Response to letter for critiques on our published article: Effect of tracheal tube cuff inflation with alkalinized lidocaine versus air on hemodynamic responses during extubation and post-operative airway morbidities in children: prospective observational cohort study, Ethiopia.

Endotracheal tube with an inflated cuff was used to manage and maintain the airway during general anesthesia in children. When the lateral pressure exerted by an inflated Endotracheal tube cuff on tracheal mucosa exceeds capillary perfusion pressure, patients may complain of cough, sore throat, and hoarseness in the postoperative period.

Effect of tracheal tube cuff inflation with alkalinized lidocaine versus air on hemodynamic responses during extubation and post-operative airway morbidities in children: prospective observational cohort study, Ethiopia.

BACKGROUND: Endotracheal tube with an inflated cuff was used to manage and maintain the airway during general anesthesia in children. When the lateral pressure exerted by an inflated Endotracheal tube cuff on tracheal mucosa exceeds capillary perfusion pressure, patients may complain of cough, sore throat, and hoarseness in the postoperative period. This study aimed to assess the effect of a tracheal tube cuff filled with alkalinized lidocaine versus air on hemodynamic parameter changes during extubation and post-operative airway morbidity in children. METHODS: Institutional based observational prospective cohort study was conducted among 56 elective children; aged 3-13 years, who underwent operation under general anesthesia with cuffed endotracheal intubation for greater than one hour by grouping into the air (group1) and alkalinized Lidocaine (group2) at Tikur Anbessa specialized Hospital. Hemodynamic parameters (Heart rate and Blood pressure) and other variables were measured starting from 5 min before extubation to 24th hours after extubation of the endotracheal tube. A Comparison of numerical variables between study group was done with an independent t-test. Data were expressed in terms of mean ± standard deviation. Categorical data were assessed by Chi-square tests. RESULTS: Postoperative Sore throat was lower in alkalinized lidocaine group compared to the air group. The mean heart rate at five minutes after extubation was significantly lower in alkalinized lidocaine group (107.29 ± 6.457 beat per minute (bpm)) compared to the air group (122.04 ± 8.809 bpm), with P ≤ 0.001. Systolic blood pressure was also significantly lower in alkalinized lidocaine group (99.64 ± 8.434 millimeters of mercury (mmHg)) compared to the air group (108.21 ± 11.902 mmHg), p = 0.016 at five minutes after extubation. CONCLUSION: Alkalinized lidocaine inflated tracheal tubes have shown improved hemodynamic and laryngotracheal morbidities in children.

Incidence and associated factors of post-dural puncture headache among orthopaedic patients after spinal anesthesia: a prospective cohort study.

Background: Post-dural puncture headache (PDPH) is one of a complication of spinal anaesthesia, influenced mostly by various factors including the patient's age, spinal needle size and design and sex. This headache can be severe and debilitating, preventing ambulation and limiting daily living activities. Objective: This study assessed the incidence and associated factors of PDPH among patients who received spinal anaesthesia for orthopaedic procedures at the Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Methods: Prospective cohort study design was employed using Consecutive sampling method among patients who received spinal anaesthesia for orthopaedics procedure at Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Data were collected by face to face interview and direct observation based on questionnaire. The data were entered to epidata 4.6 and analyzed by SPSS version 20 software. A total 95 patients aged 16-75 was participated in study. Those independent variable that were significant on binary logistic regression at P less than 0.2, were analyzed on multivariate regression, and considered significant association with PDPH at P value less than 0.05. Result: Ninety-five study participants were included in our study of which 19 (20%) had developed PDPH. Among patients who develop PDPH; 9.5% of the patients reported moderate pain while 10.5% experience mild PDPH and 80% of patient has no pain. The BMI and age were found to have significant association with PDPH [(P value 0.018, adjusted odds ratio 8.738, 95% CI, 1.461-52.269) and (P value 0.011, adjusted odds ratio 12.146, 95% CI, 1.753-84.170)], respectively) to PDPH. Conclusion and recommendation: The incidence of PDPH was found to be higher in Debre Tabor Comprehensive Specialized Hospital. The hospital management and the anaesthetists should minimize the magnitude of by strictly following different preventive strategies.

Patients' and Healthcare Professionals' Perspectives on Preoperative Informed Consent Procedure Obstacles and Potential Solutions, 2021: A Qualitative Study.

Background: Informed consent discussions are individualized not only with regard to the patients' surgical condition and goals but also with their varying information needs, health literacy, and anxiety. Information is lacking regarding the views of patients and concerned healthcare professionals on the informed consent process. Objective: This study is aimed to explore patients' and healthcare professionals' perceived barriers during informed consent process and identify suggested solutions for improvement. Methods: Patients who underwent elective surgery, anesthetists, and surgeons were the subjects of a qualitative study employing focused group discussions and in-depth interviews. The study participants were chosen through the use of purposeful sampling. Results: The main barriers identified by the patients include: inadequate explanation about the intended procedure, family's influence in the decision-making, fear of surgery, fear of light/power interruption, inadequate time for discussion, and not letting the family members attend the discussion. On the other hand, healthcare professionals also identified various barriers, which includes: inability of patients to understand the information, limited time to discuss with patients in detail, poorly designed informed consent form, poor awareness of patients, fear of patient refusal for surgery if the risks and associated health problems are explained, lack of adequate investigation to confidently explain about the disease condition, use of medical jargons, poor documentation habit of professionals and lack of legal system regarding ethical dilemmas. Conclusions and Recommendation: Patients and healthcare professionals have identified avoidable barriers that need the attention of concerned health professionals, educators, and the healthcare delivery system.