prevalence and contributing factors associated with postoperative pain in pediatric patients. Methods : Institution-based, cross sectional follow-up study was conducted from February 1 to April 30, 2020. Data were entered into Epi-info version 7 and analyzed by SPSS version 20. The strength of association of dependent and independent variables was presented by crude and adjusted odds ratio and 95% confidence interval. Binary logistic regression analysis was used and variables with a p-value of Results : A total of 153 pediatric patients aged 2 to 12 years were included. The prevalence of moderate to severe pain after pediatric surgery was 40.5% (95% CI: 32.7, 48.4). Preoperative anxiety (AOR: 2.24, 95% CI: 1.02, 4.88), history of preoperative pain (AOR: 3.97, 95% CI: 1.55, 10.19), neurologic surgery [AOR: 8.32, 95% CI: 1.77, 39.12) and incision size greater than 10 cm (AOR: 3.41, 95% CI: 1.08, 10.77) were significantly associated with postoperative pain. Conclusion : The prevalence of moderate to severe post-operative pain was high. Preoperative anxiety, history of preoperative pain, type of surgery and incision length were significantly associated with postoperative pain. The magnitude of postoperative pain remains high and a plan for adequate pain management and preoperative anxiety reduction needs to be developed.