Anesthesia
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Item ASSESSMENT OF QUALITY OF POSTOPERATIVE PAIN MANAGEMENT AMONG MOTHERS WHO UNDERWENT CAESEREAN SECTION UNDER SPINAL ANESTHESIA AT SELECTED HOSPITALS OF SIDAMA REGION, IN 2024, MULTICENTER PROSPECTIVE COHORT STUDY.(hawassa university, 2024-06) THOMAS AMENOIntroduction: Caesarean section is the most common delivery procedure in the world, and pain is a major problem in the postoperative period. Postoperative pain management outcomes and satisfactions with pain management have been important indicators to evaluate the quality of postoperative pain management. The best way of quality assessment of postoperative pain management is based on patients self-report. Objectives: To assess quality of postoperative pain management among mothers who underwent caesarean section within the 1st, 6, 12 and 24 postoperative hours among mothers taking spinal anesthesia at study area, Ethiopia in 2024. Methods: A prospective cohort study was conducted from February 2024 to May 2024 at multicenter. Pretested questionnaires were used to collect data until 24 hours after surgery. SPSS version 20 was used to code, input, validate, and analyze the data. Socio-demographic data and pain severity were summarized using descriptive statistics. Both bivariate and multivariable logistic regression analysis were done to evaluate the association between independent and dependent variable. For variables with a p-value < 0.25, multivariable logistic regression was performed. A P-value < 0.05 was considered as statistically significant. Result: Total 264 mothers participated in this study. The number of participants at the level of good quality and not good quality of postoperative pain management were 11(4.17%) and 253(95.83%) respectively. Education/Orientation on preoperative about anesthesia and operation (AOR, 6.856, 95% CI: 1.344-34.980), Adjuvant added with bupivacaine (AOR: 5.909, 95% CI: 1.314-26.570), and Nerve block done at the end of procedure (AOR: 4.643, 95% CI: 1.075 20.050), were all significantly associated with postoperative pain.Item INCIDENCE OF POSTOPERATIVE RESPIRATORY ADVERSE EVENTS AND PREDICTING FACTORS AMONG PEDIATRIC PATIENTS OPERATED AT HAWASSA UNIVERSITY COMPREHENSIVE SPECILIZED HOSPITAL:SINGLE ARM PROSPECTIVE COHORT STUDY(hawassa university, 2024-05) TESFAYE ASEFABackground: Postoperative Respiratory Adverse Events (PREAs) is the impairment of the respiratory system that occurs with the combination of patient condition, anesthetics, and surgical factors. This may result in an extended hospital stay, financial strain on the family, and may increase morbidity and mortality. The objective of this study is to assess the incidence of postoperative respiratory adverse events and predicting factors among pediatric patients operated at Hawassa University Comprehensive Specialized Hospital from January 10-March 30, 2024. Methods: A prospective cohort study was done with a total of 205 pediatric patients aged 0-15 years were included by using systematic random sampling. Data were collected by using structured questionnaire, entered into Epi-Data, and exported to SPSS version 26 for performing data analysis. Categorical data was analysed by using the chi-squared test, and normally distributed continuous data were analysed by using student t-test. Binary logistic regression was done to identify predicting factors of postoperative respiratory adverse events. Multivariable logistic regression was done in order to identify independent predicting factors of the postoperative respiratory adverse events. In the final model AOR and 95% CI were used to measure of the strength of association and statistical significance respectively, at p-value <0.05. Results: Among a total of 205 patients operated on at Hawassa University Comprehensive Specialized Hospital, the incidence of postoperative respiratory adverse events was 35.6 % with the 95%CI (28.8 – 42.9). Intraoperative use of opioids (AOR: 2.9, 95% CI:1.24-6.8), spontaneous ventilation (AOR: 4.68, 95% CI: 1.94-11.28), upper respiratory tract infection (AOR: 5.03, 95% CI: 1.84-13. 78), general anaesthesia with a cuffed endotracheal tube (AOR: 3.31, 95% CI: 1.23-8.91), age less than 1 month (AOR: 9.2, 95% CI: 1.1-77.2) and age less than 2 years (AOR:4.7,95% CI: 1.06-20.8) were independent predicting factors of postoperative respiratory adverse events. Conclusion: The postoperative respiratory adverse event among pediatric patients operated at Hawassa University Comprehensive Specialized Hospital was high. Intraoperative use of opioids, spontaneous ventilation technique, patients that have an upper respiratory tract infection, general anesthesia with a cuffed endotracheal tube, and age less than two years were independent predicting factors postoperative respiratory adverse events..Item BIRTH ASPHYXIA AND ITS ASSOCIATED FACTORS AMONG NEWBORNS DELIVERED BY EMERGENCY CESAREAN SECTION IN SOUTHERN ETHIOPIA UNIVERSITY HOSPITALS: MULTI CENTER CROSS SECTIONAL STUDY.(hawassa university, 2023-11) SELAM TAMIRUBackground: Birth asphyxia is the neonate’s inability to initiate or sustain spontaneous breathing. Even though improvements are being made to decrease the number of neonates being exposed, the magnitude and associated factors of birth asphyxia specifically in emergency cesarean sections have not been fully understood. Objective: The objective of this study is to assess the prevalence and associated factors of birth asphyxia in parturients who underwent emergency cesarean section in southern Ethiopia university hospitals. Method: A multi-center cross-sectional study was conducted among 418 parturients in 4 randomly selected university hospitals from February 7 to June 8, 2023 G.C on parturients that gave birth by emergency cesarean section. A systematic random sampling was used to collect the data using a semi-structured and pretested questionnaire from the participants and chart. The data was then encoded and entered into Epi-Data and exported to SPSS. A binary logistic regression analysis was used to identify any associated factors for birth asphyxia and variables with a P value less than 0.25 were entered into the multivariate analysis to identify independent factors. A P-value less than 0.05 was taken as significant. Result: our study found that the overall prevalence of birth asphyxia is 28%. Antenatal visits of less than 4 AOR= 10.83, 95%CI (5.574-21.057), conventional spinal anesthesia technique AOR=5.39, 95%CI (3.043-9.58), and substance abuse AOR= 5.334, 95%CI (1.773-16.05) had a significant association with birth asphyxia. Conclusion and recommendation: Our study showed that the prevalence of birth asphyxia in emergency cesarean section is high. Therefore, professionals must choose wisely the mode of spinal anesthesia and have a thorough history of the parturients substance use. Targeted educational programs should also focus more on maternal antenatal care awarenessItem PREVALENCE OF IMMEDIATE POSTOPERATIVE HYPERGLYCEMIA AND ITS ASSOCIATED FACTORS AMONG ELECTIVE PEDIATRIC PATIENTS OPERATED IN THE SOUTHERN ETHIOPIA COMPREHENSIVE SPECIALIZED HOSPITALS: A CROSS-SECTIONAL STUDY(hawassa university, 2024-06) MULUALEM BUNAREBackground: An increase in blood glucose levels immediately after surgery is known as immediate postoperative hyperglycemia, a serious risk for pediatric patients. It is linked to unfavourable results and extended hospital stays. The objective of this study was to assess the prevalence of immediate postoperative hyperglycemia and its associated factors among elective pediatric patients who operated in the southern Ethiopian Comprehensive Specialized Hospitals, 2024 G.C. Methods: A multi-centre cross-sectional study was conducted among 403 elective surgical pediatric patients in three randomly selected University Comprehensive Specialized Hospitals in southern Ethiopia from February 1 to April 30, 2024. Data were collected using a structured and pretested questionnaire and by reviewing patient charts. Two intern anesthesia students at each site collected data. The primary outcome variable was the prevalence of immediate postoperative hyperglycemia. Data were entered into Epidata version 4.6 and exported to SPSS version 26 for analysis. Binary logistic regression identified factors associated with postoperative hyperglycemia, with multivariable logistic regression using Adjusted Odds Ratios (AOR) and 95% confidence intervals to determine associations and statistical significance at a p-value of less than 5%. Result: In this study, the prevalence of immediate postoperative hyperglycemia was found to be 35.7%, 95% CI (31.3-40.8). Neonates (AOR: 4, 95% CI; 1.3-12.9), infants (AOR: 3.4, 95% CI; 1.2-9.76), toddlers (AOR: 3.73, 95% CI; 1.29-10.76), early childhood (AOR: 4.02, 95% CI; 1.47 10.96), general (AOR: 7, 95% CI; 2.4 -20) and regional anaesthesia (AOR 5, 95% CI 1.7-19.5), intraoperative dexamethasone (AOR 3.0, 95% CI 1.65-5.46), dextrose solutions (AOR 3.33, 95% CI 1.67-6.65), and neurosurgical (AOR 3.68, 95% CI 1.19-11.33) and general surgery (AOR 3.66, 95% CI 1.24-10.84) were significantly associated to postop hyperglycemia. Conclusion: The prevalence of immediate postoperative hyperglycemia was 35.7% (95% CI: 31.3 40.8). Recommendations: vigilant glucose monitoring in high-risk pediatric patients post-surgery. Future research should focus on longitudinal studies and interventions to prevent hyperglycemia.Item PREVALENCE AND ASSOCIATED FACTORS OF PREOPERATIVE FRAILTY AMONG ELDERLY PATIENTS UNDERWENT ELECTIVE SURGERY IN TEACHING HOSPITALS OF SOUTHERN ETHIOPIA, 2023: A MULTICENTER, CROSS-SECTIONAL STUDY(hawassa university, 2024-06) FRAOL HUSENBackground: Frailty impairs the mental, physical, and emotions, making it difficult to maintain stability. This is especially important for older surgical patients, who are more likely to experience postoperative complications. These complications can lead to disability, loss of independence, decreased quality of life, infections, and death. Understanding this abnormality and its impact on the surgical settings will improve the quality of post-operative care. Objective: To assess the prevalence and associated factors of preoperative frailty among elderly patients underwent elective surgery in selected teaching hospitals of southern Ethiopia, from February 8 to June 7, 2023 GC. Method: A multi-center cross-sectional study was conducted among 422 elderly surgical patients aged 50 years and older. After receiving ethical approval from the institutional review board, data were collected by a systematic random sampling in selected hospital using a semi-structured and pretested questionnaire. The data was then encoded, entered into Epi-Data, and exported to SPSS, version 26. A binary logistic regression analysis was used to identify any associated factors for preoperative frailty, and variables with a P value less than 0.25 were entered into the multivariable logistic regression. A p value of < 0.05 was considered statistically significant. Result: Our study found that the overall prevalence of preoperative frailty is 49.8%. Age 50-64 years [AOR=0.038, 95%CL (0.012-0.128)], female [AOR=2.480 CI (1.004-6.450)], BMI<18.5 [AOR=4.748, 95% CI (2.010-11.216)], preoperative anemia [AOR = 2.386, 95% CI (1.015-5.611)], and absence of preoperative hypertension [AOR = 0.005, 95% CI (0.001-0.024)] were associated with preoperative frailty. Conclusion and recommendation: Preoperative frailty was high among elderly elective surgery patients. This shows that screening for preoperative frailty and associated risk factors is crucial for elderly surgical patients in order to achieve better perioperative quality.Item INCIDENCE AND PREDICTORS OF POSTOPERATIVE PAIN AMONG PEDIATRIC SURGICAL PATIENTS AT HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, 2023, A PROSPECTIVE COHORT STUDY(hawassa university, 2023-11) ENDESHAW WALEBackground: Post-operative pain is a type of acute pain that may develop following surgical exposure and is triggered by an inflammatory reaction and the activation of afferent neural cells. In Ethiopia, there is insufficient data about postoperative pain incidence, predictors, and management in the pediatric population despite the existence of evidence-based worldwide reports. Objective: To determine the incidence and predictors of postoperative pain among pediatric surgical patients at Hawassa University Comprehensive Specialized Hospital from February 10 May 10, 2023. Methods: A prospective cohort study was conducted on pediatric surgical patients from February 10-May 10, 2023. Pretested semi-structured questionnaires were used to collect data until 24 hours after surgery. The data collectors assessed pain with time interval of 2, 4, 6, 8, 10, 12, and 24 hour postoperatively. Statistical Package for Social Sciences version 26 was used to code, input, and analyzes the data. By using binary logistic regression variables with a p-value < 0.2 were enter to multivariable logistic regression and adjusted odd ratio was calculated with 95% confidence interval. A p-value of < 0.05 was considered statistically significant. Result: A total of 142 children aged 2 months- 14 years were included in the study. The overall incidence of postoperative pain was 66.2% (95%CI: 58.2-75.4). History of preoperative pain (AOR, 4.599, 95% CI: 1.110-19.057), preoperative anxiety (AOR: 5.421, 95% CI: 1.379 21.313), duration of surgery <1 hour (AOR: 0.078, 95% CI: 0.010-0.629), 1-3 hours (AOR: 0.164, 95% CI: 0.031-0.877), and surgical incision length <5 cm (AOR: 0.024, 95% CI: 0.003 0.169) were all significantly associated with postoperative pain. Conclusion and recommendation: The incidence of postoperative pain in pediatric surgical patients is high. Duration of surgery, surgical incision length, preoperative anxiety, and pain predict postoperative pain. Therefore, care providers should target these factors to minimize the magnitude of the problem and appropriate pain management strategy should be implemented.Item INCIDENCE AND PREDICTORS OF POSTOPERATIVE PAIN IN PEDIATRIC PATIENTS UNDERWENT OPHTHALMOLOGICAL SURGERY AT HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL: A PROSPECTIVE COHORT STUDY IN 2024.(hawassa university, 2024-05) ALEMLANCHI MEBRATBackground: Postoperative pain is a type of acute pain that occurs after surgical procedures. Although there have been studies on the incidence, predictors, and management of postoperative pain in the pediatric population, there is insufficient data about ophthalmic surgical pediatric patients. Objective: The objective of this study is to assess the incidence and predictors of postoperative pain among pediatric patients underwent ophthalmological surgery at Hawassa University Comprehensive Specialized Hospital in 2024. Methods: A prospective cohort study was conducted on 130 participants aged 2 month to 14 years at Hawassa University Comprehensive Specialized Hospital from January 8 to April 8, 2024. Participants who underwent ophthalmological surgery were included using a consecutive sampling technique. Data was collected by using pretested questionnaires and analyzed using Statistical Package for the Social Sciences (SPSS) version 26. The result was summarized by using tables and figures. Logistic regression was used for the analysis technique to see the association of the independent variable and dependent variable. Variable with a p-value of 0.2 at bivariate analysis entered into multivariable analysis and p-value less than 0.05 in multivariable analysis was considered statistically significant. Results: According to this study an overall incidence of postoperative pain in pediatric ophthalmic surgical patients was 69.2% within 24hr after surgical procedure. Age (AOR=3.672, 95% CI: 1.119-12.049), urgency of surgery (AOR=4.441, 95% CI: 1.317-14.975), anxiety (AOR=9.820, 95% CI: 3.348-28.807), and type of surgery (AOR=0.097, 95% CI: 0.010-0.961) were significantly associated with postoperative pain. Conclusion and Recommendation: Based on our study finding, the incidence of pain in pediatric ophthalmic surgery was high compared with other related studies. This shows that, the problem needs attention and awareness should be created regarding the independent predictors. Therefore, Health care providers should target those predictors to minimize the incidence of postoperative pain.Item INCIDENCE AND PREDICTORS OF HYPOTENSION AFTER SPINAL ANESTHESIA AMONG PREECLAMPTIC MOTHERS WHO UNDERWENT CESAREAN SECTION IN SELECTED TEACHING HOSPITALS OF SOUTHERN ETHIOPIA, 2024: A MULTICENTER PROSPECTIVE COHORT STUDY(hawassa university, 2004-10) ADISU NEGESABackground: Preeclampsia is the most common cause of fetal and maternal problems in developing nations. The incidence of hypotension after spinal anesthesia in preeclamtic mothers during cesarean section ranges from 7-89%. In patients with severe preeclampsia, anesthesia professionals are frequently discouraged from using spinal anesthesia due to the risk of severe hypotension. Objectives: To assess the incidence and predictors of hypotension after spinal anesthesia among preeclamptic mothers who underwent cesarean section in selected teaching hospitals in southern Ethiopia. Methods and materials: A multicenter prospective cohort study was conducted among 140 mothers with preeclampsia in 6 randomly selected teaching hospitals in southern Ethiopia from February 1 to April 30, 2024. Data were entered into Epidata version 4.6 and exported into SPSS version 27 for analysis. The variables with a p-value of <0.25 in the bivariable logistic regression were inserted into the multivariable logistic regression. Multivariable logistic regression analysis identified the independent predictors of hypotension after spinal anesthesia. The degree of association was assessed using the Adjusted Odds Ratio (AOR) with a p-value of <0.05 being considered statistically significant. Results: The overall incidence of hypotension after spinal anesthesia was 50.7%. The dose of bupivacaine >10 mg (AOR=6.28, 95% CI; 1.96-20.06), spinal puncture to baby delivery duration >10 minutes (AOR=5.0, 95%CI; 1.48-16.86), estimated blood loss >500 ml (AOR=5.24, 95% CI; 1.12-24.46) and duration of surgery ≥40 minutes (AOR=5.81, 95% CI; 1.03-32.55) were identified predictors of hypotension after spinal anesthesia. Conclusion and recommendation: The incidence of hypotension after spinal anesthesia in mothers with preeclampsia was high. Therefore, professionals must use small doses of bupivacaine, reduce spinal puncture to baby delivery time, minimize blood loss, and decrease surgery duration since they are predictors of hypotension after spinal anesthesia.