Perioperative management of surgical procedure during pregnancy: a systematic review.

Background: Approximately 1-2% of pregnant women undergo non-obstetric surgery under anaesthesia during their pregnancy. This review specifically targets anaesthesia management for pregnant women undergoing non-obstetric surgery in resource-limited settings. Methods: Following the delineation of primary questions, scope, and inclusion criteria, a comprehensive search strategy utilizing advanced techniques was implemented across electronic sources, databases, and websites to identify relevant articles. A rigorous screening process was applied during the literature evaluation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement guided the conduct of this review, ensuring adherence to standardized reporting practices. Results: A total of 240 articles were initially identified from databases and websites. After screening titles and abstracts, 85 papers were excluded, and an additional 43 were removed due to duplication. Subsequently, 68 items were subjected to eligibility screening. Finally, 30 papers that specifically addressed anaesthetic considerations for pregnant women undergoing non-obstetric operations were reviewed. Conclusion: Thorough preoperative evaluation is essential for all patients, with particular attention to modifications in anaesthetic management to accommodate physiological changes during pregnancy. Urgent and emergent surgeries should proceed promptly during pregnancy to optimize outcomes for both the mother and foetus. Maintaining uteroplacental perfusion generally involves avoiding maternal hypoxaemia, hypotension, hyper- and hypocapnia, temperature extremes, and stress. When deemed safe, regional anaesthesia may offer favourable outcomes for both the mother and foetus.

Assessment of level of knowledge, attitude, and associated factors toward delirium among health professionals working in intensive care unit multicenter, cross-sectional study, Amhara region comprehensive specialized hospitals, Northwest Ethiopia, 2023.

Background: Patients in Intensive Care Unit (ICU) are at high risk of developing delirium. Lack of early detection and the inability to provide prompt management of delirium remain challenges of ICU patient care. This study aimed to assess the level of knowledge, attitude, and associated factors toward delirium among healthcare providers working in ICU. Methods: A multicenter, cross-sectional survey was conducted in comprehensive specialized hospitals from 15 April to 5 June 2023. Data were collected using a pretested, self-administered questionnaire. Ordinal logistic regression analysis was performed at p < 0.05 with a 95% confidence interval (CI). The odds ratio with 95% CI was calculated to determine the strength of the association between independent and outcome variables. Results: A total of 202 health professionals were included in this study, with a response rate of 87%. The proportions of good, moderate, and poor knowledge about delirium in ICU were 29.21 (95% CI: 23-36), 52.48 (95% CI: 45.3-59.5) and 18.32 (95% CI:13.2-24.4), respectively. The overall proportion of negative, neutral and positive attitude were 13.9 (95% CI: 9.4-19.4), 65.8 (95% CI: 58.9-72.4) and 20.3 (95% CI: 15-26.5) respectively. Being an anesthetist and exposure to training were positively associated with a good knowledge while belief in screening tool to change care and reading, and using guidelines were positively associated with a positive attitude. However, believing the impossibility of changing the practice of delirium care, and negative attitudes were delaying factors for a good knowledge. Also, workload and poor knowledge were hindering factors for a positive attitude. Conclusion: More than half of health professionals had moderate knowledge and neutral attitude toward delirium. However, some of them had poor knowledge and a negative attitude. We recommend stakeholders prepare regular training for delirium care. Also, we urge health professionals to update themselves by reading guidelines and to use screening protocols for delirium.

Predictors of postoperative delirium in paediatric patients undergoing surgery under general anaesthesia at Amhara Regional State Tertiary Hospitals: a multicenter prospective study.

Introduction: Postoperative delirium in paediatric patients is a recognised issue. Nevertheless, in low- and middle-income nations, researchers have had luck in determining its extent and predictors. Identifying predictors of postoperative delirium in paediatric patients having general anaesthesia at Tertiary Hospitals in Ethiopia was the aim of this study. Methods: A multicenter, prospective follow up study was conducted from April 15 to June 15, 2023 at the study settings. During the study period a total of 424 paediatric surgical patients treated under general anaesthesia in all study locations, ranging in age from birth to sixteen were candidates for this study. Charts and direct observation of patient's with assessment tool [Cornell Assessment of Pediatric Delirium (CAPD)] were used from each available patient. Binary logistic regression analysis was performed to determine predictors of postoperative delirium in paediatric patients undergoing surgery under general anaesthesia. Results: Postoperative delirium occurred in 160 of the 404 paediatric patients who underwent surgery under general anaesthesia. Ophthalmic surgery, corticosteroid use, anticholinergic use, severe postoperative pain, and preoperative anxiety were found to be predictors of postoperative delirium; whereas, sedative medication premedication and paracetamol used for analgesia were found to be protective against postoperative delirium. Inference and recommendation: The postoperative delirium in paediatric patients undergoing surgery under general anaesthesia was higher compared to developed countries. Ophthalmic surgery, corticosteroids, anticholinergic medications, postoperative pain, and preoperative anxiety were found to be predictors. The impact of postoperative delirium might be lessened by concentrating on its screening and factor control.

Incidence and risk factors of emergence delirium in elderly patients after general or spinal anesthesia for both elective and emergency surgery.

Background: 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. Methods: 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. Results: 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. Conclusions: Delirium in the post-anesthesia care unit is common. Anxiety, perioperative narcotics, and intraoperative blood loss were predictors of emergence delirium.

The overlooked problem among surgical patients: Preoperative anxiety at Ethiopian University Hospital.

Introduction: Anxiety was repeatedly reported as the worst aspect of the perioperative time. The objective of this study was to assess the prevalence of preoperative anxiety among adult surgical patients at University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia. Methodology: A hospital-based cross-sectional study was conducted among surgical patients at the university hospital. After obtaining ethical approval, 407 surgical patients were approached during the preoperative period. Preoperative anxiety was assessed by State-Trait Anxiety Inventory. The association between variables was determined by using binary logistic regression analysis. Strength of association was described in adjusted odds ratio (AOR), and a p-value < 0.05 at 95% confidence interval was considered statistically significant. Results: A total of 400 patients were included in this study with a 98.3% response rate. Preoperative anxiety was observed among 237 (59.3%) patients, and the median (IQR) STAI score was 50 (40-56.7); age, ≥ 60 years (AOR: 5.7, CI: 1.6-20.4, P: 0.007); emergency surgery (AOR: 2.5, CI: 1.3-4.7, P: 0.005); preoperative pain (AOR: 2.6, CI: 1.2-5.4, P: 0.005); and rural residency (AOR: 1.8, CI: 1.1-2.9, P: 0.031) were found significantly associated with preoperative anxiety. Conclusion: The prevalence of preoperative anxiety among surgical patients was high. Older age (≥ 60 years), emergency surgery, preoperative pain, and rural residency were found significantly associated with preoperative anxiety. Assessment for preoperative anxiety should be a routine component of preoperative assessment of both elective and emergency surgical patients. Preoperative pain should be appropriately managed as it can help to reduce preoperative anxiety. Optimal anxiety reduction methods should be investigated and implemented in the hospital.

Assessment of knowledge, attitude, and factors associated with oxygen therapy for critically ill patients among nurses at the University of Gondar Comprehensive Specialized Hospital Northwest, Ethiopia, 2021.

Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Assessment of practice and barriers of oxygen therapy in critically ill patients among nurses: A survey from University of Gondar Comprehensive Specialized Hospital Northwest, Ethiopia, 2021.

Background: 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. Methods: 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 of< 0.2 and < 0.05 were considered statistically significant, respectively. Results: 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). Age >39 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. Conclusions and recommendations: 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.

Perioperative Respiratory Adverse Events Among Pediatric Surgical Patients in University Hospitals in Northwest Ethiopia; A Prospective Observational Study.

INTRODUCTION: Perioperative 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. OBJECTIVE: Assess the prevalence and factors associated with PRAEs among pediatric surgical patients in University Hospitals in Northwest Ethiopia, 2020. METHODOLOGY: After 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. RESULTS: The 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 <1 year (AOR: 3.6, CI: 1.3-10.0), ASA ≥ 3 (AOR: 5.2, CI: 1.9-22.9), upper respiratory tract infections (URTIs) (AOR: 7.6, CI: 1.9-30.2), secretions in the upper airway (AOR: 4.8, CI: 1.4-15.9) and airway related surgery (AOR: 6.0, CI: 1.5-24.1) were significantly associated with PRAEs. CONCLUSIONS: Prevalence 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 <1 year, URTIs (recent or active), secretions in the upper airways, ASA ≥ 3 and airway related surgery were significantly associated with PRAEs. Clinicians should perform effective risk assessment, preoperative optimization and preparation for the management of PRAEs.

A clinical perspective study on the compliance of surgical safety checklist in all surgical procedures done in operation theatres, in a teaching hospital, Ethiopia, 2021: A clinical perspective study.

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.

The management of patients with coronavirus disease 2019 in intensive care unit (ICU) in low income countries: A review article.

BACKGROUND: The novel coronavirus, severe acute respiratory syndrome-CoV-2 (SARS-CoV2)- causing coronavirus disease 19 (COVID-19), outbreak as a world health problem and was declared as a pandemic disease by the world health organization (WHO) in March 2020. Many serious findings have been observed among victims with sever acute respiratory syndrome-CoV-2. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol. Search engines like PubMed and PMC through HINARI, Cochrane database, Google Scholar were used to get information about the current evidences on management of coronavirus disease 2019 (COVID-19) in intensive care unit (ICU). DISCUSSION: Mortality with COVID 19 is associated with geriatric population, the presence comorbidities like hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, and cancer, acute respiratory failure, higher d-dimer and C-reactive protein concentrations, lower lymphocyte counts, and secondary infections. CONCLUSION: The international recommendations on nutrition in the ICU should be followed. Some specific issues about the nutrition of the COVID-19 patients in the ICU should be emphasized. Universal infection prevention precautions (hand hygiene and use of personal protection equipment (PPE)) are invaluable during nursing of COVID 19 patients at ICU.

Withdrawn: Incidence and Risk Factors of Emergence Delirium after Anesthesia in Elderly Patients at a Postanesthesia Care Unit in Ethiopia: Prospective Observational Study.

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Assessment of Awareness, Attitude and Desire for Labor Analgesia and Associated Factors Among Pregnant Women in Ethiopia: A Cross-Sectional Study.

INTRODUCTION: Labor pain is the worst imaginable pain that women experience during their childbearing years. Untreated labor pain has numerous negative consequences, for both the mother and her fetus. Low levels of awareness and attitudes among pregnant women about labor analgesia is a major challenge that affects outcomes for both the mother and fetus. Therefore, this study aimed to assess the awareness of, attitude towards and desire for labor analgesia and its associated factors among pregnant women who visited an antenatal care facility. METHODS: An institution-based, cross-sectional study was conducted from February to March 2019. Data were collected using semi-structured questionnaires by a convenience sampling technique. Data were entered using EpiData 4.2 and exported to SPSS version 20 software for analysis. Both bivariate and multivariate binary logistic regression analysis were used to identify factors associated with awareness, attitude and desire for labor analgesia among pregnant women. Crude odds ratio (COR) and adjusted odds ratio (AOR) were calculated to show the strength of association. RESULTS: A total of 410 participants were included. Thirty-three (8%) of the pregnant women who visited the antenatal care facility were found to have an awareness of labor analgesia. In multivariate analysis, the likelihood of having awareness of labor analgesia was 7.227 times (AOR: 7.227, 95%, CI 2.406-21.720) greater among parous versus nulliparous mothers. The odds of having awareness of labor analgesia were 3.133 times (AOR: 3.133, 95%; CI 1.144-8.581) greater among government employees than among housewives. The odds of having a good attitude towards labor analgesia were 6.488 times (AOR: 6.488, 95% CI 1.894-22.227) higher in government employees than in farmers. Women in the age group of 25-31 years were 1.815 times more likely to want labor analgesia for their next delivery (AOR: 1.815, 95% CI 1.103-2.989). CONCLUSIONS: The awareness of labor analgesia among pregnant women was low. There is a need for teamwork by all stakeholders in health sectors to improve attitudes and increase the desire for labor analgesia among pregnant women who visit antenatal care facilities.

Operating room team safety and perioperative anesthetic management of patients with suspected or confirmed novel corona virus in resource limited settings: A systematic review.

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.

Patient satisfaction with anaesthesia services and associated factors at the University of Gondar Hospital, 2013: a cross-sectional study.

BACKGROUND: Patient satisfaction is the degree of fulfilling patients' anticipation which is an important component and quality indicator in anaesthesia service. It can be affected by anaesthetist patient interaction, perioperative anaesthetic management and postoperative follow up. No previous study conducted in our setup. The aim was to assess patient satisfaction with anaesthesia services and associated factors. METHODS: Institutional based cross sectional study was conducted from April 15-30, 2013 at the University of Gondar referral and teaching hospital. All patients who were operated upon both under general and regional anaesthesia during the study period were included. Standardized questionnaire used for postoperative patient interview. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) window version 20. Chi Square test used to assess the association between each factor and the overall satisfaction of patients. The proportion of patients who said they were satisfied with anaesthesia services was presented in percentage. RESULTS: A total of 200 patients were operated upon under anaesthesia during the study period. Of these, a total of 156 patients were included in this study with a response rate of 78%. The overall proportion of patients who said they were satisfied with anaesthesia services was 90.4%. Factors that affected patient satisfaction negatively (dissatisfaction level and p value) were general anaesthesia (12.6%, P = 0.046), intraoperative awareness (50%, P = <0.001), pain during operation (61.1%, P = <0.001), and pain immediately after operation (25%, P = <0.001) respectively. CONCLUSION AND RECOMMENDATION: Patient satisfaction with anaesthesia services was low in our setup compared with many previous studies. Factors that affected patient satisfaction negatively may be preventable or better treated. Awareness creation about the current problem and training need to be given for anaesthetists.