Comparison of spinal versus general anesthesia on the perioperative blood glucose levels in patients undergoing lower abdominal and pelvic surgery: a prospective cohort study, Ethiopia.

Surgery is linked with fear and stress that disrupt metabolic and neuroendocrine activities, which impair normal maintained glucose metabolism that leads to stress hyperglycaemia. This study aimed to compare the effect of general and spinal anaesthesia on perioperative blood glucose levels in patients undergoing lower abdominal and pelvic surgery. Methods: This prospective observational cohort study recruits 70 adult patients who underwent lower abdominal and pelvic surgery under general and spinal anaesthesia; 35 in each group. A systematic random sampling technique was used to select study participants. Capillary blood glucose was measured at four perioperative times. An independent t-test, dependent t-test, and Manny-Whitney U test were used for statistical analysis, as appropriate. P values less than 0.05 were considered statistically significant. Results: No statistically significant difference was observed in mean blood glucose levels at baseline and 5 min after induction of general anaesthesia and complete blocks of spinal anaesthesia. But at the end of surgery and 60 min after the end of surgery the mean blood glucose levels were statistically significantly higher in the general anaesthesia group compared with the spinal anaesthesia group (P<0.05). And the blood glucose level was significantly increased from baseline compared with the different time intervals in the general anaesthesia group. Conclusion: The mean blood glucose levels were lower in patients undergoing surgery under spinal anaesthesia compared with general anaesthesia. The authors recommend spinal over general anaesthesia whenever possible for patients undergoing lower abdominal and pelvic surgery.

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 acute postoperative pain within the first 24 h in women undergoing cesarean delivery at a resource-limited setting in Addis Ababa, Ethiopia: A prospective observational study.

Objective: This study aimed to assess the incidence and associated factors of acute postoperative pain after cesarean section within the first 24 h of postoperative period. Methods: An institutional-based prospective observational study was conducted on parturients who had undergone cesarean section in Gandhi Memorial Hospital from 1 December 2019 to 28 February 2020. A numerical rating scale was used to evaluate the incidence of acute postoperative pain. Patients having a pain score of >4 were considered having moderate-to-severe pain on numerical rating scale. Data were analyzed using SPSS version 20. Bivariable and multivariable logistic regression were used to assess the association of variables. A p value of less than 0.05 was taken as significant association with dependent variables. Result: In total, 290 parturients participated in the study with a response rate of 98%. Moderate-to-severe acute postoperative pain after cesarean section was 76.2% (95% confidence interval: 71%, 81%) in the first 24 h postoperatively. On multivariable analysis, previous cesarean section history (adjusted odds ratio: 2.80, 95% confidence interval: 1.40, 5.55; p = 0.003), preoperative anxiety (adjusted odds ratio: 2.70, 95% confidence interval: 1.45, 5.05; p = 0.003), transverse incision type (adjusted odds ratio: 3.35, 95% confidence interval: 1.67, 6.72; p = 0.002), and incision length (adjusted odds ratio: 2.46, 95% confidence interval: 1.24, 4.85; p = 0.009) were identified as risk factors for postoperative moderate-to-severe acute pain. Conclusion: The incidence of moderate-to-severe postoperative pain was high in the first 24-h postoperative period; this indicates that pain management after cesarean section was treated inadequately. History of previous cesarean section, preoperative anxiety, transverse incision, and incision length >10 cm were the factors of postoperative acute pain after cesarean section. Therefore, we suggest the study institution develop a protocol for pain management.

Magnitude and associated factors of unplanned extubation in intensive care unit: A multi-center prospective observational study.

Background: Unplanned extubation is the removal of an endotracheal tube accidently during procedural activities or by the action of the patient. It is one of the commonly reported complications among mechanically ventilated patients in the intensive care unit. This study aimed to assess the magnitude and associated factors of unplanned extubation in intensive care units at referral hospitals in Addis Ababa, Ethiopia, 2021. Methods: Institutional based prospective observational study was conducted on 317 intubated patients in the intensive care unit at referral hospitals of Addis Ababa, Ethiopia, from January 8, 2021-May 9, 2021. Data were collected using a structured questionnaire. Descriptive statics were expressed in percentages and presented with tables and figures. Both Bivariable and multivariable logistic analysis was done to identify factors associated with unplanned extubation in intensive care unit. P < 0.05 with 95% CI was set as Statistical significance. Result: The prevalence of unplanned extubation in this study was 19.74%. Being male (AOR = 3.132, 95%CI: 1.276-7.69), duration of intubation <5days (AOR = 2.475, 95% CI: 1.039-5.894), managed by junior resident (AOR = 5.25, 95% CI: 2.125-12.969), being physically restrained (AOR = 4.356, 95%CI: 1.786-10.624), night shift (AOR = 3.282, 95%CI:1.451-7.424)and agitation (AOR = 4.934,95%CI:1.934-12.586) were significantly contribute to the occurrence of unplanned extubation. Conclusion: and recommendation: This study showed that the prevalence of unplanned extubation was high in the intensive care unit. We suggest to intensive care unit staff to give special attention to early intubated patients, especially male individuals and the stakeholders of hospitals should rearrange the time of shift and physician schedules in the intensive care unit.

Effect of low-dose intravenous ketamine on postoperative pain following cesarean section under spinal anesthesia: A prospective cohort study, Ethiopia.

Background: Following cesarean delivery, mothers experience moderate to severe pain since postoperative analgesia of spinal anesthesia is limited by duration of local anesthetic agents used. Analgesic effect of local anesthetic agents could be extended and supported by adding either intravenous or intrathecal adjuvants. The primary outcome of this study is to assess effect of low-dose intravenous ketamine on postoperative pain following cesarean section under spinal anesthesia. Materials and methods: This prospective observational cohort study recruits 60 parturients who underwent elective cesarean delivery under spinal anesthesia. Those parturients who received intravenous ketamine 0.25 mg/kg following spinal anesthesia were considered as exposed group/ketamine group. The Non-exposed group was those parturients who didn't receive intravenous ketamine following spinal anesthesia. Numerical rating scale pain score, time to request first analgesia and total analgesia consumptions were recorded starting from 1st hour to 24 h after the end of surgery. Results: The median and Inter quartile range (IQR) for postoperative numerical rating scale pain score was significantly higher in non-exposed group compered to ketamine group at 1st and 2nd hour after operation (P-value<0.05). Time to request first analgesia was significantly longer in ketamine group [192.5(140-210) minutes] compared to non-Exposed group [146(130-160) minutes] with P-value < 0.001. Tramadol consumption within 24 h postoperatively were significantly lower in ketamine group compared to non-exposed group (P-value < 0.001). Conclusion: Low dose intravenous ketamine before skin incision was extended postoperative first analgesia request time by average of 45.5 min and decrease total analgesia consumption in 24 h.