Background: Perioperative mortality rate is the basic indicator of anesthesia and surgery safety in a country of health policy. However, documentation is poor in low and middle income countries. So we developed a simple prospective data collection tool for perioperative mortality determination at Tibebe Ghion Specialized Teaching Hospital, Ethiopia. Material and methods: The prospective electronic based data collection was done at Tibebe Ghion Specialized Teaching Hospital, Ethiopia with case specific of perioperative data. We compared patients with mortality at 24 h, and 48 h by Kaplan-Meier (KM) survival analysis. Logistic regression model was used to evaluate the effect of different surgical procedures on mortality. Results: From August 2019, to December 2019 data were taken from 946 cases at Tibebe Ghion Specialized Teaching Hospital. We excluded 61 (6.44%) cases with missing data information. The logistic regression analysis for 24 h mortality showed that urology and general surgery (OR = 8.03 [95% CI, 3.98 to 47.33]; P = 0.0002),neurosurgery (OR = 4.77, [95% CI,2.58–17.70]; P = 0.01), orthopedics (OR = 1.21, [95% CI,0.56–6.89]; P = 0.003), emergency surgery (OR = 2.76 [95% CI,1.03–10.51]; P = 0.04) and trauma (OR = 6.94 [95% CI,3.43–26.32]; P = 0.002) were associated with high risk of mortality (Table 3) as compared to cesarean section delivery. These significant relations were also revealed at 48 h of mortality. Other Surgeries and pediatrics category were not correlated to 24 h and 48 h of mortality. Conclusion and recommendation: There were a significant higher magnitude of mortality recorded over Urology and general surgeries, neurosurgery, orthopedic surgery, emergency surgery and trauma compared with cesarean section delivery at Tibebe Ghion Specialized Teaching Hospital. In addition, we observed the mortality rate differences between each surgical category. Tibebe Ghion Specialized Teaching Hospital should emphasis on monitoring and evaluation of patients’ outcome for the reduction of mortality. We also recommended doing this research work at multiple centers of referral hospitals for better valid information. Highlights:

Summary Reducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia. We conducted a mixed methods longitudinal cohort study incorporating a behavioural questionnaire, multiple-choice questionnaires (MCQs), structured observational skills tests and structured interviews for anaesthesia providers who attended one of four SAFE-OB courses conducted in two regions of Ethiopia from October 2017 to May 2018. Some 149 participants from 60 facilities attended training. Behavioural questionnaires were completed at baseline ( n = 101, 69% response rate). Pre- and post-course MCQs ( n = 121, n = 123 respectively) and pre- and post-course skills tests ( n = 123, n = 105 respectively) were completed, with repeat MCQ and skills tests, and semi-structured interviews completed at follow-up ( n = 88, n = 76, n = 49 respectively). The mean MCQ scores for all participants improved from 80.3% prior to training to 85.4% following training ( P < 0.0001) and skills test scores improved from 56.5% to 83.2% ( P < 0.0001). Improvements in MCQs and skills were maintained at follow-up 3–11 months post-training compared to baseline ( P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up. This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.

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Highlights Total spinal or a high neuraxial blockade is a recognized complication of central neuraxial techniques. Total spinal anesthesia is characterized by acute onset hemodynamic instability, shortness of breath, dyspnea, with a precipitous decline in GCS. It happened immediately after spinal anesthesia but it may happen even an hour after anesthesia. The anesthetist performing these procedures must be aware of this serious complication and must remain vigilant throughout. The management is mainly supportive care.

Introduction The management of postoperative pain in anaesthesia is evolving with a deeper understanding of associating multiple modalities and analgesic medications. However, the motivations and barriers regarding the adoption of opioid-sparing analgesia are not well known. Methods We designed a modified Delphi survey to explore the perspectives and opinions of expert panellists with regard to opioid-sparing multimodal analgesia. 29 anaesthetists underwent an evolving three-round questionnaire to determine the level of agreement on certain aspects of multimodal analgesia, with the last round deciding if each statement was a priority. Results The results were aggregated and a consensus, defined as achievement of over 75% on the Likert scale, was reached for five out of eight statements. The panellists agreed there was a strong body of evidence supporting opioid-sparing multimodal analgesia. However, there existed multiple barriers to widespread adoption, foremost the lack of training and education, as well as the reluctance to change existing practices. Practical issues such as cost effectiveness, increased workload, or the lack of supply of anaesthetic agents were not perceived to be as critical in preventing adoption. Conclusion Thus, a focus on developing specific guidelines for multimodal analgesia and addressing gaps in education may improve the adoption of opioid-sparing analgesia.