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Background. The surgical operation room is a known stressor workplace. Occupational stress can cause negative impacts on the personal well-being of healthcare professionals, health services, and patient care. Since there was limited research evidence in Ethiopia and the developing world, we aimed to determine the prevalence and factors associated with occupational stress among operation room clinicians at university hospitals in Northwest Ethiopia, 2021. Methodology. After ethical approval was obtained, a cross-sectional census was conducted from May 10 to June 10, 2021. The United Kingdom Health and Safety Executive’s Management Standards Work-Related Stress Indicator Tool was used to assess occupational stress. Data were collected from 388 operation room clinicians and analysed by using binary logistic regression analysis. Results. The prevalence of occupational stress was 78.4%. Rotating work shifts (AOR: 2.1, CI: 1.1–4.7), working more than 80 hours per week (AOR: 3.3, CI: 1.5–3.8), use of recreational substances (AOR: 2.1, CI: 1.1–3.8), being an anesthetist (AOR: 4.1, CI: 1.7–10.0), and being a nurse (AOR: 4.0, CI: 1.7–9.7) were found significantly associated with occupational stress. Conclusion. We found that there was high prevalence of occupational stress among operation room clinicians and factors associated with occupational stress were rotating work shifts, working more than 80 hours per week, use of recreational substances, being an anesthetist, and being a nurse. Hospitals are advised to arrange occupational health services for operation room clinicians, prepare sustainable training focused on occupational health, and reorganize shifts, working hours, and staffing.

Anesthesia Equipment malfunction is one of the most common factors contributing to intraoperative surgical patient morbidity and mortality. It is impossible to give anesthesia without proper anesthesia machine checks and airway equipment preparation. Therefore, all anesthesia professionals should make sure that the anesthetic machine and equipment are working correctly.An institutional-based prospective observational study was conducted at the University Comprehensive Specialized Hospital, Operation rooms, from April 10, 2020 to May 10, 2020. About 90 anesthetists were working regularly in the operation theater both emergency and elective patients. Those include; 26 Msc holders, 17 MSc students, 7 BSc anesthetists, and 40 graduating BSc students. These descriptive data were presented with frequency, percentage, and table.The overall compliance rate was 87%. Whereas; 12.46% of clinicians have not met the standard. Out of standards that were not performed, 25.81% were not available from the setup.The result shows that there was poor compliance with anesthesia machine check and equipment preparation before anesthesia in the operation theater according.

Getamesay Demelash,1 Yophtahe Woldegerima Berhe,2 Amare Hailekiros Gebregzi,2 Wubie Birlie Chekol2 1Department of Anesthesia, College of Medicine and Health Sciences, Debre-Markos University, Debre-Markos, Ethiopia; 2Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Yophtahe Woldegerima BerheDepartment of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Postal Address: 196, EthiopiaTel +251-912-494282Email yophtii@gmail.comBackground: Cesarean section is the commonest obstetric procedure worldwide and pain is the leading compliant during the postoperative period. The objective of this study was to assess the prevalence and factors associated with postoperative pain after cesarean section at a University Hospital in Northwest Ethiopia.Materials and Methods: A prospective observational study was conducted among parturients who underwent cesarean section. After obtaining ethical approval, 299 parturients were approached. The numerical rating scale was used to measure pain severity. The association between variables was determined at 95% CI with binary logistic regression. A p-value < 0.05 was considered significant.Results: A total of 290 parturients were included with a response rate of 97%. The overall prevalence of moderate to severe postoperative pain after a cesarean section was 85.5% (95% CI: 81.4– 89.0%) within the first 24 postoperative hours. On the multi-variable analysis, preoperative anxiety (AOR: 2.3, 95% CI: 1.1– 4.9), history of previous cesarean section (AOR: 2.3, 95% CI: 1.1– 5.0), Pfannenstiel incision (AOR: 3.2, 95% CI: 1.3– 8.0) and absence of regional analgesia (AOR: 3.7, 95% CI: 1.7– 7.9) were significantly associated with moderate to severe postoperative pain after cesarean section.Conclusion: The prevalence of moderate to severe pain in the first postoperative day was unacceptably very high. Parturients who had preoperative anxiety, history of previous cesarean section, Pfannenstiel incisions, and those who did not receive regional analgesia have significantly suffered from postoperative pain. Pain severity needs to be assessed and documented by using pain-rating scales and interdisciplinary pain management should be provided.Keywords: pain, post-cesarean section pain, postoperative pain, cesarean section, obstetric anesthesia and analgesia

IntroductionPerioperative respiratory adverse events (PRAEs) are frequent among pediatrics surgical patients and are accountable for 3/4th of perioperative critical incidents and 1/3rd of cardiac arrests.ObjectiveAssess the prevalence and factors associated with PRAEs among pediatric surgical patients in University Hospitals in Northwest Ethiopia, 2020.MethodologyAfter ethical approval obtained prospective observational study was conducted among 210 pediatric surgical patients. Perioperative respiratory adverse events were defined as the occurrence of any episode of single/combination of coughing, breath holding, hypoxemia, laryngospasm and bronchospasm. Bivariate and multivariate binary logistic regression analyses were performed and variables with p < 0.05 at 95% confidence interval were considered as statistically significant.ResultsThe prevalence of PRAEs was 26.2% (CI: 20.5–30.9%). A total of 129 episodes of PRAEs were occurred and of them, 89 (69.0%) were occurred in the postoperative period. Desaturation was the predominant adverse event which was observed 61 (47.3%) times. Age ConclusionsPrevalence of PRAEs was high among pediatric surgical patients; the postoperative period was the most critical time for the occurrence of PRAEs and desaturation was the commonest PRAE. Age

Objective Uses of simple analgesics were found insufficient to manage pain after thyroid surgery. We hypothesized that using bilateral superficial cervical plexus block (BSCPB) might influence the pattern of immediate postoperative pain and analgesic consumption. The general objective of the study was to assess the analgesic efficacy of bilateral superficial plexus block for thyroid surgery under general anesthesia. Results A total of 74 willing patients involved. Half of them had received BSCPB with 10 ml of 0.25% bupivacaine just before induction and the remaining half did not. Postoperatively, patients were assessed at immediate, 2nd, 6th, 12th and 24th h. At all endpoints, NRS-11 scores for pain were significantly lower in the block group. The time to first analgesic requirement was significantly longer 132.3 ± 71.5 min vs 71.4 ± 60.0 min, p = 0.009. Opioid and total analgesic consumption were reduced by BSCPB in the first 24 postoperative hours. There was low but non-significant rate of PONV in the block group. No clinically important adverse event was noted related to BSCPB. Trial registration The study was registered in Pan African Clinical Trial Registry on 13/01/2020 and the registration number is PACTR202001579588451. Retrospectively registered.

Tikuneh Yetneberk,1 Yophtahe Woldegerima,2 Habtamu Getnet,2 Mamaru Mollalign,2 Meseret Firde,1 Jolene N Moore3 1Department of Anesthesia and Critical Care, Debre Tabor University, Debre Tabor, Ethiopia; 2Department of Anesthesia and Critical Care, University of Gondar, Gondar, Ethiopia; 3College of Life Sciences & Medicine, University of Aberdeen, Aberdeen, UKCorrespondence: Tikuneh YetneberkDepartment of Anesthesia and Critical Care, Debre Tabor University, PO Box 272, Debre Tabor, EthiopiaTel +251923525309Email tikusosi@gmail.comBackground: 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.Keywords: health education, anesthesia training, preservice education

Introduction: Perioperative respiratory adverse events (PRAEs) are the most frequent complications in pediatrics which frequently result in morbidity and mortality. They are accountable for 75% of perioperative critical incidents and 33% of cardiac arrests. The occurrence and severity of PRAEs depends on the natures of surgery, anesthesia & patient’s status.Objective: To assess the incidence and factors associated with PRAEs in general anesthesia among pediatric surgical patients at the University of Gondar and Tibebe-Ghion Comprehensive Hospital and Specialized Hospitals, Northwest Ethiopia, 2020.Methods: After obtaining the ethical approval, a hospital-based prospective cross-sectional follow-up study was conducted among pediatric surgical patients who underwent variety of surgical operations. A total of 225 patients were included. The associations between independent variables and the outcome variables were determined at 95% CI with the Chi-squared test, Fisher–exact test, bivariate, and multivariate logistic regression. Hosmer-Lemeshow test was used to assess the goodness of fit. Variables with a p-value < 0.05 were considered significant.Results: The incidence of PRAEs among 210 (93.3% response rate) pediatrics surgical patients was 26.2% (95% CI: 20.5, 30.9). A total of 129 episodes of PRAEs were observed. Most of the adverse events (89 (69.0%)) were occurred postoperatively. Desaturation was found to be the predominant adverse event which was occurred 61 (47.3%) times. Age < 1 year (AOR: 3.6, 95% CI: 1.3, 10.0), ASA ≥ 3 (AOR: 5.2, 95% CI: 1.9, 22.9), upper respiratory tract infections (AOR: 7.6, 95% CI: 1.9, 30.2), presence of secretions in the upper airway (AOR: 4.8, 95% CI: 1.4, 15.9) and airway related procedures (AOR: 6.0, 95% CI: 1.5, 24.1) were significantly associated PRAEs.Conclusions: The incidence of PRAEs among pediatric surgical patients was relatively high (26.2%). Especially, the postoperative phase is the most critical time for the occurrence of PRAEs and desaturation was the predominant adverse event. Age less than a year, presence of upper respiratory tract infections, presence of secretions in the upper airways, ASA ≥ 3 and airway related procedures were associated with PRAEs. Clinicians should carry out effective risk assessment, optimization and adequate preparation for the management of perioperative respiratory adverse events.

Background: Cesarean section is one of the most common obstetric procedures worldwide. Following this, parturients experience moderate to severe pain in the acute postoperative period. Therefore, in resource-limited settings, for full utilization of basic analgesic modalities and to take appropriates interventions, it is vital to know about the magnitude of the problem and its factors.Objective: To assess the prevalence and factors associated with postoperative pain after cesarean section at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia, 2019.Methods: A hospital-based prospective follow-up study was conducted among parturients who undergo cesarean section in the University of Gondar Comprehensive Specialized Hospital, from mid-February to April 20, 2019, after approval of the ethical review committee. Consecutively, a total of 290 parturients were included with a response rate of 97%. To measure pain severity numerical rating scale was used. Data was entered into Epi-data version 4.2 and analyzed by SPSS version 20 (IBM Corporate). The association between independent factors and the outcome variable was determined at 95% CI with the chi-squared test, bivariate, and multivariate logistic regression. Hosmer-Lemeshow test was used to assess the goodness of fit. Variables with a p-value of < 0.05 were considered significant.Results: In this study, the incidence of moderate to severe post-operative pain after cesarean section was 85.5% (95% CI: 81.4%, 89.0%) within the first 24 postoperative hours. On the multi-variable analysis, preoperative anxiety (AOR: 2.3, 95% CI: 1.1, 4.9), history of previous cesarean section (AOR: 2.3, 95% CI: 1.1, 5.0), Pfannenstiel incision (AOR: 3.2, 95% CI: 1.3, 8.0) and absence of regional analgesia (AOR: 3.7, 95% CI: 1.7, 7.9) were significantly associated with moderate to severe postoperative pain after cesarean section.Conclusions: In this study, a large proportion of parturients had experienced moderate to severe post-cesarean pain in the first 24 postoperative hours. Preoperative anxiety, history of previous cesarean section, Pfannenstiel incision, and parturients with no regional analgesia were significantly associated with post-cesarean pain. Pain severity needs to be assessed and documented by using pain-rating scales and there should be an interdisciplinary approach to provide adequate pain management in our hospital.

Objective. We aimed to assess the level of patient’s satisfaction and associated factors regarding postoperative pain management. Methods. An institution-based cross-sectional study was conducted from April to May 2018 at the University of Gondar, and comprehensive specialized hospital data were collected through semistructured questionnaire and chart review. Level of satisfaction was measured using five-point Likert scale. Statistical analysis was done using SPSS software version 23. 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 ≤0.05 was considered as significantly associated with patient’s level of satisfaction at 95% CI. Results. A total of 418 patients were included in this study with a response rate of 98.58%. The overall proportion of patients who were satisfied with pain management services was 72.2% (95% CI: 67.7–76.6). ASA1 (AOR = 3.55: 95% CI = 1.20–10.55) and ASA2 patients (AOR = 3.72: 95% CI = 1.04–13.28), absence of postoperative pain (AOR = 1.86: 95% CI = 1.02–3.39), peripheral nerve block done (AOR = 9.14: 95% CI = 3.93 20.86), received analgesic before request (AOR = 6.90: 95% CI = 3.72–12.83), and received systemic analgesics (AOR = 6.10: 95% CI = 1.17–33.91) were significantly associated with the level of satisfaction. Conclusion. The level of patient satisfaction with postoperative pain management was considerably low. Hence, it is vital to implement time-interval pain assessment method during the first 24 hours of postoperative period and treat accordingly based on the WHO pain ladder. Moreover, we suggested that all patients who underwent major surgery should receive peripheral nerve block as part of multimodal analgesia to decrease the incidence and severity of post op pain.

Background: The main aim of this study was to assess the level of patient’s satisfaction and associated factors in post-operative pain management. Methods: An institutional based cross sectional study was conducted from April, 11-May 15, 2018. Data were collected by structured, pre-tested patient interview questionnaire and chart review. Level of patient satisfaction was measured by using five-point Likert scale and checklist. The coded data were entered to Epi-info software version 7 and analyzed using statistical package for social sciences software version 23.The strength of the association was presented using adjusted odd ratio with 95% confidence interval and p-valueResults: A total of 418 patients were included in this study with a response rate of 98.58 %. The overall proportion of patients who were satisfied with pain management services was 72.2 % [95%CI:67.7-76.6].ASA1[AOR=3.55:95%CI=1.20-10.55]&ASA2 patients[AOR=3.72:95%CI=1.04-13.28],Patients with no post-operative pain [AOR=1.86:95%CI=1.02-3.39],post-operative nerve block [AOR=9.14:95%CI=3.93-20.86],analgesic before request[AOR=6.90:95%CI=3.72-12.83] and receiving postoperative analgesics [AOR=6.10:95%CI=1.17-33.91)] were significantly associated with level of satisfaction. Conclusion: Pain assessment during immediate postoperative period, providing regular based analgesia before patient request and to promote the practice of post-operative nerve block are important to increase the level of satisfaction.

Background Anxiety is defined as an overwhelming experience of fear, worry and nervousness. It is one of the commonest events that can happen to patients waiting for surgical operations. It has multiple psychophysiological adverse effects. Even though, it has variety of unwanted consequences, in clinical practice, preoperative anxiety is commonly neglected by clinicians. The purpose of this study was to determine the prevalence and factors associated with preoperative anxiety among elective surgical patients at the University of Gondar Hospital, Northwest Ethiopia, 2017. Method Institution-based, cross-sectional study was conducted from March to June, 2017 in University of Gondar Hospital. After obtaining ethical approval from institutional review board, 178 willing adult patients scheduled for elective surgical operations were included in the. Level of anxiety was measured by State and Trait Anxiety Inventory. Statistical analysis was performed using SPSS statistical package version 20. Descriptive statistics, cross-tabs and binary logistic regression analysis were performed to identify predictors of preoperative anxiety. The strength of the association was presented using AOR with 95% confidence interval and p-value Results A total of 178 patients (98 female and 80 male) enrolled with 98.34% response rate. We observed preoperative anxiety in 59.6% patients. The mean (± SD) of STAI score was 48.63 ± 17.56. High preoperative anxiety was associated with age 18–30 years (AOR = 6.92, 95% CI = 1.39–33.82), age 31–45 years (AOR = 5.72, 95% CI = 1.61–20.28), no income (AOR = 3.21, 95% CI = 1.01–10.27), low income (AOR = 3.06, 95% CI = 1.18–7.93). Rural residency (AOR = 0.38, 95% CI = 0.16–0.89) was associated with lower risk for preoperative anxiety. Fear of being unable to recover from anesthesia (53.9%), postoperative pain (51.7%), family concerns (43.3%) were leading sources of preoperative anxiety. Significant association with preoperative anxiety found in fear of death (AOR = 2.40, 95% CI = 1.08–5.32), family concern (AOR = 2.15, 95% CI = 1.03–4.50), fear of dependency (AOR = 2.75, 95% CI = 1.57–7.20) and fear of disability (AOR = 2.75, 95% CI = 1.22–6.21). Conclusions Preoperative anxiety was high in University of Gondar Hospital. Young age, no/low income, urban residence, fear of death, dependency, disability and family concerns were predictors of preoperative anxiety. Patients need to be assessed regularly for anxiety during the preoperative visit and appropriate anxiety reducing methods should be introduced in our Hospital.

Objective: Uses of simple analgesics were found insufficient to manage pain after thyroid surgery. We hypothesized that using bilateral superficial cervical plexus block (BSCPB) might influence the pattern of immediate postoperative pain and analgesic consumption. The general objective of the study was to assess the analgesic efficacy of bilateral superficial plexus block for thyroid surgery under general anesthesia. Results: A total of 74 willing patients involved. Half of them had received BSCPB with 10 ml of 0.25% bupivacaine just before induction and the remaining half did not. Postoperatively, patients were assessed at immediate, 2nd, 6th, 12th and 24th hours. At all endpoints, NRS-11 scores for pain were significantly lower in the block group. Time to first analgesic requirement was significantly longer 132.3 ± 71.5 min vs 71.4 ± 60.0 min, p = 0.009. Opioid and total analgesic consumption were reduced by BSCPB in the first 24 postoperative hours. There was low but non-significant rate of PONV in the block group. No clinically important adverse event was noted related to BSCPB.

Background: Performing preanesthetic evaluation, documenting, and keeping readily accessible record are responsibilities of anesthetists. Documentation can improve overall patient outcome. It also has an irreplaceable role in medico-legal aspects. Documentation is one of the challenges of providing quality care. Aim: The aim of this study was to evaluate the quality of documentation practice during preanesthetic visits. Materials and Methods: This clinical audit was conducted in the University of Gondar Hospital. Predefined 22 practice quality indicators were prepared according to modified global quality index. Statistical Analysis: Descriptive statistics was performed using SPSS version 20. Results: A total of 122 preanesthetic evaluation tools (PAETs) were reviewed. None of PAETs found fully completed according to the indicators. Trends differ between elective and emergency conditions. Indicators with high completion rate (>90%) were signed a consent, medical history, history of medication, allergy, anesthesia and surgery, cardiopulmonary examination, airway examination, preoperative diagnosis, and planned procedure. Anesthetic plan, vital signs, a name, per-oral status, premedication, and age were found with below average (