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.

Comparison of Hemodynamic Response following Spinal Anesthesia between Controlled Hypertensive and Normotensive Patients Undergoing Surgery below the Umbilicus: An Observational Prospective Cohort Study.

BACKGROUND: Hypotension and bradycardia are the most common complications associated with spinal anesthesia and more common in patients with a history of hypertension. Regular use of antihypertensive medications can prevent these complications. The occurrence of hypotension under spinal anesthesia among controlled hypertensive and normotensive patients with age 40 years and above is still debated. The objective of the study was to compare blood pressure and heart rate changes following spinal anesthesia between controlled hypertensive and normotensive patients undergoing surgery below the umbilicus at Black lion hospital, Addis Ababa, Ethiopia, 2020. METHOD: A hospital-based prospective cohort study was conducted. A total of 110 elective patients with controlled hypertension (55) and normotensive (55) patients who underwent surgery with spinal anesthesia at black lion hospital during the study period were included. The sample was selected using a systematic random sampling technique. Continuous data of independent and dependent variables were analyzed using an independent sample t-test for normally distributed and Mann-Whitney U-test for nonnormally distributed between the study groups. Categorical variables between the study groups were analyzed using the chi-square test. Descriptive data were displayed using tables and figures. For continuous and categorical variables, a p value <0.05 was considered statistically significant. RESULTS: The incidence of hypotension in the controlled hypertension group (23.6%) was higher than the normotensive group (7.3%) with p value of 0.018. The occurrence of bradycardia was seen to be 12.7% in each group with a p value >0.05. There was a statistically significant difference in the mean systolic blood pressure, mean arterial pressure, mean heart rate, and vasopressor consumption at the measurement time interval between controlled hypertension and normotensive groups. CONCLUSION: Under spinal anesthesia, patients with controlled hypertension are more likely to develop hypotension than normotensive patients, but on the occurrence of bradycardia, there was no statistically significant difference between the two groups.

Lidocaine versus propofol administration on the attenuation of hemodynamic responses during extubation in the adult elective surgical patient: A prospective cohort.

BACKGROUND: Tracheal extubation is the process of removing a tube from the trachea. It is associated with an increase in heart rate, blood pressure, intracranial pressure, intraocular pressure, coughing, bronchospasm, laryngospasm, and bleeding. Many techniques, as well as drugs, have been attempted for attenuation of the airway and cardiovascular responses. Propofol and lidocaine are widely available drugs in resource-limited settings even though their relative effectiveness for smooth extubation is not well established. OBJECTIVES: To assess the effectiveness of intravenous lidocaine and propofol on the attenuation of extubation-induced hemodynamic responses in the adult elective surgical patient from November 01, 2019, to February 30, 2020, at Asella teaching and referral hospital, Ethiopia. METHODS: Institutional-based prospective observational cohort study design was conducted on 72 ASA I patients who underwent elective surgery. The study participants were allocated into three groups equally based on anesthetists' extubation plan; Group P, 0.5 mg/kg propofol, group L, 1.5 mg/kg lidocaine administered 2 min before extubation and group C was a control group. Data were analyzed by SPSS version 20 after the normality of the data was checked by the Shapiro Wilk test. One-way ANOVA followed by a Tukey posthoc test has been employed to find the pair-wise significance and a p-value of <0.05 was considered as statistically significant. RESULTS: A demographic status and clinical characteristics of the patient were comparable between groups with p-values of >0.05. After extubation; heart rate, systolic, diastolic, and mean arterial blood pressure were decreased significantly in groups of propofol and lidocaine within 10 min. Propofol shows better results in maintaining stable systolic blood pressure up to 3 min, while heart rate, diastolic, and mean arterial pressure were maintained stable up to 5 min after extubation (p = 0.001). CONCLUSIONS: 0.5 mg/kg propofol or 1.5 mg/kg lidocaine might help to attenuate extubation induced hemodynamic responses.

Caudal block with rectal diclofenac and paracetamol for pediatrics infra umbilical surgery at a comprehensive specialized teaching hospital in Ethiopia.

BACKGROUND: Caudal block is a common regional technique performed for infra umbilical surgery in pediatrics. Its limited duration of analgesia remains a gap in routine clinical practice. This study aimed to assess the analgesic effectiveness of caudal block with rectal diclofenac or rectal paracetamol among pediatric patients who underwent infra umbilical surgery. METHODS: A prospective cohort study was conducted on patients aged 1-10 years that underwent elective infra umbilical surgery. Patients were allocated into the Caudal block with rectal Diclofenac, Caudal block with rectal Paracetamol, and Caudal block alone groups based on a postoperative pain management plan. Analysis of variance was used for normally distributed data and the Kruskal Wallis H test was used for non-normally distributed. The Tukey for post hoc test was used to compare the difference between groups one with the others. Categorical data were analyzed by using Pearson Chi-squared or Fisher's exact test as appropriate. A p-value < 0.05 considered as statistically significant. RESULTS: The postoperative median pain score was lower in CD compared to CP and CA group (p-value < 0.001) at the 4th and 8th hour. Time to first analgesic request was significantly longer within CD 735 (540-1200 min) compared to CP 445 (240-840 min p = 0.029) and CA 315 (240-720 min p < 0.001). CONCLUSION: The pain score and total postoperative analgesic consumption were significantly reduced in addition to prolonged-time to request the first analgesia in the CD group compared to CA and CP group.

Prevalence and associated factors of chronic kidney disease among adult hypertensive patients in Tigray teaching hospitals: a cross-sectional study.

OBJECTIVE: The aim of this study was to assess the prevalence of chronic kidney disease and to identify associated factors of chronic kidney disease among hypertensive patients. A cross-sectional study was conducted among selected 578 hypertensive patients. Data were collected using face to face interviewing questionnaires and from medical chart review. Binary logistic regression analyses were performed and analyzed using SPSS version 23.0. RESULT: Of the total 578 hypertensive patients the prevalence of chronic kidney disease was found to be 128 (22.1%). Of these hypertensive patients, patients with uncontrolled blood pressure, overweight/obesity, dyslipidemia and diabetic mellitus, 43.3%, 33.7%, 27.3% and 28.2 respectively. After adjustment, the independent variables the significant associated factors of chronic kidney disease among hypertensive patients were age [AOR (95% CI 1.43 (1.07-1.81)], uncontrolled hypertension 4.434 [AOR (95% CI 9.45 (1.34, 14.73)], overweight/obese [AOR (95% CI 7.422 (2.72, 20.28)], dyslipidemia [AOR (95% CI) 13.749 (5.69, 33.215)], diabetic mellitus [AOR (95% CI) 2.137 (1.07, 4.26)]. In conclusion, the prevalence of chronic kidney disease was considerably high. The major associated factors of chronic kidney disease were age, uncontrolled hypertension, overweight/obese, diabetic mellitus and dyslipidemia.